Errors in Children’s Medicine Dosage Frequent, Dangerous

Many parents have trouble knowing the difference between a teaspoon and a tablespoon.  Caitlin Schmidt of CNN says that mistakes in the dosage of a medicine given to a child are frequent and can be dangerous, as more than 10,000 calls to the poison center each year are due to liquid medication dosage errors.

A study published on Monday by the American Academy of Pediatrics says there are several reasons why these mistakes take place.

- Some parents are confused about the difference between a teaspoon, a tablespoon and a milliliter because they are used interchangeably on prescription labels and on over-the-counter medications

- About 40% of parents, according to the study, incorrectly measured the dose.

- Teaspoon (tsp.) and tablespoon ( tbsp.) look similar and the names sound similar when spoken.

Dr. Jennifer Shu says that in her practice all prescriptions are measured in milliliters to decrease the number of errors and overdoses.  She recommends that parents:

- Use a syringe for sample medicines given in the doctors office.  Ask the doctor to mark the dosage level on the syringe.

- Always use the dosing device (cup, syringe…) that comes with the medicine.

- Do not use kitchen utensils (tablespoons and teaspoons) as a dosage instrument.

- Record the time and dosage of a medicine to make sure they are giving it on time and that they are not giving too much, too often.

Both the American Academy of Pediatrics,  the U.S. Center for Disease Control and Prevention, and the Institute for Safe Medication Practices advise giving medicine in milliliters as the standard for measuring liquid medications.  This will especially help parents with low health literacy and those with limited English proficiency.

Jan Hoffman, writing for The New York Times, says that many Americans do not want to use the metric system.

“There’s a traditional assumption that Americans are not good with the metric system and that the teaspoon is easier,” said Dr. Daniel Budnitz, the director of the medication safety program at the Centers for Disease Control and Prevention.

The study shows, however, that parents who measured in milliliters were far more accurate than parents who used other methods.  In fact, parents who measured with teaspoons and tablespoons are twice as likely to make mistakes.  Dr. Alan L. Mendelsohn, associate professor of pediatrics at N.Y.U. and a senior investigator on the study, addresses another problem.

“In many cases where the prescription was in milliliters, the parent nonetheless dosed in tablespoons or teaspoons,” Dr. Mendelsohn said.

Dr. H. Shonna Yin of New Yorlk University School of Medicine, as part of the study, interviewed 287 parents after they had given medication to their children prescribed at the emergency departments at Bellevue Hospital in Manhattan and Woodhull Medical Center in Brooklyn.

“Parents may encounter different units of measurement as they’re being counseled by their doctor or pharmacist, and those units may be different from what they see on the prescription or bottle label,” she said. “So there’s no wonder that they can be confused.”

Dennis Thompson of WATE an affiliate of ABC reports that the inaccuracy of using kitchen spoons to administer medicine can look even more worrisome when you consider that the dosage is prescribed according to the child’s weight.  This makes giving the precise dosage even more important.  Also, children are more sensitive to drugs than adults, making proper dosing crucial.  Some pharmacy chains have begun to add syringes and milliliter dosing instructions with the medicine.

Heather Free, a pharmacist in Washington, D.C. is also a spokesperson for the American Pharmacists Association.

 “Parents should ask their doctor or pharmacist to tell them the dose in milliliters instead of teaspoons and tablespoons,” Free said. “Parents should also make sure to use a dosing device, like an oral syringe, dropper or dosing spoon, rather than a kitchen spoon, to measure out the dose.”