Q: My 2-year old hates taking medicine. What can I do to make it taste better?
Many liquid medicines taste awful, and getting a child to take a spoonful of something bitter can be quite a battle. If you’ve ever grumbled, “Don’t doctors have ANY IDEA how nasty this stuff tastes?” you’re not the only one!
Every few years, our clinic sponsors a “taste test” of common liquid medicines to help educate our family physicians-in-training by giving them a taste – literally – of their own medicine.
The new doctors line up to sample 10 to 12 different liquid medicines, half of which are commonly prescribed antibiotics. The other samples include medicines for asthma like prednisone and prednisolone, stomach medicines like Zantac® (ranitidine) and laxatives like Miralax® and docusate.
Each “judge” picks up a small paper cup with 10 plastic spoons, a pencil, and a scoring sheet that lists each medicine in alphabetical order. Their mission is to rate each medicine from 1 to 5 on the following 4 characteristics: Smell, Taste, Texture, and Aftertaste. A sample with an Extremely Good/Pleasant taste would score 5 on the 1-5 scale compared to Extremely Bad/Terrible, which would rate it as 1.
To avoid creating a bottleneck, we set up two tables, each with an identical set of liquid samples awaiting their judgment. Two double-lined trash containers stand close by, along with 2-liter bottles of grapefruit flavored Fresca® and lemon-lime Sprite®.
The judges’ job is to taste each offering and evaluate it. They are instructed to dip one of their unused plastic spoons into the liquid, sniff it, taste it, and then SPIT IT OUT. The lined trashcans nearby are used as spittoons and the Fresca® and Sprite® help to “cleanse their palate” after each sample.
As a veteran of several previous taste tests, I encourage the judges to spit, assuring them from painfully personal experience that though spitting isn’t pleasant, it’s much, much better than getting a world-class stomach ache.
As they mill around sampling the various colored liquids, you hear, “Smells okay, how bad can it taste?”… “Ugh, this one’s nasty”…“I always wondered how this tasted”… “How can something that smells good taste so awful?”…“Eeeuw!”
Our liquid antibiotic samples often include amoxicillin, amoxicillin with clavulanate, cephalexin, sulfamethoxizole-trimethoprim, and azithromycin. Along with these are liquid versions of prednisone and prednisolone, which are nearly identical medicines prescribed for asthma and severe allergic reactions. Prednisone tablets are widely used in adults; young doctors will often select the liquid version of prednisone when prescribing for children. Unfortunately, liquid prednisone tastes absolutely horrid. Prednisolone liquid tastes bitter but liquid prednisone tastes even WORSE. Having young doctors taste each one helps them remember to avoid using liquid prednisone and order prednisolone liquid instead.
As their votes are tallied, we ask our family physicians-in-training to brainstorm ways parents can deal with bad-tasting medicines. The most popular strategy? Mixing the medicine into something else, covering up its smell, taste or texture. Most liquid medicines can be given with food, so pudding, applesauce, or ice cream are good choices.
The next most popular approach is to follow up the spoonful of offensive medicine with a “chaser” to rinse off your taste buds quickly, removing the taste. The adult judges overwhelmingly preferred grapefruit flavored Fresca® as a “chaser” over the sweeter Sprite®. Other suggestions for chasers include fruit juices or a favorite soda. Chocolate syrup can cover up a lot of bitterness either by mixing it into pudding or ice cream with the medicine or used by itself as a chaser.
Because flavors depend on scent receptors found in the lining of your nose, an older child could hold his nose while swallowing and then quickly swallow something to remove the taste.
You can also add flavoring to the entire bottle of medicine. Some pharmacies will add flavoring to liquid medicines if you request it. You can also use small amounts of liquid flavor concentrates at home. Crystal Light® or MiO® are flavor concentrates found in most grocery stores. There are also small vials of candy making extracts used to flavor homemade candies available at some groceries and kitchen supply stores.
Even though some antibiotics must be kept in the refrigerator between doses, serving any liquid medicine really cold will usually change its flavor into something easier to swallow, like the difference between sipping an ice-cold beer or root beer and the same beverage at room temperature.
