Over the counter (OTC) liquid medications for children are packaged with a diverse set of various measuring tools. The dropper that comes with liquid acetaminophen (Tylenol) will look very different than the dropper that comes with liquid Vitamin D or infant multivitamins. Even more discrepant are all the various caps for medications used in older children like liquid Motrin or Benadryl. If your cabinet looks anything like mine, caps and syringes are scattered about and distant from the bottle with which they were originally packaged. Because of this, many of us get confused when dosing medications for children. It’s time OTC liquid medications for children were packaged with a universal dosing device. And….time that pediatricians and all physicians be required to use only one unit of measurement (whenever possible) to avoid ongoing confusion for prescription medications, too. A new study functions as a wake-up call for drug makers and pediatricians alike; we need to do a better job helping families learn how to safely dose OTC liquid medications for infants and children. Current practice isn’t going to cut it.
A recent study in JAMA found… that although the FDA recommended that all OTC medications to be packaged with a dispensing device in 2009, only 74% of the OTC medications for children come with a measuring spoon or syringe. And more, researchers found that 98% of liquid OTC medications for children have inconsistencies, excess information, or confusing dosing instructions. Clearly, clarity is an issue for nearly all OTC medications for children.
Dosing medications for children shouldn’t be this confusing. While we can easily standardize doses for adults, medications for children are based on their mass or weight. We worry about over-dosing children. But we worry about under-dosing children, too. I hate to think of families under-dosing fever reducers or pain relievers and thus not adequately treating a child. The child suffers more. We can do better for our children. But some changes are essential.
- Only 148 of 200 OTC liquid medications studied came with a syringe or cap to dose the medicine, meaning only 74% of these medications complied with FDA 2009 recommendations for safety.
- The 200 medications tested represented 99% of the market share of liquid medications for children.
- Of the 148 medications that had a dispensing device, 83% of medications came with a cap, 13.5% with a dropper, and 2.7% with an oral syringe.
- “Nearly all products examined (98.6%) contained 1 or more inconsistencies between the labeled directions and the accompanying device with respect to doses listed or marked on the device, or text used for unit of measurement.” Translation: nearly all medications had inconsistencies, superfluous information, or confusing dosing instructions. An example of excess information included medications that called for dosing in teaspoons with doses ranging from 1-2 tsp. The cap included had markings for up to 4 tsp, a dose that would never be recommended.
- Drugs that didn’t come with a syringe or cap were often medications used for both children and adults or for gastrointestinal complaints.
Tips On Improving How You Dispense OTC Medications:
- If you’re unsure about how to dose a particular medication for a child, call your pediatrician’s office, talk with your local pharmacist, or call the nursing line for help.
- Don’t use a spoon from the kitchen to dose medications. Ever. There is mountain of studies that finds this is dangerous for children.
- It’s always okay to ask! No question about dosing medications is silly, simple, or stupid. Ever. The study mentions that 1 in 3 US adults and at least 1 in 4 US parents have limited health literacy; an even greater percentage have poor numeracy. Measuring out medications with confusing instructions may be difficult for many of us.
- Bring OTC medications from your home to the well child check or acute care visit with your pediatrician. If you have any question about how to dose them, review it. It is common to be confused (!) and the pediatrician can help you understand how to dose medications safely and effectively while instructing you with the tools/syringes/caps you have in your home.
When Will had his adenoids removed in June, Seattle Children’s Hospital Pharmacy gave us a syringe with a little black line that indicated the correct dosage. Althoguh generally speaking, I am fairly comfortable with my knowledge on appropriate dosing, when your child is sick or it’s the middle of the night, it’s easy to get confused. I think it would be great if you could take an OTC medication up to the counter and ask for the pharmacist to provide a marked syringe for the correct dose for your child at their current weight/age.
Children’s also put a rubberband around the neck of the bottle, securing the syringe to the medication. Also, genius. So, if you purchased a bottle of acetaminophen for your six month old who weighed 18 pounds and it was appropriate marked by the pharmacist, you would then secure that syringe to that bottle with the rubberband. If you have more than one child, you could ask for two syringes and buy two bottles. Then, mark each bottle with your child’s name so there is no confusion.
Though this is specifically about OTC medications, I am also curious about the dosing errors for prescribed medications. I would be especially interested to know how many parents truly give their children the full course of antibiotics or hit every scheduled dose of a multiple times a day drug. Adult compliance is poor after the fifth day and I wonder how it compares with pediatrics.
I’d like to offer a qualified disagreement on having syringes marked in both measurement systems. For context, I’m not a physician, just a dad (of an 8-month-old) who is also a chemist, and sometime chemistry teacher.
It may be impractical to implement, but I’d much rather see all medicines using a single measurement regime, and one that doesn’t have an equivalent in common kitchen implements.
Marking it in teaspoons, and giving dispensing information in teaspoons, leads to confusion about just how much a teaspoon is, and can lead to substitutions with dispensing instruments (namely, actual tea spoons) that are … not calibrated, shall we say.
If the FDA were to demand standardization of medicine dispensing equipment, I’d love to see them require metric, and require a syringe or cup clearly indicated in metric, and only metric. And emphasize that this syringe is the thing you must use to dose.
It could be that I’m biased here in how easy this would be for parents to follow (since it has the drawback of being metric, thus scary to non-science types). Not sure about that, but since all dosing instructions I’ve seen so far on OTC stuff are in metric, seems like we’re already partway there.
The syringes and spoons from Children’s are keepers! Most other places give you poor quality syringes that don’t seal or don’t have korcs or have numbers wash off or aren’t calibrated very precisely. We got tired of it all and got ourselves a good quality set of syringes (and 1 spoon for the preschooler) in these doses: 1 ML / .2 TSP syringe, 5 ML / 1 TSP syringe, 10 ML / 2 TSP syringe and 10 ML / 2 TSP spoon. Easier than keeping track of all that stuff. If I am supposed to dispense .8ML of tylenol and I have the right syringe, why use that annoying dropper?
Nat Bourre says
Thanks for this informative article. It is definitely a concern for parents to ensure that they provide their child with the correct dosage. You mentioned liquid Vitamin D for infants, so we thought it would be appropriate for us to add a comment that not all liquid Vitamin D for infants require an external dosing device. Baby Ddrops comes with a Eurodropper at the opening of the bottle. The Eurodropper is designed so that each drop that comes out of the bottle is a consistemt size. Only 1 drop of Baby Ddrops is required to get the full recommended daily dose of 400 IU, as recommended by the American Academy of Pediatrics.