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Parents should be careful with children's medication dosages

Dr. Scott Krugman
Dr. Scott Krugman (Baltimore Sun)

That teaspoon of acetaminophen parents give their children when they have a fever may not be a teaspoon at all. Studies show parents who use utensils from the kitchen drawer may inadvertently give their child too little or too much of all kinds of medicines, and that can sometimes lead to severe side effects. Parents should be using a carefully marked dropper or the cap that comes with the medication, consulting the recommended dosages for their child's weight and age, according to Dr. Scott Krugman, chairman of pediatrics at MedStar Franklin Square Medical Center.

How big a problem are incorrectly measured drugs for kids?

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A recent study found more than 10,000 calls to the poison center each year are due to liquid medication dosage errors.

Because children's dosages for each medication vary by weight, there are no "standard" medication doses for medications prescribed to children. Additionally, many medications come in a variety of concentrations. Both of these features increase the likelihood of a medication error.

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Multiple studies have demonstrated that even when the right dose is prescribed, around 40 percent of parents incorrectly dose their children.

One of the easiest ways to mis-dose a child is to use a kitchen spoon. Kitchen "teaspoons" or "tablespoons" are not calibrated and create a scenario in which parents can easily underdose or overdose their child's medicine.

Not understanding the concentration of a medicine can lead to errors because sometimes a smaller quantity of medicine can actually be a higher dose. Recently, acetaminophen infant drops were reformulated as a result of this since less than 1 ml of the infant drops used to contain as much medicine as 2.5 ml of the children's suspension. Now, both infant and children's formulations have the same concentration.

Is there a big difference between a teaspoon and a tablespoon when it comes to most medications?

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Most teaspoons are equivalent to 5 milliliters (ml) while a tablespoon is 3 times as much, or 15 ml. This difference may not seem like a lot, but for some medications a threefold difference in amount can be very serious.

For example, a common asthma medicine, prednisolone, comes in a concentration of 15 milligrams (mg) in 5 ml. A wheezing 30-pound toddler might need 2 teaspoons, or 10 ml of prednisolone, which would be 30 mg of medicine. If a parent were to use a tablespoon and give 2 tablespoons or 30 ml, the child would receive 90 mg of medicine, which would be a substantial overdose.

Other less concerning issues with mixing teaspoons and tablespoons include running out of medicine too soon and difficulty getting the child to take a larger amount of medicine.

Are there common symptoms that happen when kids are overdosed?

The problems with overdosing a medicine can vary substantially, depending on the medicine and the amount that was overdosed. In general, giving too much of a medicine will lead to a greater likelihood of having side effects from the medicine.

For example, giving three times the amount of a common antibiotic like amoxicillin may cause a bit of an upset stomach or some increase in diarrhea. However, some medicines may have severe side effects. If a parent mixes up teaspoons and tablespoons of the common fever reducer acetaminophen, and gives three times the amount more than once or twice, the child can develop acute liver toxicity, which can lead to liver failure.

The greatest risk occurs in the smallest children, because the increase in amount of medicine per pound of body weight is significantly higher.

Where can you find information on appropriate medication doses for children?

Your most reliable resource is your child's doctor or health care provider or pharmacist. When you are given a prescription, make sure you clarify how much medicine to give your child.

Many doctors' offices and pharmacies carry oral syringes that should be used to measure the exact amount of medicine for your child. Using a specific milliliter measuring tool is the single most important safety tool for parents to use to prevent over- or underdosing.

Finally, for some common over-the-counter medications, many doctors have dosing tables to give to parents or that can be found on their website so parents know exactly how much medicine they should give to their child, based on their current weight. The American Academy of Pediatrics parent website http://www.healthychildren.org has an example of one of these for acetaminophen.

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