Americans are lackadaisical about medication dosing. This is especially true for over-the-counter medications, which are widely perceived as safe at any dose.
Take pain relievers like ibuprofen or naproxen, for example. It is estimated that more than 20 million Americans take one of these drugs every day. Only one in five bothers to read the directions on the label. One in four takes more than the recommended dose. Half didn’t know such drugs could have serious side effects.
It’s bad enough when adults ignore instructions and cautions for themselves. It is unforgivable when they fail to pay attention to proper dosing for their children.
Almost a year ago, a study showed that many parents had difficulty measuring out the correct dose of liquid medicine for their children (Archives of Pediatrics and Adolescent Medicine, Feb., 2010). This was especially pronounced when they were given a dosing cup. About half got the dose right with a cup that had the markings etched on it; only a third did well when the markings were printed on the cup. They did considerably better, though not perfect, when using an oral syringe or dropper.
Why does this matter? Dosing mistakes, usually overdoses, are the most common cause of adverse drug events affecting children.
Even over-the-counter medicines can be dangerous in very young kids. A new study examined the number of emergency department visits for toddlers under two both before and after October 2007. That was the date the FDA asked manufacturers to stop marketing infant cough and cold remedies. the investigators found that children under two were rushed to the ED for problems related to cough or cold medicines only half as often after 2007 (Pediatrics, Dec., 2010).
It’s encouraging to learn that babies are safer without infant cough syrup, nose drops and cold products. But there are plenty of other children’s medicines available without prescriptions, and there is still a lot of confusion about how to measure out the doses properly.
A team of doctors at New York University School of Medicine studied 200 top-selling liquid medicines for children (Journal of the American Medical Association, online Nov. 30, 2010). These included pain relievers, allergy medicines, cough and cold remedies for kids older than two and drugs for gastrointestinal upset.
What they found was rather alarming. Nearly one-fourth of the medicines were sold without any measuring device, whether a cup, a spoon, a dropper or an oral syringe. Even those that included a device for measuring the liquid medicine had inconsistencies between the way the cup or spoon was marked and the dosing instructions on the label.
This makes proper dosing unnecessarily difficult for parents and could lead to problems. Parents should be especially wary about using household spoons since they are notoriously inaccurate.
Instead, parents should use either an oral syringe or a hollow-handled medicine spoon with accurate markings. Most important, parents should read labels and follow the instructions closely.
The People's Perspective on Medicine