Oral syringes dose more accurately than cups

Parents are less likely to make dosing errors when giving their child liquid medications if they use an oral syringe-rather than a cup-to measure the dose, a recent trial showed. The study was conducted among 2220 English- or Spanish-speaking parents of children aged no older than 8 years.

Investigators asked participants to measure medication in 3 amounts (2.5, 5, and 7.5 mL) using 3 tools-1 cup and 2 syringes (1 syringe with 0.2-ml increment markings and 1 with 0.5-mL increment markings)-for a total of 9 doses. Parents were randomly assigned to 1 of 5 groups that differed as to which measuring units were used on the medication bottle label and on the dosing tools they were given and how well the 2 sets of markings matched. For example, for group 1 the units on the bottle label and dosing tools fully matched-“mL” and “mL,” respectively; whereas group 5 received a discordant pairing-“teaspoon” on the medication bottle label and “mL” and “tsp” on the dosing tools. Labels were provided in English or Spanish at the parent’s preference.

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On average, parents made errors in about one-quarter of their trials, with 84.4% of them making 1 or more dosing errors over the 9 trials. Overdosing accounted for 68% of errors: 21% of parents made 1 or more large errors (>2 times the dose). Parents made more errors with 2.5-mL and 7.5-mL dose amounts than with 5-mL dose amounts. Overall, participants tended to make fewer errors as they progressed through the 9 trials.

The odds of making a dosing error were more than 4 times higher using cups than they were with syringes, although neither syringe type nor participants’ health literacy or language was related to differences in error rates. Investigators also observed little variation in errors among the 5 tested unit pairings, although use of a teaspoon-only label paired with a milliliter and teaspoon tool was associated with more errors than milliliter-only labels and tools (Yin HS, et al. Pediatrics. 2016;138[4]:e20160357).

My take

Here’s a study that shows how you can help to prevent common dosing errors. For liquid medications, prescribe using mL, not teaspoon, not cc. Give parents oral medication syringes marked in mLs only. Caregivers seem to make fewer errors when dosing is in whole numbers so, when it is appropriate, consider rounding to whole mL amounts. Finally, keep in mind that these errors are common, so educate parents on how to avoid mistakes in measuring liquid medications. The American Academy of Pediatrics Committee on Drugs offered helpful advice on this topic in a recent policy statement. It is worthwhile reading: Pediatrics. 2015;135(4):784-787. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.