# Just for good measure

This content is sponsored by PM Pediatrics

By. Dr Christina Johns, MD, MEd

I took this photo of a few VERY DIFFERENT SIZED teaspoons that are in my kitchen. Tapping into my artistic side? Brainstorming about a new concept for a musical instrument? Doing ANYTHING not to go crazy over hearing my daughter’s croupy cough ONE MORE TIME?

Actually, not the first two. I’m not musical or artistic, but I am hella INSANE over the cough. But the photo is really an illustration of why we need to stop measuring liquid medicine for kids in teaspoons, and instead be modern girls and boys and use the metric system like the rest of the world and measure in milliliters. Let’s talk about this since it’s about accuracy and safety.

Research published in Pediatrics online very clearly demonstrates the poor accuracy of medicine dosingby caregivers. The Today show even talked about this study, which reports that, even under supervision, about 80% of all caregivers measured children’s medicines incorrectly. 68% of those incorrect doses involved giving too much medicine. This potentially could have bad consequences. Imagine if your child needed the “smaller” teaspoon amount of medicine but you, with all good intention, filled up the large spoon when you measured. Instant overdose. I’m overdramatizing a bit, but there is meaning here. Just ask the folks at various Poison Control Centers.

So what’s the rationale?

1. All medicine dosing in children is based on milligram per kilogram-of-body weight. This is why your child is (should be) weighed every time s/he has medical care. Every medicine is different, too, so the best practice is to get a current weight and perform the dosing calculation on the spot.

2. How accurate does it need to be? There’s a safe dosing “range” for medicine to allow for some margin of error. That being said, some medicines have a more narrow range than others, so it’s really worth it to just get it right the first time. Learn how to use a syringe and measure in milliliters. Even the medicine dosing cups that have lines in milliliters are just not as accurate as syringes. You can take apart a syringe and wash it just like any other dish. Reusable! #Win!

3. Read all medicine labels. Most have a maximum dose. Pay attention to this. If it seems like you are giving a big dose, it’s completely reasonable to ask and double check. Pharmacists are amazing resources for this. I have them peer check me regularly.

Here’s a research-related example of why it’s so important to pay attention to dosing

As science advances, we learn more about dosing different conditions. Amoxicillin, for instance, is commonly used to treat strep and ear infections. In the past few years, a few things have changed in prescribing Amoxicillin:

• We have increased the strength of the dose of this medicine for ear infections.
• We have decreased the daily frequency of the dose for strep throat.

Because of continuing research, what was once considered best a few years ago, may no longer be the best method.

I have a few of those medicine dosing cups laying around my house

but they are not used for giving actual medicine. They have been deployed for:

• getting a sip of water before bed (a key part of the delay tactics)

• trying out a new drink (the pomegranate juice was NOT a hit), and

• doling out a few M&Ms as a homework treat (halfway full, and only with children who are old enough to understand the difference between medicine and candy ).

Lots of handy uses. Again, what those cups AREN’T getting used for? Medicine. Same with the teaspoons.

Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from our highly skilled staff, with patients and families everywhere.

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