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Many children’s medications these days come with a dose cup to help measure out the right amount. But if the dose cup goes missing or if the only direction on the bottle says something like “one teaspoon” what do you do. What is a teaspoon anyway?

A study published recently in the journal Pediatrics points out that this problem isn’t insignificant. Researchers found that 40% of parents made significant errors in dosing children’s medications and made twice as many errors if the recommended dose was in spoonsful instead of milliliters. Ordinary spoons vary widely in capacity. A typical soup spoon – what one might think of as a tablespoon – might not actually hold a tablespoon of liquid and the same is true for a tableware teaspoon compared to a kitchen measuring teaspoon. Kitchenware is in standard sizes but tableware is not.

Not only that but a tablespoon is easy to mistake for a teaspoon, but it holds three times as much liquid. If a parent used a tablespoon when a teaspoon is called for in medication directions, the child would receive  a triple dose, which might be a serious thing.

In the study, even if a dose cup was included with a medication, if the directions said “teaspoon” or “tablespoon” 30% of parents used a household spoon instead of the dose cup. This resulted in measured doses that were 20% higher or lower than they should have been. In contrast, if label directions indicated a dose in milliliters, the dose cup or dropper was used by all but just 1% of parents.

The problem is that thinking in milliliters is foreign to most Americans but thinking in spoonsful is not. If the dropper or dose cup is not handy, parents are unlikely to be able to dose out milliliters at all. And even though the dose cup or dropper might be in milliliters, a 2009 study found that the bottle directions on 98% of the 200 top children’s medications are in teaspoons or tablespoons. So the problem of “what’s a spoonful” is real and dangerous.

Here’s the deal: take very seriously dosage amounts on children’s medications. Even though a child may be crying and upset and you might be in a hurry to get the medication measured out, take your time and use as exact tools as you can find. The dose cup or dropper that came with the medication is best. Lacking that, know which spoon in your silverware drawer corresponds the best to the sort of spoon indicated on the medication label.

When you measure, be accurate. Don’t overfill or underfill the measuring device. If you’re using a dose cup, hold the cup at eye level to make certain you’ve hit the dose line precisely.

Do your very best, once you’ve got medication measured out, to get it all into the child. This is certainly easier said than done, many times, with a squirmy, resistant toddler and liquid in an easily-spilled spoon. Remember that if you do spill and then try to make up the difference by adding a bit more, you are unlikely to hit the exact dose and the child may get more or less than she should.

Finally, if the child immediately vomits up the medication, don’t give a second dose without consulting an expert. Children are tiny and it’s easy to overdose them. If you’re unsure if your child got the medication he needs into his system, call your doctor’s office or the local poison control center for advice.

Having a sick child is no fun for anyone. But making a child sicker by not medicating enough or medicating too much isn’t a good thing either. Take time to review medications ahead of time and take care to use the right spoon!


© 2014, Patricia Nan Anderson. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. Ask for Dr. Anderson’s book, Parenting: A Field Guide, at your favorite bookstore.