The Right Spoonful of Medicine

Dosing errors in child medications may be reduced with milliliter measurement

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) A dash of this and a pinch of that work for cooking, but not medications. But even using teaspoons and tablespoons may not be precise enough for kids' medications.

A recent study found that parents' dosage errors for children's medications were common.

The findings revealed that those who used milliliters to measure out doses instead of using teaspoon or tablespoon measurements made fewer errors.

In addition, those who had a weaker understanding of health or weaker English-speaking skills also made more errors.

"Ask your pediatrician about correct children's medication dosing."

The study, led by H. Shonna Yin, MD, of the Department of Pediatrics at New York University School of Medicine, looked at ways that dosing errors in children's medications might be reduced.

The researchers analyzed data provided from a larger study involving 287 parents whose children were prescribed medications while at the ER.

The researchers looked at how many errors in measuring medication doses for the children were made by the parents.

A dosing error was considered not knowing the correct dose that had been prescribed or knowing the correct amount but not measuring out that amount correctly.

Overall, more than a third of the parents (39 percent) had made an error in measuring out the dose for a child's medication.

Further, 41 percent had erred in knowing what the properly prescribed amount was.

Out of all the parents measuring out medications, 17 percent of them used a nonstandard instrument, such as a kitchen spoon instead of a standard measurement spoon or cup.

Then the researchers separately looked at those who had measured doses using milliliters and those who had measured doses using teaspoon or tablespoon units.

They found that the adults measuring medication in teaspoon or tablespoon units were twice as likely to make a mistake than those measuring the medication in milliliters.

In fact, 43 percent of the parents who measured teaspoon or tablespoon doses made a mistake, compared to only 28 percent of parents measuring the medication in milliliters.

Similarly, 45 percent of parents using teaspoon or tablespoon measurements made an error in knowing the correctly prescribed dose, compared to 31 percent of parents using milliliters to measure the medication.

In their calculations, researchers adjusted their findings to take into account the parents' ages, language, country, race/ethnicity, socioeconomic status, education and health literacy.

The researchers also considered the ages of the children and whether the children had a chronic disease.

One finding, however, was that mistakes were more likely among parents who had limited English speaking skills or had low health literacy, or an understanding of personal health care.

"A move to a milliliter-only standard may promote the safe use of pediatric liquid medications among groups at particular risk for misunderstanding medication instructions, such as those with low HL and non–English speakers," the researchers wrote.

In an interview with dailyRx News, Thomas Seman, MD, a pediatrician at North Shore Pediatrics in Danvers, MA, said that this is "interesting research but not surprising to any MD who has been in practice for even a little while."

According to Dr. Seman, "Measurements such as teaspoons or tablespoons are fairly inexact in and of themselves. As the report says, good enough for cooking but not for medicine. Afterall, do you fill the spoon up to the top, just below or do you pour until the liquid mounds above the spoon. Either way there can be a significant percentage difference in the doses."

Dr. Seman continued, "Since some medicines are given so they build up levels in the body, either over- or under-dosing could achieve levels higher or lower than desired and can occur more or less rapidly than is required. The safety concerns with this are such that if the levels are not precisely controlled with some medications then the side effects of the medicine can be just as harmful and potentially even worse than the disorder that is being treated.

"Most of the countries outside of the United States use the metric system and therefore foreign-born parents are more familiar with this form of measurement. Plus, the precision associated with it is unsurpassed," he said. "Medicine has been using the metric system for years because, as the article demonstrates, the amount needed can be more precisely measured."

Dr. Seman described how he helps parents give their children the right medication dose. "In our office, when a child is born, we give the parents a welcome gift which contains a syringe measuring device that measures in milliliters, as well as teaspoons. This seems to help parents understand the importance of being careful when dosing," he said.

The study was published July 14 in the journal Pediatrics. The authors reported no potential conflicts of interest.

The research was funded by the National Institute of Child Health and Human Development and the NIH National Center for Research Resources.

Review Date: 
July 14, 2014
Last Updated:
July 18, 2014