Unintentional medication overdoses are a preventable problem sending 70,000 children to emergency departments each year in the U.S. alone. It’s also a common cause of hospitalizations among children aged zero to four, according to the Ontario Medical Association.
Most medications for children treated as outpatients are given as liquids. On Monday, the American Academy of Pediatrics released a policy statement to address two common sources of preventable errors for liquid medications:
- Giving the wrong volume.
Pediatrician Ian Paul, the lead author of the statement, said they’re calling for a simple, universal standard of metric doses in order to change how doctors write prescriptions, how pharmacists dispense liquid medications and dosing cups, and how manufacturers print labels on their products.
The preferred device to use is an oral syringe, said pharmacist Julie Greenall, director of projects and education at the Institute for Safe Medication Practices Canada in Toronto.
"The spoons in your kitchen drawer are good for soup and cereal and not for medication," Greenall said.
Part of the problem with kitchen spoons is they aren’t precise to measure a child’s medication, Paul said.
Metric vs. Imperial
Caregivers could also misinterpret millilitres for teaspoons or confuse teaspoons and tablespoons.
People may be confused because they don’t understand imperial measurements, which they never learned, Greenall said.
"They don't have that context so they're not going to think, 'Well, this looks like too much volume.’ A volume in a syringe,10 millilitres, is not really that much liquid so it doesn't look like this would be too much medication for a baby."
The institute’s tips to consumers include:- Whenever you receive a new prescription, ask why the medicine has been prescribed, what the correct dosage is, and how often to take it.
- If the medicine has been prescribed for your child, the dose may depend on the child's age and weight. Make sure the prescriber and the pharmacy filling the prescription knows your child's current age and weight.
- If the pharmacy dispenses a liquid medicine or you pick one up off the shelf, ask for an oral syringe to measure the dose accurately. Ask the pharmacist to tell you the dose that has been prescribed and then show you how much liquid will provide this dose. If any of the information you receive is different from what you expected, ask the pharmacist to check the prescription with you again.
- Ask the doctor and the pharmacist about any side-effects to watch for and when to contact a healthcare provider for help. This information is especially important when you are giving medicine to babies and young children.
Greenall also thinks it’s important the U.S. academy is taking a position on moving to metric units in health care, which could help prevent confusion on both sides of the border.
In 2011, ISMP Canada issued an alert about oral syringes marked in both millilitres and teaspoons after it received a report about a baby who was prescribed 2 mL of liquid antibiotic but the caregiver mistakenly measured two teaspoons or 10 mL — five times the intended dose. The baby had vomiting and diarrhea for 24 hours.
The U.S. academy recommends devices for precise measurements should be distributed with medication.
In Canada, Greenall said some smaller pharmacies may provide a reference in both millilitres and teaspoons but prescription medications and medication device are in millilitres.