Giving your child the wrong dose of medication is one of the most common medication errors in Canada. It happens to careful, attentive parents all the time. The dosing charts on the box are based on age, but your child's weight matters more. The measuring spoons in your kitchen drawer are inaccurate. The concentration of one brand of ibuprofen is different from another. Your pharmacist at Acme Drug Mart can clear all of this up in about two minutes.
Why age-based dosing charts are not enough
Over-the-counter children's medications like acetaminophen (Tylenol) and ibuprofen (Advil) print dosing ranges on the package based on age. The problem is that children of the same age can have dramatically different weights. A small three-year-old might weigh 12 kilograms while a large three-year-old weighs 18 kilograms. That is a 50 percent difference in body mass, and the dose should be different for each child.
Weight-based dosing is more accurate. Acetaminophen is dosed at 10 to 15 milligrams per kilogram of body weight per dose. Ibuprofen is dosed at 5 to 10 milligrams per kilogram. When you bring your child's current weight to the pharmacy, we calculate the exact dose and write it down for you. No guessing, no reading the fine print on the box at two in the morning with a crying child.
The measuring tool matters
Studies consistently show that parents who use kitchen spoons give inaccurate doses. A kitchen teaspoon can hold anywhere from 2 to 9 millilitres depending on its size and shape. The actual dose of a teaspoon is 5 millilitres. That variation is enough to underdose or overdose a small child.
Use the measuring device that comes with the medication, and only that device. An oral syringe is the most accurate option for young children. It lets you measure to the half-millilitre and deliver the liquid directly into the child's cheek, which reduces spitting. A dosing cup works for older children who can drink from it without spilling.
Never mix devices between products. The measuring cup that came with one brand's acetaminophen may have markings calibrated for that brand's concentration, which could be different from another brand's concentration. If you have lost the original measuring device, ask us for a replacement oral syringe. We keep them at the pharmacy and they are free.
Concentration differences between products
This catches parents off guard more than anything else. Infant acetaminophen drops and children's acetaminophen liquid are different concentrations. Infant drops are 80 milligrams per millilitre. Children's liquid is 160 milligrams per 5 millilitres, which works out to 32 milligrams per millilitre. If you give your child the infant drops dose using the children's liquid dosing, they get less than half the intended amount. If you give the children's liquid dose using the infant drops syringe, they could get more than double.
Health Canada standardized concentrations for some children's pain relievers in recent years, but different brands, generic versions, and products from different countries may still vary. Always check the concentration on the specific bottle you are using and dose from that bottle's instructions or from the dose your pharmacist calculated for that specific product.
Common dosing mistakes parents make
- Doubling up on the same ingredient. Many cold and flu combination products contain acetaminophen. If you give a child Tylenol for fever and then a cold medicine that also contains acetaminophen, they are getting a double dose. Always check the active ingredients list on every product.
- Dosing too frequently. Acetaminophen can be given every four to six hours. Ibuprofen every six to eight hours. In the middle of a rough night it is easy to lose track of when the last dose was given. Write down the time of each dose or use a phone alarm.
- Giving adult medications to children. Adult-strength acetaminophen tablets are 500 milligrams each. Cutting one in half for a child is imprecise and can lead to overdosing. Adult cold medications containing decongestants and antihistamines are not recommended for children under six at all.
- Stopping antibiotics early. When your child starts feeling better after a few days of antibiotics, the temptation is to stop. Completing the full course is important to clear the infection and prevent antibiotic resistance. If your child is having trouble with the taste or side effects, talk to us about strategies to help.
- Using expired liquid medications. Liquid medications, especially reconstituted antibiotics, have shorter shelf lives than tablets. Using last year's leftover amoxicillin is both ineffective and potentially unsafe. Check dates and bring expired products to us for disposal.
Giving medication to a reluctant child
Every parent has been there. The child clamps their mouth shut, spits out the medicine, or cries through the entire process. Here are strategies that actually work:
- Use an oral syringe aimed at the inside of the cheek. Squirting liquid at the back of the throat triggers gagging. Aiming at the cheek lets the child swallow at their own pace.
- Give small amounts at a time. Instead of trying to get the full dose in one go, give a little, let the child swallow, then give more.
- Mix with a small amount of food or drink. Check with us first, some medications should not be mixed with certain foods. But acetaminophen liquid can usually be mixed with a small spoonful of chocolate pudding, applesauce, or juice. Use only a small amount so the child finishes all of it and gets the full dose.
- Chill the medication. Cold dulls taste buds. Refrigerating the liquid (if safe to do so, check the label) can make it more tolerable.
- Let the child choose. Offer a choice where both options are acceptable: "Do you want to take your medicine from the syringe or from the cup?" A small sense of control helps.
- Ask about flavouring. Some pharmacies can add flavouring to liquid medications. Ask us if this is an option for your child's prescription.
When to call your pharmacist about dosing
Call or visit us any time you are unsure about:
- The correct dose for your child's current weight
- Whether two products contain the same active ingredient
- How soon you can give the next dose
- Whether a medication can be mixed with food
- Whether you need to wake a sleeping child for a scheduled dose
- What to do if your child vomits after taking a dose
These are exactly the questions your pharmacist is trained to answer. You are not bothering us. Getting the dose right is one of the most important things we do, and we would much rather you call at midnight than guess. Reach us at Acme Drug Mart or call (780) 443-0202 during regular hours.
Keep a medication record
For children who take medications regularly, or during an illness where they are getting multiple products, keep a simple written log: medication name, dose, and the time you gave it. This is invaluable if you need to call your pharmacist, visit a walk-in clinic, or hand off care to another parent or caregiver. A note on your phone works. So does a sticky note on the fridge.
When you bring your child's medication record to the pharmacy, we can review everything at once, check for interactions, and make sure doses are optimized for their current weight. A quick medication review takes a few minutes and can prevent problems before they start.