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Accurately administering oral medication to children isn't child's play
  1. V L Beckett1,
  2. L D Tyson1,
  3. D Carroll2,
  4. A W Kelsall3
  1. 1School of Clinical Medicine, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
  2. 2Department of Paediatric Surgery, Addenbrooke's Hospital, Cambridge, UK
  3. 3Department of Neonatal Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK

Abstract

Introduction A number of devices including metal teaspoons, calibrated spoons and oral syringes are available to administer medications. The aims of this study were to determine which measuring devices were preferred by caregivers and which were the most accurate.

Methods We compared caregivers' accuracy when measuring paracetamol suspension using different devices and the variance of doses achieved using each device. Participants completed a questionnaire detailing demographics, regularity of administering children's medication, preference and perceived accuracy of paediatric medication devices. Caregivers measured 5.0 ml of 120 mg/5 ml paracetamol suspension using a 5.0 ml metal teaspoon, 5.0 ml calibrated spoon and 5.0 ml oral syringe. Samples were weighed then converted into mls (conversion rate=1.09 g/ml, Orbis Pharmaceuticals).

Results We recruited 277 caregivers aged 17–68 years attending outpatient clinics. Most (98%) were parents with children less than 18 years of age at home. Most would choose an oral syringe (59%) or calibrated spoon (52%) to dispense medication. The majority (84%) considered the syringe most accurate and easiest to use (70%). Medication was mainly administered by mothers (94%). Accuracy did not vary with caregivers' age, gender, instrument preference, number and age of children. The mean volumes measured with the metal, calibrated spoon and oral syringe were 3.99, 5.00 and 5.13 ml respectively. Volumes administered ranged from 2.49 to 6.52 ml. There were significant differences from the specified 5 ml volume using the metal spoon (single sample t test, t=22.46, p<0.0001), oral syringe (single sample t test, t=0.0087, p<0.0001) and when comparing the volumes measured with each device. The variance of the volumes measured with an oral syringe was significantly smaller than that measured using a calibrated spoon (Pitman's test; ρRho=-0.797, p<0.0001) or metal spoon (Pitman's test; ρ=-0.709, p<0.0001).

Conclusions There were significant differences in the volumes of medication measured using commonly available devices. Oral syringes were the most consistently accurate, having the smallest variance. The increased variability with calibrated or metal spoons may result in under or overdosing especially when administering drugs with a narrow therapeutic window. We recommend the oral syringe for measuring children's medication. Accuracy in volume measurements can be further improved by parental education.

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