Another good thing about a syringe is that if a child refuses to open its mouth, you can just stick the syringe in its nose and squeeze the bulb.
1
One person here noted that the difference between the therapeutic dose and the dose which will cause serious harm, for Tylenol, is a small difference. It's worth reading the Wikipedia entry for acetaminophen (or PubMed). Even therapeutic doses, especially if they are repeated, cause depletion of glutathione family enzymes, superoxide dismutase in particular. The glutathione family of enzymes is involved in a lot more than just detoxifying acetaminophen. Depleting them, even if not to the point of becoming poisoned by their absence, results in the body (read liver) in general and the immune system specifically being hobbled, being inhibited in performing those functions which are especially important when it is dealing with some illness or inflammation.
Thank you. Good story.
Next article should be 'Most parents don't have their kids car seats installed correctly'.
Next article should be 'Most parents don't have their kids car seats installed correctly'.
As a pharmacist, there is another issue with dosing for children that has developed as more and more doctors use their computers to calculate dosing for children. We now get prescriptions with directions like " Take 3.65 ml every 6 hours " or ".75 teaspoonfuls every 6 hours". Also the computers often calculate a dose using weight only without factoring in the age of the patient. A 5 year old child often ends up with a huge tablet or capsule which he cannot swallow, so we have to contact the doctor to try to get it changed.
1
This is an embarrassing and potentially dangerous failure of design. Poorly labeled cups, dossage instructions that are oft on the inside of a 2 sided label that has to be removed with a fingernail to be read, print in a font size nearly impossible to read in ideal conditions, and certainly impossible at 3am in a dimly lit bathroom under the fog of fatigue.
The FDA must now mandate design standards for dossing pediatric medicines:
- placement : must be on distinct panel on box and on medicine container itself, not requiring opening or untaping of other instructions to view
- minimum font size: 14
- font:
- font color against white background
- doser (oral syringe or cup) must include physical and visual demarks for most common dosages
- instructions: use dosage for child's weight
- frequency : give once every four hours. Do not give for more than 3 days. After 3 days, consult a physician.
- display as table:
under X months: DO NOT USE
. X months - x months: consult pediatrician
20-30lbs: 30ml
. 31-40:
40-50:
51 : use children's advanced product, etc...
Solvable. Easily.
The FDA must now mandate design standards for dossing pediatric medicines:
- placement : must be on distinct panel on box and on medicine container itself, not requiring opening or untaping of other instructions to view
- minimum font size: 14
- font:
- font color against white background
- doser (oral syringe or cup) must include physical and visual demarks for most common dosages
- instructions: use dosage for child's weight
- frequency : give once every four hours. Do not give for more than 3 days. After 3 days, consult a physician.
- display as table:
under X months: DO NOT USE
. X months - x months: consult pediatrician
20-30lbs: 30ml
. 31-40:
40-50:
51 : use children's advanced product, etc...
Solvable. Easily.
2
Not necessarily. I'd say that 3/4 or more of all medications dispensed are dispensed in the pharmacy's own generic containers, NOT the manufacturer's containers. While the pharmacy issues a fact/warning/info sheet with the medication, it's relatively basic if you understand pharmaceutical language -- and incomprehensible if you don't. It's also easily lost or discarded. There's no room on the pharmacy's dispensing container for the sort of tables you're looking for -- unless you now add a SECOND sheet of instructions which can be easily lost or discarded.
As a parent, and having one of my children heavily prone to catching any and every virus in the universe, I am always doubly careful to read the dosing directions and ascertain, on the cup, the EXACT amount needed.
Experience has also taught me that certain OTC meds, particularly pseudophedrine, and some anti-histamines need to be titrated down from the recommended dosage, whether in a child or an adult. Use what works and only go up to the recommended dosage if necessary.
Anti-Biotics need to be dosed exactly and carefully. Some require refrigeration, some room temp. Some taken with food, some on an empty stomach.
There's a type of syringe used outside the USA that's better for thicker meds because it has cap that goes on the bottle the syringe passes through, allowing for more accurate dosing and the ability to get ALL of the med needed. I don't know why CVS and Walgreen's and other pharmacies don't use them.
Experience has also taught me that certain OTC meds, particularly pseudophedrine, and some anti-histamines need to be titrated down from the recommended dosage, whether in a child or an adult. Use what works and only go up to the recommended dosage if necessary.
Anti-Biotics need to be dosed exactly and carefully. Some require refrigeration, some room temp. Some taken with food, some on an empty stomach.
There's a type of syringe used outside the USA that's better for thicker meds because it has cap that goes on the bottle the syringe passes through, allowing for more accurate dosing and the ability to get ALL of the med needed. I don't know why CVS and Walgreen's and other pharmacies don't use them.
The syringe is fine when your kids are young, but past a certain age it gets inefficient. The dosage for liquid Advil for a 10 year old (my oldest) is 2.5 tsp. To fill a standard tsp syringe 2.5 times is messy and time consuming. It would also be helpful if all of the dosage cups had standard markings. My kids are 10, 8, and 3 and I've moved to chewable a whenever possible. They are neater and have less room for error. You can order almost all kids medicine in chewable form over Amazon. And I also taught my older kids to swallow pills at a relatively young age.
The microscopic font on the labels could not help. I'd like to see how a larger font would impact the results.
1
Wish the reporter had covered the basics of what the researchers did.
Were the directions contrived?! Did they use actual medicines and their tools?! What were the 5 pairings? What were the many pairings possible?!
"They randomly assigned 2,110 parents to one of five pairings of the many possible combinations of tools and label instructions."
Were the parents under a time pressure?
What did the parents say were the reasons for their errors?!
How much of the problem lay in a lack of unit conversion skills, basic math skills, or the discrepancy between directions and tools?
What % of medicines have that problem?
Without knowing that, we're left with sweeping conclusions whose credibility remains suspect!
Were the directions contrived?! Did they use actual medicines and their tools?! What were the 5 pairings? What were the many pairings possible?!
"They randomly assigned 2,110 parents to one of five pairings of the many possible combinations of tools and label instructions."
Were the parents under a time pressure?
What did the parents say were the reasons for their errors?!
How much of the problem lay in a lack of unit conversion skills, basic math skills, or the discrepancy between directions and tools?
What % of medicines have that problem?
Without knowing that, we're left with sweeping conclusions whose credibility remains suspect!
1
Parents should be given the CHOICE between milliliters and tsp-tbsp. They will probably choose the latter. I have found that people don't even understand tsp.-tbsp measures. This is, of course, due to poor education. And of course, syringes or similar devices should be given out by pediatricians, with children's WEIGHT indicated on the devices to indicate appropriate dose. Similarly, such devices should be included with first time purchases of OTC medicines. For free.
Given that few medications in what I call convenience medications that relieve symptoms or are designed to accelerate recovery have a barely statistical benefit over placebo and given that prescribed doses are a generalized educated guess I wonder if it matters.
I am convinced that doses that range between plus or minus 100% of recommended likely will not show a statistical relevant outcome.
Are doses errors dangerous? Probably not. Otherwise the pharmaceutical companies would have taken precautions to make dosage fault proof. They would have discovered the potential problem this in randomized trials.
I am convinced that doses that range between plus or minus 100% of recommended likely will not show a statistical relevant outcome.
Are doses errors dangerous? Probably not. Otherwise the pharmaceutical companies would have taken precautions to make dosage fault proof. They would have discovered the potential problem this in randomized trials.
1
Unfortunately it is very easy to cause serious damage with tylenol overdosing, by even small amounts. http://www.huffingtonpost.com/2013/09/24/tylenol-overdose_n_3976991.html
Why not include a dose syringe with each bottle of OTC or prescription medication both for children and adults? Clear instructions, in several languages, must be included.
Any prescription with an oral syringe should include an explanation by the pharmacist, not a pharmacy tech. In addition to explaining the importance of the proper dose, the pharmacist must explain that four times a day means every six hours, not four times during daylight hours. (Doctors need to write precise instructions as people don't always think.) Yes, it's annoying waking a child or an adult for that middle-of-the-night dose, but that's how many drugs must be taken. (Think before you give the first dose so you have only one "wake-up" dose.)
Taking antibiotics incorrectly will lead to a second course of medication and a child who is sick twice as long. Do not give orange juice or grapefruit juice with oral antibiotics! (They neutralize some antibiotics.) Read the prescription label and included information. If you're unsure, ask the pharmacist -- again, don't ask the tech. You can call if questions arise at home. Pharmacists have years of training and continuing education. Part of their job is answering questions. (You may have to wait a couple minutes because there are other patients with questions.)
If your pharmacist is no help, change pharmacies.
Any prescription with an oral syringe should include an explanation by the pharmacist, not a pharmacy tech. In addition to explaining the importance of the proper dose, the pharmacist must explain that four times a day means every six hours, not four times during daylight hours. (Doctors need to write precise instructions as people don't always think.) Yes, it's annoying waking a child or an adult for that middle-of-the-night dose, but that's how many drugs must be taken. (Think before you give the first dose so you have only one "wake-up" dose.)
Taking antibiotics incorrectly will lead to a second course of medication and a child who is sick twice as long. Do not give orange juice or grapefruit juice with oral antibiotics! (They neutralize some antibiotics.) Read the prescription label and included information. If you're unsure, ask the pharmacist -- again, don't ask the tech. You can call if questions arise at home. Pharmacists have years of training and continuing education. Part of their job is answering questions. (You may have to wait a couple minutes because there are other patients with questions.)
If your pharmacist is no help, change pharmacies.
1
Really, if you want to knock them out without killing them, you actually have to look up the recommended dosage by weight and age and do some arithmetic. It's irresponsible to just wing it.
1
Completely agree. The one by age assumes the child is small my kids are always at the top of the weight chart!
As a pediatrician, I've been dumbfounded by Emergency Room discharge instructions, assisted by dosage calculators, which advise parents to administer "4.37 milliliter" of a medication. An idiotic, and potentially dangerous, precision which is another gift of Electronic Medical Records. We are truly teaching our health care providers to bypass thought in the name of "productivity".
2
I would guess that the biggest cause of wrong dosing is that it's usually 3am, in the dark, you're half-asleep, and you are barely sure you understand your kid's symptoms etc! Just my personal experience...
8
Ann, that only makes things worse! They did this during the daytime, with no kid's health on the line. All the parents had to do was read the directions and pour out a dose!
Measure twice, fill once.
2
As a physician, i found giving doses of syrupy medication from a cup disconcerting. Some of it would spill, some would dribble on a cheek, some would be left in the measuring cup, etc. As soon as possible i switched to chewable meds. It turns out that most OTC medications for children( above 2) come in chewable form. Sometimes they are harder to find, but they exist. Benadryl, tylenol, motrin all are exist as flavored chewable tablets, in dosages for small children. It is easy to be sure what dose to give (one tablet) and what went in.
17
My children recently turned one and two, and I've been spoiled the oral syringe when administering Tylenol for a fever- it's fool-proof. Last month my daughter had her first (hopefully only, at least for a while) hospitalization, and after three nights and a mountain of discharge instructions, my husband and I were also stressed with the handful of medications we had to give her. Each one had a different unit of measurement, none were standard, and at her follow-up visit with our regular pediatrician the next day, he said that two of them the dosage was too high for our 25-lb toddler. And they were all prescribed by the hospital pharmacist (at one of the best pediatric hospitals in the area). It was a frustrating and stressful experience.
16
I hope they were not "prescribed" by any pharmacist. Pharmacists dispense but in most of the US, but they are not allowed to prescribe.
Any time instructions for medications are unclear, stop the conversation immediately. Get each drug's instructions in writing and explained verbally. At a hospital, if you don't get clear instructions, call the office of the Director of Medicine and find out how to get answers. There is always the Board of Pharmacy (record the pharmacist's name). They don't usually answer questions, but will deal with pharmacists who won't answer reasonable questions.
It is most likely that a doctor (resident, intern) wrote the prescriptions and the pharmacist was as mystified as you were. The pharmacist cannot override prescriptions but often finds them irrational. (In community pharmacies, the rules are different. Dangerous combinations and obviously fake prescriptions are often torn up, but almost never filled. Fakes for controlled substances result in a call to the appropriate authorities.)
Ask for clarification when you have questions. Ask again if the answer doesn't make sense. Don't worry about the line behind you. Do not leave until you get answers.
Any time instructions for medications are unclear, stop the conversation immediately. Get each drug's instructions in writing and explained verbally. At a hospital, if you don't get clear instructions, call the office of the Director of Medicine and find out how to get answers. There is always the Board of Pharmacy (record the pharmacist's name). They don't usually answer questions, but will deal with pharmacists who won't answer reasonable questions.
It is most likely that a doctor (resident, intern) wrote the prescriptions and the pharmacist was as mystified as you were. The pharmacist cannot override prescriptions but often finds them irrational. (In community pharmacies, the rules are different. Dangerous combinations and obviously fake prescriptions are often torn up, but almost never filled. Fakes for controlled substances result in a call to the appropriate authorities.)
Ask for clarification when you have questions. Ask again if the answer doesn't make sense. Don't worry about the line behind you. Do not leave until you get answers.
1
Here in France, all liquid children's medication is dosed with a weight-graduated syringe specific to the medicine (i.e. each bottle comes with its own branded syringe, which can't be used with a different medicine). This takes all the guesswork out: you double check your kids' weight on the scale and dose the liquid to the kg - meaning it is precise to 2lbs. I was baffled trying to decipher the proper dosage for Tylenol and anti-histamines this summer in the US; dosing by age rather than weight seems absurd, given the wide range of childrens' body types, and their rapid rate of growth. It seems like a no-brainer...except probably to drug companies worrying about loss of profits for the cost of manufacturing and supplying the custom syringes.
38
Good for you France
This is the United States. Requiring the user to count one or two pills or fill a cup to a line is about as far as you could go without causing panic and resentment.
I'm sure Sen. Cruz will find an international conspiracy in this proposal. After all, we should be using good old teaspoons as God obviously intended,
9
This problem is greater because of our poor science curriculum in public schools and Universities. It is exacerbated by parents waiting longer to have kids. Measuring a dose is something we all should be able to do pretty easily but some new parents may not have done any such task in over 2 decades when they suddenly face a screaming child, interrupted sleep and need to pour or measure a precise dose.
Sorry, but our math and science curricula cover the basics in fine shape... The biggest problem is that the curricula are a mile wide and an inch deep-- covering far too much terrain.
There is a problem, though, in that how we test, drill, rank, and stigmatize students puts them off of mathematics and any real number sense. Too much computation, too much of the wrong conceptual approaches.
Bottom line: this is so important that it should be taught directly in math classes. Give students med bottles with tools and see how they do. Work on units and practice this until there are no errors.
There is a problem, though, in that how we test, drill, rank, and stigmatize students puts them off of mathematics and any real number sense. Too much computation, too much of the wrong conceptual approaches.
Bottom line: this is so important that it should be taught directly in math classes. Give students med bottles with tools and see how they do. Work on units and practice this until there are no errors.
This is particularly troubling for parents using Tylenol and other forms of acetaminophen, for which doubling the recommended dosage over 24 hours can cause fatal liver damage. Ibuprofen is much safer.
13
I would add that when it comes to medicating children (everyone actually) you should stop and speak to your pharmacist. The pharmacist will provide you with a oral dosing syringe. Sometimes there is more to dosing than just the patient's weight. Don't take chances with your loved ones. Speak to a professional, talk with a pharmacist.
14
Agreed about the syringe! I've found it much, much easier to give an agitated infant/toddler her medicine with an oral dosing syringe, compared to a spoon. Easier to maintain accuracy with the amount of medicine being measured, and easier to administer. My daughter always spat out spoon-fed medicines, and therefore only got some of the recommended dose. We'd then have to wait at least 4 hours before trying again. But, with a syringe, I could aim it towards the back corner of her cheek, squeeze out as much as I thought she could reasonably swallow (say, 2.5 mL of a recommended 5 mL dose), and then withdraw the syringe and blow on her face. This method usually encouraged her to swallow her medicine, and if she spat that half-dose out, I had the rest still in the syringe, and could try again. Plastic dosing syringes come standard with infant paracetamol (acetaminophen) and ibuprofen in the UK, and my husband and I have actually saved these and use them with other medicines that only provide a spoon.
9
When an adult takes medicine, it's pretty standard: one pill is one dose, regardless of the medicine. Some take less, some more, but one is standard. We do not accidentally take 4 ibuprofen when we meant to take 1.
With kids it ought to be the same, one ml per each 10 lbs of body weight, for example. If my kid takes 3ml of ibuprofen, the proper dosage for acetaminophen or an allergy medicine ought to be the same.
To ask a sleepless parent at 4am to calculate when their child is screaming with a fever is asking for overdoses.
With kids it ought to be the same, one ml per each 10 lbs of body weight, for example. If my kid takes 3ml of ibuprofen, the proper dosage for acetaminophen or an allergy medicine ought to be the same.
To ask a sleepless parent at 4am to calculate when their child is screaming with a fever is asking for overdoses.
9
That is not a bad idea, Zach.
I am on the small side, and since adulthood I have always started with a smaller dose than indicated, for OTC meds and also prescription painkillers or muscle relaxants. The recommended dose of most meds is too much for me. But as an adult I know this and I know how I feel. It's hard to gauge for children. Your idea of standardizing 1 mL/10lb is a great one.
I am on the small side, and since adulthood I have always started with a smaller dose than indicated, for OTC meds and also prescription painkillers or muscle relaxants. The recommended dose of most meds is too much for me. But as an adult I know this and I know how I feel. It's hard to gauge for children. Your idea of standardizing 1 mL/10lb is a great one.
8
People take just one ibuprofen???
5
Why would you take more than one?
It's difficult to surmise that this wasn't intentional, or at a minimum, no one took care to avoid it - after all, the caregivers were overdosing children, which if you forget about the danger to the patients, only equals spending much more money on these drugs than needed.
2
My name is Matt Battle. Cleveland 19 News did a story on me about a product I invented to solve these problems, it getting worldwide attention! The link is below:
http://www.cleveland19.com/story/34284406/accurate-measuring-cup-medicin...
Hope you guys like it I spent the last 7 years of my life speaking and working with doctors, engineers and patent attorneys to prevent dosing errors in children!
-Matt