A U.S. pediatrician group is recommending liquid medication for children should be administered in metric milliliters, rather than the more common but less precise teaspoons or tablespoons, to avoid accidental overdoses.
More than 70,000 children end up in U.S. emergency rooms annually because of such overdoses, the American Academy of Pediatrics notes in a new policy statement.
The statement has been published in the journal Pediatrics.
"Even though we know metric units are safer and more accurate, too many health care providers are still writing that prescription using spoon-based dosing," says Dr. Ian Paul, a pediatrician at Penn State Milton S. Hershey Children's Hospital and lead author of the new metric dosing guidelines. Paul also is chief of academic general pediatrics at Penn State College of Medicine.
"Some parents use household spoons to administer it, which can lead to dangerous mistakes," he says, noting that just incorrectly using a tablespoon rather than a teaspoon triples the recommended dose.
The new policy recommends all medication be administered in milliliters, abbreviated as mL, and in addition prescription amounts should include "leading zeros," so that half a milliliter should read 0.5 mL.
Trailing zeros, such as 0.50 for the same half-milliliter dose, should be eliminated to reduce confusion as to the proper amount, the group says.
Instead of spoons, the new policy suggests a plastic medicine syringe with clear markings be used to measure out the dose and administer it directly into a child's mouth.
The recommended metric dosing standard - already in place in much of the world - is "based upon newer evidence suggesting this is both more accurate and less likely to cause large dosing errors," Paul says.
Previous studies have indicated that parents using only milliliters for giving medicine to children make fewer errors than parents who use teaspoons or tablespoons.
Most doctors are already familiar with metric dosing and comfortable with it, but parents and caregivers may require some instruction in the new dosages, Paul acknowledges.
Doctors should go over the dosage with families when medications are prescribed, and pharmacies, health centers and hospitals should print prescription labels displaying only metric dosages and include a suitable measuring device, the pediatrician group says.
Other health professionals say they agree with that recommendation.
"The statement calls on places that dispense the medications - typically pharmacies - to provide an appropriate device," says Dr. Roy Benaroch, an assistant professor of pediatrics at Emory University in Atlanta.
"These should be offered at no extra charge. Parents can reuse them to eliminate waste as long as they're cleaned out well and their markings don't rub off," he says.