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Accurately administering oral medication to children isn't child's play
Victoria L Beckett1, Luke D Tyson, Daniel Carroll
1School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, UK. victoria.beckett@cantab.net
Insights
Calibrated spoons provided the most accurate medication volume, while oral syringes offered the least variability. Choosing the right device for measuring oral medications is crucial for accurate dosing.
Area of Science:
- Pediatric Pharmacology
- Medication Safety
- Drug Administration Devices
Background:
- Accurate measurement of liquid oral medications is essential for safe pediatric dosing.
- Parents and caregivers commonly use household items like spoons and oral syringes to measure medication volumes.
- Variability in measurement devices can lead to significant dosing errors.
Purpose of the Study:
- To compare the accuracy and precision of different devices used by caregivers for measuring oral liquid medications.
- To identify the most reliable device for administering pediatric oral medications.
Main Methods:
- A study involving 277 caregivers measuring 5 ml of paracetamol suspension.
- Comparison of volumes measured using a metal teaspoon, calibrated spoon, and oral syringe.
- Measurement accuracy assessed by weighing samples and converting to volumes, analyzing mean volume and variance.
Main Results:
- Calibrated spoons yielded the most accurate mean volume (close to 5 ml), with no significant difference from the target volume.
- Oral syringes demonstrated the smallest variance (greatest precision) in measured volumes.
- Metal spoons and oral syringes showed significant deviations from the target 5 ml volume.
Conclusions:
- Calibrated spoons are the most accurate for achieving the correct medication volume.
- Oral syringes offer the highest precision, minimizing dose variability.
- Healthcare providers should guide caregivers on appropriate device selection based on medication properties and therapeutic index to prevent under- or overdosing.
Objective:
Parents administer oral medications with various measuring devices including metal teaspoons, calibrated spoons and oral syringes. We aimed to determine which was the most accurate.
Design:
Self-controlled, non-randomised, experimental study.
Setting:
Caregivers attending paediatric outpatient clinics.
Methodology:
Caregivers measured 5 ml of 120 mg/5 ml paracetamol suspension using a 5.0 ml metal teaspoon, 5.0 ml calibrated spoon and 5.0 ml oral syringe. Samples were weighed and converted to mls.
Main Outcome Measures:
The mean volume and variance of volumes were measured for each device.
Results:
We recruited 277 caregivers (98% parents). Volumes measured ranged from 0.83-6.52 ml. Accuracy did not vary with caregivers' age, gender, instrument preference, number and age of children. The mean volumes measured with the oral syringe (95% CI 5.09 to 5.17 ml) and metal spoon (95% CI 3.90 to 4.08 ml) were significantly different to the desired 5 ml volume (p<0.0001), dissimilar to the mean volume measured using the calibrated spoon (95% CI 4.91 to 5.09 ml, p=0.99). The variance of volumes measured with the oral syringe (SD 0.348 ml) was significantly smaller (p<0.0001) than that measured using a calibrated spoon (SD 0.762 ml) or metal spoon (SD 0.749 ml).
Conclusions:
The calibrated spoon was the most accurate producing a mean volume of 5 ml, while the oral syringe had the smallest variance. The increased variability of calibrated or metal spoons may result in under or overdosing especially when administering drugs with a narrow therapeutic window. Health care professionals must make a case-by-case decision regarding which device is preferable depending on the medication in question. Parental education could improve measuring accuracy.
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