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Child Medications Should Be Dosed In Metric Units--Not Spoonfuls

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The scenario is all too familiar—a child is rushed to the emergency department with a suspected overdose, after receiving a medication at home.  The parents or caregivers are concerned they may have measured too much using a common kitchen utensil—a teaspoon or tablespoon.

While children commonly receive doses of liquid medications using teaspoons and tablespoons, pediatricians are now urging not only parents and caregivers, but medical providers and pharmacists, to use only one method of measuring out medications—the metric system using milliliters or mls.

A recent report published March 30 in the journal Pediatrics, provides the rationale for switching to such a system.

The new metric dosing guidelines, set forth in the report from the American Academy of Pediatrics (AAP) represent an important effort to increase the safety of dispensing medications to children.

Using the metric system is the most accurate way to measure doses of medications in order to avoid an unintentional overdose. In fact, thousands of children are seen and evaluated in the emergency department annually for such a scenario. The ultimate cause is often unclear instructions for measuring, which are often specified as fractions of teaspoons.

While many parents and caregivers believe they can accurately measure out medications using half or quarter teaspoons, the truth is that there is variability each time dosing occurs. The end result may lead to progressive overdosing of  medications which can have dangerous side effects.

Acetaminophen (Tylenol) is one example of such a medication—and liver failure could result if an excessive dose is consistently given to a child by a caregiver who is not accurately measuring the dose in a consistent manner.

Beside this, some caregivers may inadvertently use a tablespoon instead of a teaspoon to measure out doses, placing children at high risk for unintentional overdoses. This could potentially lead to three times the dose of a particular medication being given to a child, placing them at high risk for adverse outcomes.

One common medication used for allergies and allergic reactions—diphenhydramine (Benedryl)--if given in excess, could lead to excessive drowsiness and place children at risk for seizures or a compromised ability to protect their airway, ultimately requiring intubation and mechanical ventilation.

Other classes of drugs, including narcotics such as codeine, represent another danger in terms of doses. These medications require precision dosing, and frequency, and carry a high potential for overdose if incorrectly administered.

The new AAP guidelines recommend all medications to be given in milliliters or mls. In addition, all prescriptions should include “leading zeros” such as 0.5 ml for half a ml dose, and eliminate trailing zeros, such as 0.50 ml to reduce confusion for parents or caregivers regarding the dose.

The AAP has actually recommended such changes in guidelines for dosing since the 1970’s. With the new AAP set of guidelines released today, it is the hope that there will be widespread adoption by not only parents and caregivers, but medical providers, retailers, drug manufacturers, and pharmacists.

Weights are often another source of confusion among parents and caregivers, as many do not adhere to using kilograms (kg) for weight-based dosing of medications. If a medication is not administered using kilogram-based dosing, there is a risk it may lead to an incorrect dose.

In order to accurately measure a dose of a medication, a syringe with clear markings for the quantity in mls should be used. Parents and caregivers can then dispense the medication directly into the child’s mouth. This ensures that the correct dose is actually given.

Such standardized measures, if widely adopted, can help to reduce medication dosing errors, prevent adverse outcomes, which can ultimately can help reduce suffering and risk for death.

In fact, the recent advent of electronic health records (EHR) may further help to standardize dosing of medications using the metric system, creating one uniform approach to dispensing medications to children. Based on weights, the correct dose in mls is printed in prescriptions or sent electronically to the pharmacist.