Antidepressants Blog

The following example illustrates application of positive reinforcement to a child for managing his medication. When one step is assimilated, move on to the next one until the final goal is achieved.
Step 1: The child is taught to identify the shape, size and colour of the medication he has to take. This can be done by showing the child what different tablets look like — one that is white, another which is circular like a coin and or smaller than any coin. Make him repeat each characteristic and reinforce after each medication is correctly remembered.
Step 2: The child is taught the names of the medicines. Make him repeat the names and reinforce when it is done correctly.
Step 3: The child is taught to recognize and recall the times and situations when medicines have to be taken. For example, evening medicines may have to be taken at 8:00 p.m. which may be the bed time. Make the child keep a daily calendar where he can mark the time when a particular medication is taken. This not only serves as a reinforcer but also keeps a check that the medicines for that particular time have been taken.
Step 4: The child starts taking the medication under close supervision according to a previously prepared routine. For example, the parents can put the morning pills in the middle of the breakfast plate. The medicine must be taken before the plate is filled. The child can be encouraged to say something like ‘Okay mummy, I am taking my medicine now.’
Step 5: The next step is to encourage the child to come and ask for his medicines at the proper time.
Step 6: The child progresses to taking the medicine in the presence of parents.
Step 7: If the child can consistently take medicine without being reminded for about two weeks he may be allowed to manage his own medication. The parents must continue to supervise for the next three times or so. Slowly the supervision can be tapered off.
Step 8: Gradually the child becomes self-sufficient as far as his medicines are concerned.
Step 9: Slowly the child is taught to tackle situations like vacations, changes in school routine and spending the night with a friend. If necessary, the child can be helped to develop a method for remembering to take medication at unusual hours.
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One potential cause of recurrent diarrhoea that is often overlooked is poor food hygiene. People vary greatly in their ability to resist food-borne infections: some have a ‘cast-iron constitution’ and remain well however filthy the kitchen, while others need far more stringent hygiene. Judging hygiene standards by the way other people live is not necessarily a good policy.

Many people are unaware that food which has been kept for a long time is not always rendered safe by thorough cooking – some bacteria produce toxins that are not destroyed by heat, even though the bacteria themselves are killed. These toxins can produce a short-lived bout of diarrhoea. So anyone in the habit of keeping food or leftovers for long periods of time may be regularly exposed to this sort of ‘food poisoning’. Food should be eaten as fresh as possible, and other basic hygiene measures adopted. These include washing the hands with soap after visiting the lavatory and before preparing food – water alone does not remove bacteria. Kitchen worktops should also be kept clean, knives and chopping boards should be washed in hot soapy water after cutting up meat, and raw meat should never be stored alongside or above cooked meat. Dishcloths and other items used for washing up should be rinsed out thoroughly and hung up to dry; they should also be replaced regularly as they are ideal breeding grounds for bacteria. Cloths used for drying-up should be washed regularly, and pets should be kept off surfaces used for food preparation. Any leftovers should be heated for 20 minutes or more to kill bacteria.

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