Measuring Kids' Meds Correctly Isn't Always Simple

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Parents or other caregivers are responsible for seeing that sick kids get the proper medicine — in the correct amount. But does that always happen? According to a new report in the journal Pediatrics, dosing kids isn't always done properly — and sometimes it's the equipment that's used and how it's labeled that makes the difference. Led by Dr. H. Shonna Yin from the New York University Medical School, investigators assessed the accuracy (or lack thereof) of parents' measurement of children's liquid medications.

The investigators assessed the accuracy of parents' medicine measurement while varying the labeling on packages and measurement tools (e.g., spoons, syringes, and cups). They checked accuracy when directions for amounts were given in milliliters (mL) versus teaspoons, and when the package and tools labels did and didn't agree (for example, when a label used the term teaspoon, while the tool used mL or tsp).

Twenty-one hundred parents or caregivers  of children 8 years old or less were included in the study. Each one was asked to measure 3 different amounts of a liquid 'medicine'  (2.5, 5.0 and 7.5 mL) using three different tools : a cup, a 10 mL syringe with 0.2 mL marks, and a 10 mL syringe with 0.5 mL marks.

They found that almost all the parents measured at least one dose incorrectly. About 85 percent made one or more such errors, and over 2/3 of those errors would have led to overdosing a child. Twenty-one percent of parents made errors large enough give a child twice the dose prescribed. In addition, parents were nearly 4 times as likely to make large errors when using medicine cups as they were with syringes. Error rates for dosing were not greatly affected by either the markings on the syringes, or by the differences in labels on packages and tools.

The authors found that the error rate was lower for smaller amounts when syringes were used, and suggested that providers might give parents appropriately-sized syringes to take home when such amounts are prescribed.

With respect to medication measurement, ACSH medical director Dr. Jamie Wells (a board-certified pediatrician) adds:

"Proper medication dosing, in particular in younger infants and children, is a very real concern for parents and pediatricians.  In fact, the topic often consumes a significant portion of the office visit as well as after hours phone calls.  Several factors  challenge accuracy, for instance, what pharmacies dispense isn't always uniform, multiple sick kids in a home, lack of sleep, spitting out doses and so on...  Educating the public about measuring doses with syringes as opposed to cups has been the mainstay of practice for quite some time, and is routinely demonstrated.  Because dosages are based on a child's weight and require a bit more precision in the pediatric world, parents can empower themselves by always knowing their child's most current weight. This will come in handy when clarifying with a physician correct administration — a vital and necessary component of the error reduction process."