Pediatric Dosing – Giving Kids Medicines Safely
Pediatricians who work with medical students commonly say the phrase, “children are not little adults.” This is because children’s bodies are different in the way they grow and develop, as well as in the types of illnesses they get and how they overcome them. This adage is particularly true when it comes to medications. Dosing of medications in Pediatrics is unlike most other areas of medicine because it is done by weight. These smaller bodies make it more difficult to dose correctly – for instance, while an adult may take 400mg of ibuprofen (often 2 pills), a child may take anywhere from 80mg to 200mg, depending on his or her size.
Additionally, it is difficult for children to take medication by swallowing pills – and impossible for infants and toddlers. Thus, we have liquid formulations of medications. While this makes the medication administration easier, it also significantly increases room for error. Depending on the strength – or concentration – of the medication it can be a very big deal if a caregiver incorrectly measures the amount to give.
A study in the journal of Academic Pediatrics in 2014 demonstrated that over 40% of caregivers given an incorrect dose of medication with liquid medicines. This occurs due to a variety of factors, including misreading labels, poorly designed dosing mechanisms (cups, droppers, etc), or challenges with health literacy (ie, difficulty with the ability to understand health information and instruction).
Avoiding dosing errors
- Pay attention to decimals on prescription medications. Read dosing instructions on the bottle very carefully. I have seen patients who were given 1ml instead of 0.1ml of medication, or 5ml instead of 0.5ml. Depending on the medication, this can be VERY dangerous. If you are unsure of how much medication to give, talk to the pharmacist or your child’s Pediatrician.
- Pay attention to age restrictions on over the counter medications. Ibuprofen should not be given to infants under 6 months of age, while many cough and cold medications are not recommended to be given under age 6 years. Ignoring these age restrictions places your child at risk for side effects, complications, and organ damage.
- Pay attention to dosing recommendations on over the counter medications. Some over the counter medications may come in different strengths for different ages – for example, the infant version of ibuprofen is more highly concentrated than the children’s version. So giving the same amount of each version will result in a significantly higher dose of in the infant concentration.
- Do not share prescription medications amongst other family members. Sometimes parents will give an antibiotic prescribed for one sibling to another because they are “sure it’s the same infection.” This is not recommended for a variety of reasons, but dosing errors are one of them. Siblings may vary widely in weight and that can change the correct dose for the child significantly.
- Only use the dosing mechanism given with the medication. While it is true that 5ml = 1 teaspoon, kitchen measuring spoons should NOT be used for doing medications.
Responsibility
Occasionally I will talk with families who have incorrectly dosed a medication for their child, either by a small amount or by a large amount. There is usually a significant amount of remorse from the parent and concern for harm to the child. Many medications can be harmless if overdosed but most can have serious if not deadly consequences.
It is of upmost importance that Pediatricians and other health care providers discuss dosing with families. When I send in a prescription, I tell the family what the dose will be so they know what to expect when giving the medication. In turn, it is also the responsibility of the adult giving the medication to read the dosing on the label before administering the mediation. This is particularly important with over the counter medications, in which the caregiver must find the correct dose according to weight, usually found in a chart on the bottle. If you have any questions about dosing of medications, please reach out to your child’s Pediatrician.
Final thoughts
Medications are a part of life, and they can significantly impact the well being and comfort of a child. From something as simple as fever relief from ibuprofen to as life-saving as a cardiac medication, the administration of any medication should be done with precision and care. Make sure to always use the dosing mechanism provided. Take care in measurements. Pay attention to weight-based charts and to the frequency in which the medication is safe to give. Taking the time to get it right is both important and necessary for your child to thrive.
If you enjoyed this post, please sign up below to subscribe for blog emails. You will receive notification when new posts are available. If you do not receive a welcome email upon registering, please check your spam folder.
