Medicine time for kids? Ditch the kitchen spoon

When I was a kid, part of the ritual of taking medicine was Mom pouring it into a spoon pulled from a kitchen drawer. But that kitchen-spoon approach has been put through the scientific wringer—with not-so-favorable results.

A study released in the Annals of Internal Medicine last month, Spoons Systematically Bias Dosing of Liquid Medicine, found that participants were more likely to pour too little medicine into a medium-sized spoon, and too much into a large sized spoon. And a study published just this week in the February 2010 Archives of Pediatric and Adolescent Medicine found that dosing errors were very common among parents when they used dosing cups compared with droppers, dosing spoons, or oral syringes. As a concerned parent, I cringe at the thought that such an error could lead to a medication being ineffective at best, and harmful at worst, to my young children. (For more about unintentional overdosing and poisoning, see a poisoning fact sheet from the Centers for Disease Control and Prevention.)

One solution to the problem is to use an oral syringe. A 2008 study showed that participants were more likely to measure an acceptable dose of medication with an oral syringe than with a dosing cup, though syringes were the devices they reported using least (they had used droppers, dosing cups, and teaspoons more often). The new study published this week shows that parents had fewer dosing errors when they used syringes and droppers. A syringe requires you to pull a stopper up, drawing liquid into the cylinder. A dropper has a bulb at the top that, when squeezed and released, draws the liquid into the cylinder. The only problem with the syringe, according to the people in the study, was that it was harder to use, which could affect the accuracy of doses administered that way.

Our advice: Ask for or buy a dosing syringe (and a bottle adapter, which may make the syringe easier to use) from the drug store or pharmacist; ask the pharmacy staff to show you how to use it; and practice using the syringe with water or clear juice to get better at it before using it to draw up a dose of your child's medicine. (See medication safety for children for more advice on giving medication to a child.)

Safe medication tips:

• When you talk to the pediatrician, write down the exact amount of medication to give your child, as well as the time and frequency for administering it. Make sure that matches the instructions on the bottle or package label when you pick it up. If there's a discrepancy, talk to the pharmacist. (Once, my son's doctor prescribed medication in ml's (milliliters) but the bottle itself had it measured as cc's (cubic centimeters)." A quick call to the pharmacy cleared up the confusion (they're the same), but it would have been better to check it at the pharmacy counter before I left. Ask the doctor whether your child should take the medication with a bit of food, such as a cracker, to offset any discomfort.
• Beware of possible drug interactions. Before giving your child any medicine, whether prescription or over-the-counter, tell your doctor and pharmacist about any other medicines (including vitamins or supplements) she takes in order to prevent adverse drug interactions. Write down the answers to any other questions you may have, such as side effects to look out for, and when the medication should be taken and under what conditions (with or without food or dairy products, for example).
• If you give your child over-the-counter medication, make sure you are giving him the right product. Infant and child versions of the same drug or brand contain concentrations formulated for specific age and weight ranges.
• Keep this information handy: Most liquid medicines are measured in teaspoons (tsp) and milliliters (ml): 5 ml equals 1 teaspoon (tsp); 15 ml equals 3 teaspoons or 1 tablespoon (Tbsp); and 30 ml equals 1 fluid ounce (oz).
• Know your child's weight, write it down, and keep it handy. This information is crucial for correct dosing, whether you consult a medication box or, in an emergency, a doctor or poison-control person.
• Debrief your child's caregivers. Write down and discuss how much and when to give your child a medication, and double-check with them at the end of the day to confirm whether the medication has been given and when. Also make sure they have the Poison Center number on hand (see below).
• If you don't have an oral syringe or dropper, withhold the medication until you can obtain one. The old aphorism, "when you don't know what to do, do nothing," applies here.
• Call for help if poisoning occurs. You can reach your local Poison Center by calling 1-800-222-1222. Keep this number near all your phones. Someone is available to answer calls 24 hours a day, seven days a week. Be sure your caregiver is also aware of the number. Poison Centers answer non-emergency calls as well as emergency calls. For example, you can call for information about poison prevention or to find out about drug interactions, poisonous plants, and safe pesticide use.

For related information, see OTC cough and cold medications not for children 2 years old and younger and the Food and Drug Administration's Safe Use Initiative.

—Artemis DiBenedetto