ONU HealthWise

Errors with spoons when measuring prescriptions

Editor’s Note: The following article was written by Karen L. Kier, Pharmacist on behalf of the ONU Healthwise Team.

Be Our Guest was a song from Beauty and the Beast. During the song’s animation, we see spoons diving into a punch bowl.  

Why talk about spoons? Many medications for children come as liquids requiring measuring.  

In early 2000, about 73% of consumers used a kitchen teaspoon to give medication to their child. This number dropped to 17% in 2014. Even with this improvement, a 2023 study showed dosing errors are still occurring.  

A kitchen teaspoon should measure 5 milliliters (mL) of liquid, while a tablespoon should hold 15 mL. Unfortunately, household spoons are not reliable and result in errors. To overcome this problem, manufacturers will often include a dosing cup or syringe with the bottle. Many pharmacies offer oral syringes to reduce errors.  

A study involving 2,000 parents was conducted to evaluate the interpretation and measurement of correct doses for children. The participants were asked to read and measure either 5 mL or one teaspoon or 5 mL (one teaspoon). The results indicated 99% of parents made a measurement error of one or more doses. There were more errors with 1/2 teaspoon (2.5 mL) or 1 and 1/2 teaspoon (7.5 mL). Two out of the 3 mistakes involved giving too much medication and 20% of those were large overdoses.  

In the study, parents were less likely to make a mistake when using an oral syringe versus a dosing cup. The dosing cups increased the odds of a mistake especially with smaller doses. Some of the problems were attributed to parents confusing the abbreviations tsp for teaspoon with tbsp for tablespoon. Others did not read the label and they assumed the dose for the child was the entire cup. A typical dosing cup holds 30 mL or 6 teaspoons, which can result in a significant overdose. 

The study reported the least amount of errors occurred when the medication label contained only mL dosing instructions and an oral syringe marked in only mL was included. The Institute for Safe Medication Practices (ISMP) encourages companies to use mL in the labeling and not refer to teaspoons.  

The 2023 study evaluated 14 over the counter children’s medications for pain and fever. The study looked at the packages for acetaminophen and ibuprofen liquids. Acetaminophen is best known as Tylenol®, while ibuprofen is known as Motrin® or Advil®.  

Of the 14, most had all key FDA-required sections for labeling except for the pictographic dosing chart. The authors felt this was due to limited space to provide a picture to help guide dosing.   The researchers stressed the importance of talking to healthcare professionals about dosing prior to administering a liquid.

Giving the right dose for the child’s weight and age is critically important. Medications including products for cough, cold, fever, or pain can have side effects. Acetaminophen in high doses can cause liver damage, while ibuprofen can increase the risk for kidney damage. 

The ISMP gives some specific recommendations including using an oral syringe instead of a kitchen spoon or dosing cup. Ask for an oral syringe. Make sure to measure doses in milliliters (mL) rather than in teaspoons. Read the label and get advice from a healthcare professional before providing medicine. The American Academy of Pediatrics website healthychildren.org provides pictograph dosing charts for children.  

Be our guest and ask us for help when dosing liquid medications for children!