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The right dose: Use the right tools to medicate your child

It's 3 a.m., the baby is crying, inconsolable. Her fever is back and you need to get her some Tylenol, so you stumble into the kitchen and fumble through the cabinets and find the liquid medication that will treat your child's illness.

The question is what do you use to give the medicine, and will you give the right amount?

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If you are like 80 percent of the more than 2,000 parents in a study in the journal Pediatrics and published online on Sept. 12, you will have given either too much or too little medicine, perhaps giving as much as two times the recommended dose, as 21 percent of the parents studied did.

This wasn't the result of negligence, however, it was a result of using the wrong tools. When it comes to medicating children, according to Dr. Cynthia Roldan, chief of pediatrics at Carroll Hospital, kitchen spoons or measures simply don't measure up.

"We always tell [parents] not to use any household or kitchen tools, like a teaspoon measure," Roldan said. "People think a teaspoon is a teaspoon and it's not — a teaspoon from your kitchen set is different from a teaspoon from my kitchen set."

Liquid medicines should be dispensed with the measuring tools supplied by the physician or pharmacy, Roldan said, such as a graduated measuring cup, dropper or oral syringe.

"When we have a smaller infant, I will send the patient home from the hospital with a syringe so I know the parent has the correct measurement tool," she said. "It's easier, you stick it to the side of the cheek, you squirt it in there and they take it better than with something else for a small infant."

Parents would also do well to make sure they know how to use the dosing tool properly, Roldan said, and parents can always ask a pharmacist to demonstrate how to use a syringe or dropper to ensure they understand the procedure before heading home. They should also ask their physician or pharmacist to be clear about how often to give the medication and how they are measuring the dosage, be it milliliters or teaspoons, she said, although the concern over the use of nonstandard measuring tools has some providers shifting their prescriptions.

"Physicians are trying to get away from using the wording teaspoon or tablespoon because of that concern, that people will reach for the kitchen tools," Roldan said. "They are trying to use milliliter-only units, so they will say take 3ml, or 5ml, and that also I think helps to distinguish that this is a different measurement."

Getting it right when it comes to medicine really does matter, Roldan said, as overdosing can have uncomfortable effects. Many antibiotics can cause fairly nasty diarrhea in children if they are given too much, she said, while acetaminophen, also known as Tylenol, can be dangerous.

"Acetaminophen seems like a benign drug, but if you overdose on acetaminophen it can cause liver damage," Roldan said. "The other side of it is, if you are underdosing, then you are not going to get the effect you are looking for."

In other words, that fever you are looking to reduce at 3 a.m. could keep on kicking if you don't give enough Tylenol, so using the right tool is important.

So is reading the label. Roldan said it's not only vital that you ensure you are using and correctly measuring out the proper dose of the medication, it's also important to check to see if the medication needs to be refrigerated, and if it needs to be shaken before use — many medications can settle, so that doses from the top are too low a concentration and doses taken from the end of the bottle are too strong.

"You have to read those labels," she said. "If it says to shake it, you have to shake it. There's a reason why."

If, in the middle of the night you find yourself confused about a medication for your child or the dosage, don't just wander down the Google medical rabbit hole. The American Academy of Pediatrics, of which Roldan is a member, maintains a site just for you, www.healthychildren.org.

"It's a really nice website and it answers a lot of questions, answered by a pediatrician," she said. "It's very parent-friendly, because it talks about what to look for, when should I call the doctor, what can I do before I call the doctor."

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