Dosing Unclear on Kids' Medicines

What Is the Doctor's Reaction?

You bought an over-the-counter cold medicine for your child. According to the box, the dose for his weight and age is 2 teaspoons.

You look at the cup that came with the medicine, and find that 2 teaspoons isn't marked on it. There are markings for 1 teaspoon, as well as for drams, "cc's", even ounces. But nowhere does it say 2 teaspoons. So you go to the silverware drawer, pull out a dessert spoon, and fill it twice with medicine for him.

Chances are, he didn't get the right dose — because unless you use a measuring spoon, there's no way to be sure that you are giving exactly a teaspoon. Sadly, this happens all the time. That's because most nonprescription liquid medicines for children have confusing directions. If the medicines include measuring devices, they are often confusing, too.

These are among the findings of a study published this week in the Journal of the American Medical Association.

Researchers looked at 200 top-selling liquid non-prescription medicines for children. They looked to see if the medicines came with a measuring device. Then they checked whether the dose instructions matched the markings on the device. They also looked to see if the package and the devices used standard abbreviations, and to see if they were defined.

Nearly 3 out of 4 medicines came with a measuring device, which is good. But in just about all of them (98.6%) the dosing directions and the markings on the devices were different in some way.

Some were like the example above, where a dose didn't appear on the measuring device. Some had extra markings, such as for an amount that was less than the smallest dose or more than the highest dose. Researchers also found that standard abbreviations were not always used. This could cause confusion. And most of the time, abbreviations weren't defined, which could cause confusion as well.

These findings are important — and scary. Studies have shown that 40% to 60% of parents make errors when giving medicines to their children. Errors are far more likely to happen when instructions are confusing. And sometimes those errors harm a child.

This is a big reason why the American Academy of Pediatrics discourages the use of over-the-counter cold medicines for children under the age of 6. They don't help much, and they can be dangerous when given incorrectly. In October 2007, under pressure from children's doctors, cough and cold medicines for children under age 2 were recalled. In the months after the recall, visits to the emergency room for serious reactions to these medicines dropped by half.

What Changes Can I Make Now?

First and foremost, don't give your child any medicine without checking with your doctor. Be sure it's something that will help your child.

When giving medicines, make sure you know how much to give. Most doses are based on a child's weight, not age. Check with your doctor's office if you have any questions. Your pharmacist can also help.

Use a measuring device designed for giving medicines. Syringes are best, as they allow you to measure most exactly.

Never use spoons out of the silverware drawer. If you are going to use something from the kitchen to measure a teaspoon, use a measuring spoon. Remember that a tablespoon (abbreviated T. or tbsp.) is equal to three teaspoons (t. or tsp.). Make sure you know which one to use.

If you ever get confused about measuring medicines, don't guess! Call your doctor's office or pharmacy for advice.