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"Food Issues and Picky Eaters"
Enzymes Beyond Applesauce: How to Teach Your Preschooler to Take Enzymes
by Lisa C. Greene
Your toddler is changing and growing up right before your eyes! He or she is becoming more independent, capable, and wants to do everything him or herself. "No! ME do it!" becomes a common refrain during the two's and three's.
Wise parents use this independent streak to their advantage! Even though it takes more time, allow your toddler to help you as much as possible with chores, cooking, getting dressed their way, and taking medications. Parents don't realize that when they tell their toddler, "No, I'll do it" they are training them not to be helpful, independent, and responsible down the road. Taking the time now to encourage independence will save you time, effort, and possibly heartache later.
Using choices for this age group is a critical parenting skill- especially around medical management. Choices will promote your toddler's independence as well as help avoid power struggles before they occur: "We need to do your breathing treatments this morning before we leave. Would you like to start them now or in five minutes?" Most kids say: "Five minutes!" After the time is up, say: "Five minutes is up so it's time to start your breathing treatments. Would you like to push the buttons or have me push them?" Of course your toddler will say, "Me! Me!" Then follow up with even more choices like, "Do you think you can keep the mask on or would you like me to hold it?" "Would you like to watch Dora on TV or color her picture?" You get the idea...
One of the "rites of passage" for children with CF is swallowing pancreatic enzymes whole instead of opening capsules and sprinkling beads on the spoon with applesauce. Many parents are surprised at how young their child can actually do this. I know we were with our own two children.
We discovered by accident that our son Jacob was ready. I had left some empty enzyme shells on his high chair tray after opening them up for the applesauce and he started playing with them. Then, of course, they ended up in his mouth. We realized, "Hey! This kid might be able to take them on his own!" So, then we tried putting the whole enzyme right on top of the applesauce and it all went right down the old hatch! Then, we tried putting the enzymes along with some cheerios on his tray and he just popped them into his mouth.
Jake was three years old when he started taking enzymes on his own. With our daughter, we tried this process a little earlier and she was able to take them around age two and a half. By the time both kids were in the first grade, they were chucking down a handful of enzymes and other pills with no problem.
Lots of praise, excitement, and enthusiasm is the key to encouraging children to try swallowing the enzymes whole. Also, say the word "enzymes" once they start taking the capsules so they learn the proper term from the beginning. Our kids were so cute; they both called them "Zen Zimes" for a long time.
If your child doesn't cooperate, don't get frustrated or impatient. Just stay calm, matter-of-fact and say, "Okay, all done. We'll try again later." And just move back to an easier method, such as swallowing the beads in apple sauce.
If your child does not spontaneously learn to swallow pills, ask your CF team for help. A behavioral intervention was developed by Alexandra Quittner, PhD and Kristen Marciel, PhD. This intervention teaches children to swallow pills by practicing with small candies and eventually swallowing their enzymes. It is recommended that you ask your CF Team about this program and use this approach with the assistance and supervision of your CF Team.
Here is a link: http://www.childrensal.org/workfiles/Clinical_Services/CF/pillswallowing.pdf
Parents often ask: what age should I start this? Of course it depends on your child. Some kids have a hard time taking pills even when they are teenagers! I've also heard of children as young as eighteen months of age taking enzymes whole. Personally, I think around three years of age is a good time to give it a try with the help of your CF Team.
If my kids could take their enzymes by age three, then it's possible your child can, too!
Click here for a YouTube video of a 15 month old chucking down the enzymes. Amazing!! :-)
Lisa C. Greene is the mother of two children with cystic fibrosis, a parent educator and public speaker. She is also the co-author with Foster Cline MD of the award-winning Love and Logic book “Parenting Children with Health Issues.” For more information, see www.ParentingChildrenWithHealthIssues.com.
For more Tips for CF Parents, visit Lisa’s website at www.TipsForCFParents.com.