Ode to the Peridontal Syringe: An Invaluable Aid When Raising a CF Child

Parents of CF infants and toddlers know that one of the most challenging tasks (aside from airway clearance!) is to get stuff - whether it be medicine, enzymes, food, nutritional supplements, or whatever - into them. Now, there are lots of diverse ways of doing so. But in this little essay, we would like to pen an ode to the peridontal syringe, which has been a lifesaver for our family.

A peridontal syringe is like a syringe, only it has no needle. It is small, only about 2 inches long and ½ inch diameter. It consists of an outer shell with a short little nipple, with the shell having gradated measurements along the side; and a rubber-tipped plunger inside. One puts liquid or semi-liquid "stuff" in the shell and then uses the plunger to squirt the stuff into the mouth of one's uncooperative child. As the force of the squirt is enough to put the "stuff" far back into the child's mouth, the child will almost always swallow what has been squirted into them.

Here is how we use the peridontal syringe in our home:

1) Enzyme administration: We take the plunger out of the syringe, spoon in a little applesauce, open an enzyme capsule, put the contents in the syringe, spoon in a little more applesauce. We put the plunger just inside the top of the shell. Since there is an air pocket between the top of the applesauce and the plunger, we turn the syringe upside down and gently tap the end of the plunger on the counter. The applesauce/enzyme mixture settles on top of the rubber tip of the plunger. We then push the plunger in gently until the mixture reaches the opening of the syringe's nipple. We sneak up behind the child in question, deftly put one hand on their forehead so they can't move their head, put the tip of the syringe in their mouth, and squirt. Don't squirt directly towards the center back of the mouth - they might gag. Squirt off a little to one side. Also, sometimes a very uncooperative toddler will clamp their teeth on the syringe nipple, but not close their lips around it. If your toddler does this, know that they are planning on letting the "stuff" dribble back out their mouth rather than swallowing it! Tell your sweet toddler to close his mouth. If he does, there is virtually no way that he can stop swallowing it.

2) Food and nutritional supplements: Often CF children need additional food. Sometimes we make a creamy food mixture to supplement their diet of regular food. As long as the food is at least semi-liquid, it will go through the syringe. Such a food mixture is also a good time to hide in some not-very-nice tasting nutritional supplements. For example, if you give DHA to your child, it comes in gel capsules as a fishy-tasting oil. As we do with the enzymes, we put a little food in the syringe, then pierce the gel capsule of DHA, squirt the contents into the syringe, then spoon in a bit more food, getting rid of air pockets as mentioned in #1.

3) Juice and nutritional supplements: With some nutritional supplements, such as oral GSH, you will want to mix the supplement with a little juice to mask its flavor. With a very liquid substance, like juice, you need not (indeed, cannot) use the previous method for placing the stuff in the syringe. For this kind of job, you need to pull the juice up into the syringe by placing the tip of the syringe in the liquid and pulling back on the plunger. If there are any air pockets, use the method described in #1 to take them out.

4) Nasal irrigation: Some have found that regular nasal irrigation with warm salt water or other concoction helps prevent sinus infections that so often plague CF persons. A sterilized peridontal syringe is a great way to irrigate one's nasal passages, because the pressure it provides is enough to get the water in your sinuses, but gentle enough not to be painful.

Other Helpful Tips

*** Yes, you can wash the syringes. You can boil them, put them in the dishwasher, or scrub them in warm, soapy water. After about 4 washings, however, the rubber tip will be too mushy to be useful. At that point, discard the syringe.

*** After a washing, the rubber tip might be so dry that it is almost impossible to use the plunger. Simply put a dab of cooking oil on the rubber tip and the plunger will work easily.

*** When you get to be a pro, you can use the syringe with only one hand. For example, you can have a little bowl of semi-solid food that you are feeding your CF infant. You are holding the infant in one hand, and dipping the syringe into the bowl and pulling up the food with just one hand. This involves anchoring the shell of the syringe with most fingers of the hand, while holding the top of the plunger with another and simultaneously pushing the shell of the syringe away with one finger. Sounds complicated, but after the first time you do it, it will seem like second nature.

*** If food gets stuck in the nipple of the syringe, run water through it to dislodge. If that doesn't work, use a pin to dislodge the food.

*** You don't need a prescription to get these syringes. Any medical supply store will sell them to you in boxes of 100. (When we had toddlers, we prefered the Monoject syringes, which are "Monodose Oral Medication Syringes with Tip Cap."  They hold 6 ml each. They are (or at least were when we used them) manufactured by Sherwood Medical Company of St. Louis, Missouri, and the reorder number is 8881-906104. A box of 100 sold for about $13.00 when we first started using them. Here's a box of 100 sold by Amazon for $19 in 2015.)