April 8, 2015
Pediatrics Group Calls for Metric-Only Dosing of
Liquid Medications

Chicago—Teaspoon and tablespoon measurements may be fine for baking, but they should not be used to give liquid medicine to a child, according to a new American Academy of Pediatrics (AAP) policy statement, which calls for use of only metric measurements on prescriptions, medication labels, and dosing cups.

“Spoons come in many different sizes and are not precise enough to measure a child’s medication,” said pediatrician Ian Paul, MD, FAAP, lead author of the policy statement, “Metric Units and the Preferred Dosing of Orally Administered Liquid Medications,” in the April 2015 Pediatrics. “For infants and toddlers, a small error—especially if repeated for multiple doses—can quickly become toxic.”

More than 70,000 children visit emergency departments each year as a result of unintentional medication overdoses, according to the AAP. One problem is that caregivers sometimes mistake milliliters for a teaspoon, while another common error is the use of the wrong type of measuring device. The result? A child could receive two or three times the recommended dose.

“One tablespoon generally equals three teaspoons. If a parent uses the wrong size spoon repeatedly, this could easily lead to toxic doses,” Paul pointed out.

In fact, the preferred dosing device is a syringe with flow restrictions, but cups, and spoons marked in milliliters also are acceptable, according to the policy statement. A recent study found that medication errors are significantly less common among parents using only milliliter-based dosing rather than teaspoons or tablespoons.

Over-the-counter liquid medications for children often have metric dosing on the label, yet also include a measuring device marked in teaspoons, or the reverse, which can confuse caregivers, according to the AAP.

The AAP has previously testified before the FDA urging metric-only labeling and dosing for both prescription and OTC products. The updated 2015 policy statement recommends:

• The adoption of standard language, including mL as the only appropriate abbreviation for milliliters. Liquid medications should be dosed to the nearest 0.1, 0.5, or 1mL.
• A clear statement of how often a dose is needed should be on the label. Common language like “daily” should be used rather than medical abbreviations like “qd,” which could be misinterpreted as “qid,” which was a common way for doctors to describe dosing four times daily.
• Review of milliliter-based doses with families by pharmacists and other healthcare professionals when they are prescribed and dispensed.
• The removal of extra markings on dosing devices that can be confusing, and limits on the size of those devices to avoid two-fold dosing errors.
• Elimination of labeling, instructions and dosing devices that contain units other than metric units.

“We are calling for a simple, universally recognized standard that will influence how doctors write prescriptions, how pharmacists dispense liquid medications and dosing cups, and how manufacturers print labels on their products,” Paul said.
U.S. Pharmacist Social Connect