Standardizing measuring instruments and labels may reduce the dosing errors commonly made by parents with oral pediatric medication.

With cold and flu season approaching, many parents will be trying to alleviate their children’s illnesses with medication, much of which comes in liquid form.

incorrect dose for children

While measuring liquid medication correctly is important for properly treating some illnesses, giving children the proper dose can be complicated for parents.

Medication packages use a confusing array of units — including teaspoons, tablespoons with various abbreviations, and milliliters — and a variety of measuring implements.

A new study published today in the journal Pediatrics suggests that measuring medication for children using oral syringes may cut down on dosing errors.

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What researchers discovered

The research found that parents were more than four times more likely to make errors when using measuring cups than syringes.

The beneficial impact of syringes was greatest for smaller doses.

Additionally, 84 percent of parents made at least one dosing error of greater than 20 percent while measuring nine doses of medication under experimental conditions using an oral syringe or cup.

Most of the errors involved providing too much medicine with 21 percent of parents measuring a dose more than two times the specified amount.

“I was surprised by how many errors parents were making,” said Dr. Shonna Yin, associate professor of pediatrics and population health at NYU School of Medicine, and the study’s lead author.

Giving too much medicine might lead to side effects, while an illness may not be properly treated if a child is given too little medicine, Yin told Healthline.

“As a pediatrician in a public hospital setting, I’ve seen many parents confused about how to give medication to their child correctly,” she said.

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How research was conducted

The new research is the first phase of the SAFE Rx for Kids study, which is funded by the National Institutes of Health (NIH).

More than 2,000 English- or Spanish-speaking parents who brought a child to an urban clinic participated in the current study.

They were asked to measure three different medication amounts (2.5, 5, and 7.5 milliliters) using three different measuring tools designed for liquid medication. Those were a 10-mL syringe with 0.2 mL or 0.5 mL increment markings or a measuring 30 mL dosing cup.

Participants were divided into five groups that varied based on the measurement units used on the measuring tool and instructions.

In the first group, mL was used for both. But in the other groups, the units or abbreviations for units used on the measuring tool and instructions did not match, or the measuring tool or instructions included units in milliliters and teaspoons.

The researchers found that significantly more measuring errors were made by parents given dosing tools with milliliter and teaspoon markings combined with teaspoon-only labels compared with those who received milliliter-only labels and tools.

However, in the milliliter-only group, parents still made errors around 25 percent of the time.

The results suggest the need to adopt strategies that go beyond the American Academy of Pediatrics’ recommendation in 2015 that only metric measurements like milliliters be used on medication bottles and dosing cups.

Using metric measurements instead of teaspoons and tablespoons can help to avoid mixing up units and abbreviations and deter the use of regular kitchen spoons, Yin said.

Parents may have been more accurate with the oral syringes because the cups were bigger and provided more room for overdosing, she said.

Also if a cup isn’t placed on a flat surface, the medication may not be accurately measured.

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What parents can do

The dosing syringes and cups used in the study can be obtained from a pharmacist or doctor, or purchased at a drug store.

“Parents shouldn’t be afraid to ask questions if they are confused” about giving the right dose of medicine to their children, Yin said. “Many, many parents are confused.”

The study’s results suggest that using syringes and milliliters only will be beneficial in helping parents to accurately give medication to their children, and that more strategies are also needed.

“Because parents may not use tools provided to them, counseling and general education about the importance and proper use of standard dosing tools remain important,” the authors wrote.

“There’s still a lot of room for more research,” Yin said.

To that end, she is investigating additional approaches, like the use of pictograms on medication labels that illustrate how much medication to give.

The next step is to test some of these ideas in a real-world setting, she said.

“I hope we can find a way to make it easier for people so it’s a lot more straightforward to give medication safely,” she said.