Giving a child liquid medicine looks simple. Two studies of parents found it is easy to get wrong, and that the way the dose is written and the tool used to measure it both play a part.
Units make a difference
A 2014 study in Pediatrics looked at 287 English- or Spanish-speaking parents whose kids were prescribed liquid medicine in two emergency departments. It defined an error as more than a 20 percent deviation from the dose. 39.4 percent of parents made an error measuring the intended dose, and 41.1 percent made an error with the prescribed dose. 16.7 percent used a nonstandard instrument, such as a kitchen spoon.
Parents whose instructions used teaspoon or tablespoon units made errors more often than those using milliliters only: 42.5 percent versus 27.6 percent for the intended dose, about twice the odds after adjustment. The associations were greater for parents with low health literacy and for non-English speakers. The study was cross-sectional, so it shows an association rather than proving the units caused the errors.
Tools make a difference too
A larger randomized experiment published in 2016 had 2,110 English- or Spanish-speaking parents of kids 8 and under, in three urban pediatric clinics, measure nine doses each using a cup and two kinds of oral syringe. 84.4 percent made at least one dosing error, and 21.0 percent made at least one large error, defined as more than twice the dose.
Cups produced more errors than syringes, with an adjusted odds ratio of 4.6, especially for smaller doses. A teaspoon-only label paired with a milliliter-and-teaspoon tool was associated with more errors than milliliter-only labels and tools (adjusted odds ratio 1.2). Parents measured the doses in a clinic setting, not at home.
What that means for teaching parents
The American Academy of Pediatrics issued a 2015 policy statement recommending metric, milliliter-based dosing devices for children's liquid medicines. The study authors concluded that their findings support a milliliter-only standard, and recommended oral syringes over cups, particularly for smaller doses. Beyond that, a few practical habits help when teaching parents:
- Write and say the dose in milliliters, and show them the exact line on the syringe to fill to.
- Ask the parent to measure the dose in front of you, rather than asking whether they understand.
- Give them something to check at home, when they measure the dose on their own.
Qik Productions makes short animated medication videos for kids and parents, each reviewed by a specialized pharmacist, that families can replay at home. See medication education videos.
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