Most Parents Give the Wrong Dose of Liquid Medication

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Most parents unwittingly give their kids the wrong dose of liquid medication — in some cases more than twice as much as instructed, a new study shows.

The study, conducted at pediatric clinics in New York, Atlanta and Stanford, Calif., also found that most dosing errors occurred when parents used a measuring cup. There were fewer errors when parents measured the dose with an oral syringe.

Pediatric medicines generally rely on liquid formulations, and parents have to decipher a sometimes bewildering assortment of instructions in different units with varying abbreviations — milliliters, mL, teaspoon, tsp., tablespoon. Some medicines come with a measuring tool, but often the units on the label are different from those on the tool.

The Food and Drug Administration in 2013 recommended that over-the-counter products use standard dosing tools and consistent labeling, but the changes were not required. Last year, the American Academy of Pediatrics endorsed moving to milliliter-only dosing, and recommended standard dosing tools.

For this study, published online today in Pediatrics, Dr. H. Shonna Yin and her colleagues ran an experiment to see what combination of tools and instructions would produce the fewest errors in dispensing liquid medication. They randomly assigned 2,110 parents to one of five pairings of the many possible combinations of tools and label instructions.

In nine trials, 84.4 percent of the parents made at least one dosing error, and more than 68 percent of the errors were overdoses. About 21 percent of parents at least once measured out more than twice the proper dose. Smaller doses produced more errors. When the dose was 2.5 milliliters, there were more than four times as many errors as when it was 5 milliliters.

The results “provide the evidence” in favor of standard dosing, said Dr. Ian M. Paul, a professor of pediatrics at Penn State College of Medicine who was not involved in the study.

It was the tool used to give the medication that had the biggest effect on errors. When a cup was used, there were four times as many errors as when an oral syringe was used.

“If the parents don’t have an oral syringe, the provider should give one to the parents to take home,” said Dr. Yin, who is an associate professor of pediatrics at New York University. “Especially for smaller doses, using the syringe made a big difference in accuracy.”