No More Kitchen Spoons for Children's Medicine

Metric measurements recommended for children's medication over kitchen spoons to prevent unintentional overdose

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) A spoonful of sugar may help the medicine go down, but new recommendations stress that the medicine shouldn't be measured by the spoonful.

A new policy statement from the American Academy of Pediatrics (AAP) calls for the use of metric measurements instead of teaspoons or tablespoons for all medications for children.

“Spoons come in many different sizes and are not precise enough to measure a child’s medication,” said lead statement author Ian M. Paul, MD, in a news release. “For infants and toddlers, a small error — especially if repeated for multiple doses — can quickly become toxic.”

Travis Hale, PharmD, vice president and pharmacist at Remington Drug Co. in Remington, VA, told dailyRx News the AAP recommendation makes sense.

"When you're looking at choosing an appropriate dose of medication for a child, quite often you're choosing that dose based on their weight, not their age," Dr. Hale said. "Given the variability of one child's weight to another, the metric system of measurement allows for specific dosing for that child as opposed to limitations of the teaspoon/tablespoon system. With metric measurement, you have flexibility to deliver a more exact dose than you do when you refer to a teaspoon, 1/2 teaspoon, and so on."

Dr. Hale continued, "To compound matters, when one introduces 'household spoons' as measurement devices for medication, that creates a whole new level of variability in dosing. While your spoon may be a 'teaspoon,' studies have been done showing quite a wide range in volumes of liquid in one of those 'household teaspoons.'"

According to the AAP, over 70,000 kids visit the emergency room each year due to unintentional overdoses. Confusion over medication dosing information is likely a factor in these events, these researchers said.

The AAP noted that some liquid medicine labels describe doses in metric terms like milliliters while others use terms like teaspoon. Products often do not have uniform abbreviations for these measurements, Dr. Paul and team noted.

“One tablespoon generally equals three teaspoons," Dr. Paul said. "If a parent uses the wrong size spoon repeatedly, this could easily lead to toxic doses.”

In the face of these concerns, the AAP said all involved parties — like parents, medication manufacturers, doctors and pharmacists — should rely only on metric measurements for children's medicine.

“We are calling for a simple, universally recognized standard that will influence how doctors write prescriptions, how pharmacists dispense liquid medications and dosing cups, and how manufacturers print labels on their products,” Dr. Paul said.

Dr. Hale noted that "this is where a community pharmacist can play an important role in helping select a product, determine an appropriate dose, and provide that peace of mind and confidence for a parent or caregiver when treating a child. Speaking as a parent, I double check myself before selecting a product and determining a dose that's safe for my child or any other child for that matter. Once that has been done, it is very important to use a calibrated measuring device and preferably one that uses the metric measuring system."

Dr. Paul and colleagues noted that many childhood overdoses are preventable, and steps like these can help.

This policy statement was published March 30 in the journal Pediatrics. Dr. Paul and team disclosed no conflicts of interest.

Review Date: 
April 1, 2015
Last Updated:
April 3, 2015