Save the spoon: Use metric-dosing devices for kids’ liquid meds

Don’t use a kitchen spoon to give children liquid medications; instead use metric milliliter-only dosing, urges a statement, published online March 30 in Pediatrics.

The American Academy of Pediatrics (AAP) has previously supported the recommendation for metric dosing of orally administered liquid medications through federal testimony before FDA and metric-only labeling in a policy statement on electronic prescribing.

The recommendation comes from “increasing recognition that medication errors and overdoses are common, but most are preventable,” said pediatrician Ian Paul, MD, FAAP, lead author of the policy statement.

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Each year more than 70,000 children visit emergency departments as a result of unintentional medication overdoses. Sometimes a caregiver will misinterpret milliliters for teaspoons. Another common mistake is using the wrong kind of measuring device, resulting in a child receiving 2 or 3 times the recommended dose.

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

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Research has demonstrated that common over-the-counter liquid medications for children often have metric dosing on the label, but include a measuring device marked in teaspoons, or vice versa, causing confusion among caregivers. One recent study demonstrated that medication errors are significantly less common among parents using only mL-based dosing rather than teaspoons or tablespoons.

“Formulary managers should encourage liquid medications be dispensed with syringes for precise measurement,” Dr Paul said. “They should seek out liquid medication bottles that have flow-restrictor technology.”

Metric units should be used exclusively by providers without any reference to ‘spoon-based’ dosing, according to Dr Paul.

“Parents should administer liquid medications with a syringe that has metric units, preferably one that has a flow restrictor,” he said. “Pharmacies and others that dispense medications should ensure provision of a proper dosing device.”