Children should no longer be prescribed liquid medications that use teaspoon or tablespoon measurements but should get their liquid medications in syringes using metric-based dosing, the American Academy of Pediatrics Committee on Drugs said in a policy statement.

“Spoons come in many different sizes and are not precise enough to measure a child’s medication,” lead author Dr. Ian M. Paul, professor of pediatrics and public health sciences at Penn State University, Hershey, said in a prepared statement. “For infants and toddlers, a small error – especially if repeated for multiple doses – can quickly become toxic.”

The committee made other specific recommendations about clinical practice and advocacy in that policy statement (Pediatrics 2015 [doi:10.1542/peds.2015-0072]), including:

• Dose orally administered liquid medications using metric-based dosing with milliliters (mL) only, to “avoid confusion and dosing errors associated with common kitchen spoons.” Avoid using alternative abbreviations to mL (such as ml, ML, or cc).

• Dose to the nearest 0.1, 0.5, or 1 mL. Avoid dosing to the hundredth of a milliliter.

• Include leading zeros preceding doses less than 1 mL (such as 0.5 mL) to avoid 10-fold dosing errors, but avoid trailing zeros after decimals.

• Clearly note the concentration (strength) of all orally administered liquid medication (such as milligrams per milliliter [mg/mL]) so the dose can be accurately calculated.

• Review milliliter-based doses with patients and families when you administer or prescribe orally administered liquid to be sure they understand metric dosing units.

• Encourage electronic health record vendors to incorporate use of metric units for orally administered liquid medications; this would “eliminate the ability of providers to prescribe medications using non-milliliter–based dosing regimens,” the statement said. Likewise, advocacy efforts should target pharmacies, hospitals, and health centers so they dispense only orally administered liquid medications with metric dosing on the label.

“Syringes are the preferred dosing device for administering oral liquid medications,” according to the statement, but acceptable alternatives are “cups and spoons calibrated and marked in milliliters.”

The AAP also encourages manufacturers to make changes so “dosing devices” have no “extraneous or unnecessary liquid measure markings that may be confusing to caregivers,” and “should not be significantly larger than the dose described in the labeled dosage to avoid twofold dosing errors.” The academy also wants manufacturers to “eliminate 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,” Dr. Paul said in the statement.


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