By Karen L. Kier
Pharmacist on behalf of the ONU Healthwise Team 

Be Our Guest was a song from the 1991 Disney film Beauty and the Beast. The song was performed by Mrs. Potts (Angela Lansbury) and Lemière (Jerry Orbach). During the song’s animation, we see spoons dancing and diving into a punch bowl. In the movie, the Beast struggles to eat with a spoon and Belle puts down her spoon and drinks out of the bowl. 

Why talk about spoons? Many medications for infants and children come in liquid dosage forms requiring measuring. Spoons are used to give medications to children. 

In early 2000, about 73% of consumers used a kitchen teaspoon to give medication to their child. This number dropped to 17% when evaluated in 2014. Even with this improvement, a 2023 study showed dosing errors are still occurring. 

A kitchen teaspoon should measure 5 milliliters (mL) of liquid, while a tablespoon should hold 15 mL. Unfortunately, household teaspoons and tablespoons are not reliable and result in dosing errors. To overcome this problem, manufacturers will often include a medicine dosing cup or syringe with the bottle for more accurate dosing. Many pharmacies offer oral medication syringes to reduce errors in dosing. 

A study involving 2,000 parents was conducted to evaluate the interpretation and measurement of correct doses for children. The participants were asked to read and measure either 5 mL or one teaspoon or 5 mL (one teaspoon). The results indicated 99% of parents made a measurement error of one or more doses. There were more errors with ½ teaspoon (2.5 mL) or 1 and ½ teaspoon (7.5 mL). Two out of the 3 mistakes involved giving too much medication to the child and 20% of those errors were considered large overdoses. 

Interestingly in the study, parents were less likely to make a mistake when using an oral syringe versus a dosing cup. The dosing cups increased the odds of making a mistake especially with smaller doses. Some of the problems were attributed to parents confusing the abbreviations tsp for teaspoon with tbsp for tablespoon. Others did not read the label and they assumed the dose for the child was the entire cup. A typical dosing cup holds 30 mL or 6 teaspoons, which can result in a significant overdose. 

The study reported the least amount of errors occurred when the medication label contained only mL dosing instructions and an oral syringe marked in only mL was included in the packaging. The Institute for Safe Medication Practices (ISMP) encourages companies to only use mL in the product labeling and not refer to teaspoons. 

The 2023 study in Exploratory Research in Clinical and Social Pharmacy evaluated 14 over the counter children’s medications for pain and fever. The study only looked at the labeling and packages for acetaminophen and ibuprofen liquids. Acetaminophen is best known by its brand name of Tylenol®, while ibuprofen is known as Motrin® or Advil®. 

Of the 14 products, most had all key FDA-required sections for labeling except for the pictographic dosing chart. The authors felt this was due to limited space on packaging to provide a picture or image to help guide correct dosing. The researchers stressed the importance of talking to healthcare professionals about dosing prior to administering a liquid medication to children and to make sure you have the right dose.

Giving the right dose for the child’s weight and age is critically important. Medications including over the counter products for cough, cold, fever, or pain can have critical side effects if too much drug is given. Acetaminophen in high doses can cause liver damage, while ibuprofen in high doses can increase the risk for kidney damage. 

The ISMP gives some specific recommendations for dosing liquid medications for children. They include using an oral syringe instead of a kitchen spoon or a dosing cup. Ask your pharmacist for an oral syringe. Make sure to measure doses in milliliters (mL) rather than in teaspoons or tablespoons. Inspect instructions on the label and get advice from a healthcare professional before providing medicine. Verify the dose before giving. The American Academy of Pediatrics website healthychildren.org provides pictograph dosing charts for common over the counter medication for children. 

Be our guest and ask us for help when dosing liquid medications for children!

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