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AAP adopts mL dosage units in place of spoons





CHICAGO — The American Academy of Pediatrics last week urged parents, physicians and pharmacists to use only metric measurements on prescriptions, medication labels and dosing cups to help ensure kids receive the correct dose of medication. Medication should not be measured in teaspoons or tablespoons, especially not spoons taken from a kitchen drawer.


“Spoons come in many different sizes and are not precise enough to measure a child’s medication,” stated pediatrician Ian Paul, lead author of the policy statement, “Metric Units and the Preferred Dosing of Orally Administered Liquid Medications,” in the April 2015 Pediatrics. “For infants and toddlers, a small error – especially if repeated for multiple doses – can quickly become toxic.”


Each year more than 70,000 children visit emergency departments as a result of unintentional medication overdoses. Sometimes a caregiver will misinterpret milliliters for teaspoons. Another common mistake is using the wrong kind of measuring device, resulting in a child receiving two or three times the recommended dose.


“One tablespoon generally equals three teaspoons. If a parent uses the wrong size spoon repeatedly, this could easily lead to toxic doses,” Paul said.


One recent study demonstrated that medication errors are significantly less common among parents using only mL-based dosing rather than teaspoons or tablespoons.


The updated 2015 policy statement recommends:


  • Standard language should be adopted, including mL as the only appropriate abbreviation for milliliters. Liquid medications should be dosed to the nearest 0.1, 0.5, or 1 mL;

  • How often a dose is needed should be clearly stated on the label. Common language like “daily” should be used rather than medical abbreviations like ‘qd’, which could be misinterpreted as ‘qid’ (which in the past has been a common way for doctors to describe dosing four times daily);

  • Pediatricians should review mL-based doses with families when they are prescribed;

  • Dosing devices should not have extra markings that can be confusing, and should not be significantly larger than the dose described on the label, to avoid two-fold dosing errors; and

  • Manufacturers should eliminate labeling, instructions and dosing devices that contain units other than metric units.


“We are calling for a simple, universally recognized standard that will influence how doctors write prescriptions, how pharmacists dispense liquid medications and dosing cups, and how manufacturers print labels on their products,” Paul said.


This recommendation aligns with the Consumer Healthcare Products Association’s voluntary codes and guidelines on “Standard Terminology and Format for Labeling of Volumetric Measures on OTC Pediatric Orally Ingested Liquid Drug Products” which specify that for liquid products intended to be given to children less than 12 years of age, “mL” only should be used for dosing directions and on dosing devices. These guidelines were last updated on Nov. 14, 2014.


“CHPA and our member companies commend the American Academy of Pediatrics for its endorsement of the exclusive use of metric based dosing (mL only) to avoid dosing errors,” CHPA VP regulatory and scientific affairs Barbara Kochanowski said.“As noted in a July study published in Pediatrics, teaspoon and tablespoon units can be confusing for some parents, potentially leading to kitchen spoon use instead of the standard dosing device that comes with the medicine. Our association believes mL only labeling along with encouraging parents to read and follow the label every time will help decrease medication errors.”

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