Most participants were able to correctly interpret a pediatric dosing chart, although some errors were noted when the age and weight were discordant. In a previous study, only 40% of caretakers were able to state a correct dose of acetaminophen for their child when given the child’s weight and all package labeling.8 Parents often fail to revise medication doses as a child grows older and gains weight and therefore tend to underdose.4,8,9 Although less serious than overdosing in terms of morbidity, underdosing of acetaminophen may lead to ineffective treatment of fever and unnecessary visits to the clinic or emergency department.
It is not surprising that women and participants with higher education levels had higher total performance scores. In previous studies of liquid medication, the majority of the caretakers giving medication to children were mothers.3,8-10 Women are therefore more likely to have experience administering liquid medication than men. Fortunately, parental education has been shown to be very effective in eliminating medication dosing errors.10 In a recent study by McMahon and colleagues of 90 English-speaking and Spanish-speaking families, 100% of them dosed medication correctly when given instructions and a syringe with a line marked at the prescribed dose.
Conclusions
The recommendation for the use of the oral dosing syringe made by the AAP almost 25 years ago is just as relevant today. On the basis of our study results, we make the following additional recommendations to clinicians: (1) when possible, indicate the dosing interval by the number of doses in a day, rather than by the number of hours between doses; and (2) always consider the possibility of a medication dosing error when faced with an apparent treatment failure.
Acknowledgments
Our study was funded by a grant from the American Academy of Family Physicians Foundation and the Minnesota Academy of Family Physicians Foundation.