Pediatric Dosing
Loren Bonner
In the hopes of reducing liquid medication dosing errors in children, a new study is providing insight into the kinds of dosing tools parents and caregivers are using.
“We wanted to learn about parent dosing tool use, beliefs, and access so that we could find out how we can better design interventions to reduce medication errors,” said lead author H. Shonna Yin, MD, MS, associate professor of pediatrics and population health at New York University School of Medicine.
Researchers analyzed data from three urban pediatric clinics involving nearly 500 families from various parts of the country—New York, Georgia, and California. More than two-thirds of parents in the study had limited health literacy. The findings, published in the December 2019 issue of the Journal of Pediatrics, found that 62% of parents reported using oral syringes and 22% said they used dosing cups.
Although dosing cups are less accurate than oral syringes, 24% of the study participants, especially those with low health literacy, believed dosing cups were the best tool type for dosing accuracy. Parents with limited health literacy had greater odds of dosing cup use, according to the study results.
Yin said that low parent health literacy was linked to a twofold increased odds of using dosing cups most of the time, and that parents who believed that dosing cups are the best tool for accuracy had a 16-fold increased odds of reporting use of dosing cups most of the time. “Addressing this misperception could be especially helpful for those with low health literacy, who are at risk for medication overdoses,” she said.
The study can serve as a reminder, especially for pharmacists, to inform and educate parents and caregivers about accurate dosing and the importance of using oral syringes to avoid medication errors.
Less kitchen spoon dosing
On a positive note, the study suggests that parents of young children, even those with low socioeconomic status, are choosing to use oral syringes and dosing cups most of the time instead of kitchen spoons, which are known to up the risk of error even more. It appears that parents also have access to a range of dosing tools at home with standardized measurement markings, such as a cup, syringe, dosing spoon, or dropper.
“Compared to prior studies, it appears that oral syringe use is becoming more common, and fewer parents are using kitchen spoons to dose,” said Yin.
She added that looking at these issues is timely since there is a nationwide push by CDC and others to move to milliliter only and avoid spoon-based dosing. However, concerns have been raised about whether parents have access to dosing tools, especially those with milliliter markings. These findings may alleviate some of those concerns, said Yin.
Where pharmacists are needed
Kalen Manasco, PharmD, BCPS, FCCP, FPPA, pointed out that the majority of people who participated in the study didn’t have chronic medical problems.
Pediatric patients with chronic health issues “frequently use medications and go to the doctor more often, and [their caregivers] would probably be more knowledgeable about syringes versus dosing cups because they had a pharmacist intervene at some point,” said Manasco, who is a clinical professor and division head in the department of pharmacotherapy and translational research at the University of Florida College of Pharmacy.
Although OTC education is important from a pharmacist’s standpoint, patients might not seek them out when browsing the cough and cold aisle. On the other hand, with a prescription, a pharmacist would be providing an oral syringe and more education.
“I even like to open up the package and show [the patient’s caregiver],” said Manasco.
Yin said she’d like to see pharmacists not only give an oral syringe to parents when dispensing prescription medications, but teach them that using oral syringes is best for accuracy.
“Pharmacists can educate parents that dosing cups can be error prone, especially with small doses, and can counsel parents about strategies to use dosing cups correctly, such as putting the cup on a flat surface, and looking at the dosing cup at eye level when measuring out the dose for their child,” said Yin.
She added that pharmacists can warn parents about circumstances in which dosing cups should not be used, such as with small volume doses and medications with a narrow therapeutic index.