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Children's medications standard needed to prevent over medicating or under medicating.

Children do not have the ability to decipher whether they are taking the correct medication dose or not.

New reports show that doctors may not be stressing an important concept to parents- they need to administer right dose of medicine for children. But this often does not happen and children are often getting over medicated and sometimes getting under medicated.

The New York Times reports on the growing issue.

Thousands of parents actually contact poison centers across the country to inquire about whether they have given their children too much medicine after getting vague doctor instructions or misreading a medicine bottle.

Parents are often confused about what dosage to administer for children under the age of twelve. Some medicines are to be measured in milliliters, others in teaspoons and some in milligrams. But many parents are accustomed to using tablespoons and try to eyeball what the proper dose would be after conversion to tablespoons. This does not always go well.

Many medical associations are now saying that doctors and pharmaceutical companies should administer one type of measurement to make things easier on parents. They say the preferable mode of medication administration should be milliliters. “A new study in Pediatrics has found that parents who dosed medications in milliliters were far less likely to make errors than those who gave their children medicine in teaspoons and tablespoons,” according to The Times.  

How was the study conducted? Dr. Yin of New York University School of Medicine led a team that interviewed around 287 parents just after they had finished giving medication to their children. The medicine had been prescribed at the emergency departments at Bellevue Hospital Center in Manhattan and Woodhull Medical Center in Brooklyn. Scientists found that more than 40 percent of the parents had not measured their children’s medicine correctly. This large percentage was disturbing as it could mean serious health consequences for some children in a setting where they are being given certain strong medicines. Results showed that one out of six parents resorted to random household utensils, such as soup spoons and large table spoons.

Actually, parents who measured medicine in teaspoons and tablespoons were around two times as likely to make mistakes than those parents who measured using milliliters. What did parents with milliliter prescriptions tend to use? Parents with milliliter prescriptions usually used syringes or dosing cups in most cases. Dr. Paul, a co-investigator and professor of pediatrics at Penn State University College of Medicine, said that a syringe that delineated milliliters was an exact measure and therefore worked quite well. However, around 25% of the parents did not receive a measuring device or some kinds of cup with the medication. Those parents were more likely to look through kitchen drawers, although some who did get the devices still used their own teaspoons and tablespoons thinking they were easier or cleaner.

Dr. Paul told The Times, “A kitchen spoon is less precise. There are no markings on it, and they vary widely in size. You could way overdose. Mistaking directions for a tablespoon rather than a teaspoon, even when using a medical dosing spoon, could be a significant error: a tablespoon of medicine is threefold stronger than a teaspoonful and could result in an overdose with harmful consequences.”

On the other hand, making the opposite error and under-dosing a kid can also cause serious problems. For example, if an antibiotic is given at too small a dose for strep throat, it may not be effective and the infection could surge on. The physician will probably have to prescribe a second, stronger medication in such a case.

Mary Poppins sang that a spoonfull of sugar helps the medicine go down. But parents need to keep in mind that this does not mean that they should always actually give their children a spoonfull of medicine.

It is not only a parent’s lazy grab for a kitchen utensil that can cause serious mistakes. Dr. Mendelsohn, an associate professor of pediatrics at N.Y.U. and a senior investigator on the study, made a statement saying that dosing mistakes could occur at various levels. Parents could have trouble deciphering between abbreviations for measurements such as teaspoon (tsp) and tablespoon (tbsp) because they are so similar. Also, a doctor’s handwriting could be misinterpreted or misread. Or sometimes a pharmacist could give the dose in teaspoons when a milliliter measuring device was not at hand, which can create serious issues.

Dr. Mendelsohn told the Times, “In many cases where the prescription was in milliliters, the parent nonetheless dosed in tablespoons or teaspoons.” But Dr. Yin emphasized that parents were not necessarily to blame because they were often exposed to inconsistent information. Dr. Yin told the Times, “Parents may encounter different units of measurement as they’re being counseled by their doctor or pharmacist, and those units may be different from what they see on the prescription or bottle label. So there’s no wonder that they can be confused.”

“Outreach to pharmacists and other health professionals is needed to promote the consistent use of milliliter units between prescriptions and bottle labels,” according to CBS.  

A slow shift to a one pattern unit appears to be in the works. The American Academy of Pediatrics has recommended that all physicians prescribe medicine in milliliters in electronic medical records to make things easier on patients and parents of patients. One set standard for regularity and has also been suggested by the Institute for Safe Medication Practices and the Food and Drug Administration.

CNN news also endorsed the mililiter usage plan stating,

“Parents should record the time and dosage of medicine they give their child, to make sure that they’re not giving too much or too often. The American Academy of Pediatrics, U.S. Centers for Disease Control and Prevention, and the Institute for Safe Medication Practices have all recommended using milliliters as the only standard unit of measurement for liquid medications. According to the study, adopting a milliliter-only unit of measurement would reduce confusion and decrease medication errors, especially for parents with low health literacy or limited English proficiency.”

Researchers hope that the new plan will be in effect within a year.