August 19, 2019 by Peter B. Laird
Dosing Alert: Parents Over-Medicating Kids, Study Says
Too often parents are giving their kids the wrong dose of medicine, according to a new study published in Pediatrics, a medical journal.
Nearly 85 percent of parents have made at least one small dosing error when giving medicine to a child, according to the study: Liquid Medication Errors and Dosing Tools. About 21 percent of parents have made at least one large error when treating a child with medicine. Most errors involve giving a child too much medicine, and a large error involves doses that are accidentally doubled.
“Poorly designed labels and packaging are key contributors to medication errors,” according to authors of the study.
Researchers studied different types of dosing tools and medicine labels to find reasons and patterns for the mistakes. The study involved about 2,100 parents of children, age 8 and younger. The parents, who spoke either English or Spanish, were supplied with different product labels and measuring tools. Each parent was told to prepare nine doses of medicines, using three different measuring tools: a cup and syringes in two different sizes.
“More errors were seen with cups than syringes across health literacy and language groups, especially for smaller doses,” the researchers report. What’s more, the accuracy rate was the same for the two sizes of syringes.
Teaspoon-only labels led to more errors than medicine labels with instructions written only in milliliters, even when the medicine came packaged with a teaspoon tool.
“Recommending oral syringes over cups, particularly for smaller doses, should be part of a comprehensive pediatric labeling and dosing strategy to reduce medication errors,” the researchers say.
Dosing Mistakes and Kitchen Spoons
There’s reason for concern: Every year, poison centers around the country receive large volumes of calls from concerned parents or caretakers after a child was given the wrong dose of a liquid medication, according to published reports. Those dosing problems are more likely to occur when a kitchen spoon is used for measurements.
“Don’t grab the kitchen spoon. It doesn’t give you a precise measurement, and increases the risk of an underdose or overdose of medicine,” says Javier Hiriart, M.D., a pediatrician and physician with Baptist Health Primary Care.
The National Institutes of Health agrees and points to a recent study about the hazards that can develop when random kitchen spoons are used to dispense liquid medicine to children. The chances of errors are heightened when parents are confused or unaware of the difference between a teaspoon and a tablespoon.
Parents using kitchen teaspoons and tablespoons were twice as likely to pour the wrong amount of medicine or to make some other mistake related to the dose, according to a 2014 study. Approximately 30 percent of parents who were told to provide a teaspoon or tablespoon of medicine used any kitchen spoon to measure out the dose, and were 250 percent more likely (2.5 times) to give the wrong dose.
That’s a problem because the prescribed doses are often exact calculations based on a child’s weight, and even a little extra can raise the risk of adverse side effects or an overdose, Dr. Hiriart says. And at the other extreme, an underdose could seriously hamper the medicine’s ability to combat a fever, ear infection or other illness. And that’s especially true if you’re dealing with antibiotics, in which precise and complete doses are important to treatment, he says.
Prescriptions for Improvement
As a result of the data and the increased risk of errors, different medical and pharmacy groups are now pushing for new procedures for prescribing, dispensing and administering liquid medicine to children. The U.S. Centers for Disease Control & Prevention, the American Academy of Pediatrics and the Institute for Safe Medication Practices recommend that:
- Doctors prescribe milliliter doses for children as opposed to prescriptions based on teaspoon or tablespoon measurements.
- Pharmacists convert liquid prescription doses to precise volume measurements.
Small details matter, according to a report about medicine safety and children from the U.S. Food and Drug Administration: “With measuring devices, pay attention to the small details. It can be easy to misread a measurement or a marking. You don’t want to give your child a tablespoon when you’re supposed to give him a teaspoon, or give her 5 milliliters (mls) when you’re supposed to give her 0.5 mls. Mistakes like this can be deadly.”
Other best practices include providing parents with milliliter-based dosing syringes at either the doctor’s office or at the pharmacy, Dr. Hiriart says.
“I’ve seen pharmacists take out a marker and clearly mark off on the dosing syringe how much medicine should be poured,” he says. “That step further reduces the room for error.”