Tips on safer dosing of medications for children

Here are some of the best tips I've learned over the years to avoid confusion and errors:

1. Never use a kitchen teaspoon or tablespoon to measure out the volume of medicine to give your child.  Eating utensils and cooking measurers are notoriously inaccurate.  Instead, use a medicine syringe.  These are often found in the package, you can purchase them at your local drugstore, or most pharmacies will give you a dosing syringe or two (especially if you are filling a prescription at the same time).

2. FIRST, figure out what your goal dose is for your child in milligrams (mg) of medicine rather than in volume of fluid.  THEN, see what the concentration of mg is per millilter (5ml is one teaspoon, therefore the concentration is often displayed as mg per 5ml).  For tablets or capsules you want to verify the mg per tablet/capsule.
Once you know what the goal dose is in mg and how many mg there are per ml, then you can calculate the number of ml you need to deliver the desired dose of mg.
(This also works for tablets or capsules in older children to determine how many tabs or caps to give.)
This is how pharmacists and doctors figure out how much medicine to dose for your child.
The trick is that many medicine come in multiple concentrations so you really have to pay attention to the specific concentration of the medicine you are about to give your child on that occasion.

3.  Make sure that shake up your liquid medicine before giving it.  This is particularly important liquid medicines that are suspensions.  Suspensions are liquids with small solid particles "suspended" in them.  Since the active medicine is in the solid particles, it is important to "re-suspend" the liquid by shaking the bottle before dosing each time so that the concentration of mg per ml can remain consistent.

3.  Here is the weblink to an article from the AAP on how to most safely dose liquid medications for children: www.healthychildren.org/English/health-issues/conditions/treatments/Pages/Using-Liquid-Medicines.aspx.

4. Teaspoons and Tablespoons are not the same.
Be aware that a teaspoon is 5ml and a tablespoon is 15ml.
This is a three-fold difference, therefore most pediatricians are taught to dose in ml (or teaspoons) and avoid dosing in tablespoons.  If you think your doctor wrote for your child's dose in tablespoons, call to clarify before giving the first dose.

Heat illness and other Sports Injuries

At this time of year I usually get questions about sports injuries including heat-realted illnesses.  As I've mentioned to many parents before, I'm a great fan of the AAP's website for parents-- www.healthychildren.org.

In particular, this website has a whole section dedicated to sports injury prevention and treatment (www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/default.aspx).

Making sure that your young athlete pre-hydrates well by drinking >6-8 glasses of water a day, with frequent water breaks during exercise (especially when outside in the heat).  Water is the preferred fluid for hydration when exercising for less than 3 consecutive hours.  In general, commercial sports drinks are not necessary and provide unnecessary calories which can lead to excess weight gain.

Change in OTC liquid Acetaminophen (Tylenol)

It's been way too long since I last posted, but I've been busy with the new practice location and my now 3 month-old daughter.

Anyway, I thought my first post in a while would be about the "simplification" of over-the-counter liquid acetaminophen dosing. 

Starting this summer, parents will no longer be able to find new packages of "infant concentrated" acetaminophen.  Up until now, there have been 2 different OTC concentrations available: "Infant" 80mg per 0.8ml and "Children's" 160mg per 5ml (5ml = 1 teaspoon).  Unfortunately this substantial difference has led to confusion among parents leading to the accidental overdosing of some children.  Therefore, starting soon all liquid acetaminophen will be sold in the 160mg per 5ml concentration.

It is always best to base your child's dose on his/her current weight.  Soon, we will be updating the dosing recommendations on http://www.bluefishmd.com/ to include dosing by weight for young infants using the 160mg per 5ml.

Also, here is a pretty good summary of the reasons behind the changes from the abcnews website:   http://abcnews.go.com/Health/w_ParentingResource/infant-dose-counter-acetaminophen/story?id=13535850.

And finally, a good summary on when a parent should use fever reducers in the first place from the AAP's parent website: http://www.healthychildren.org/English/news/Pages/AAP-Issues-Advice-on-Managing-Fevers-in-Children.aspx.

I hope this helps clear up some of this confusion.
I plan to blog more often again so stay tuned.

-RAC