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Why It's So Easy To Give Kids The Wrong Dose Of Medicine

If the recommended dose on a bottle of allergy medicine is a teaspoon or tablespoon, lots of us reach in the kitchen drawer.

But kitchen spoons are notoriously inaccurate. "They can be way off," says physician Darren DeWalt of the University of North Carolina. Some kitchen teaspoons are twice as big as others, says DeWalt.

Even if you mean well, it's very easy to make a mistake. In theory, the little plastic "dosing" cups or droppers that come with medicine bottles should improve accuracy. But a study just published online by JAMA finds 98 percent of the top-selling 200 over-the-counter children's medications sold in 2009 came with confusing inconsistencies in dosing instructions.

A common mix-up: The instructions on the bottle give teaspoon measurements, but the dosing cup marks milliliters, or ml. And who remembers this conversion?

The Food and Drug Administration has issued draft guidelines aimed at making the instructions on over-the-counter medicines less confusing.

Many experts -- including the lead author of the new research -- say adopting one unit of measurement would be the best way to go. "If we could have milliliters be the only unit of measurement used, then I think this may be the best system," says researcher H. Shonna Yin of New York University School of Medicine.

The industry group that represents makers of over-the-counter kids' medications, the Consumer Healthcare Products Association, says they've already made some progress in improving dosing instructions for parents.

They're moving closer to adopting consistent units of measurement, so that the directions on the bottle match the markings on the dosing device.

"It will take between now and next year to fully implement the guidelines," says CHPA's Barbara Kochanowski. So far, the group hasn't committed to a milliliter-only system.

These changes may seem small, but UNC's DeWalt, who wrote an accompanying editorial for JAMA, argues that they're important. He says deaths from overdoses of over-the-counter medicines are fairly rare. But think about potent allergy medicines. "If I was to give my child too much Benadryl, it would pretty much knock them out," DeWalt says.

DeWalt argues that pharmaceutical companies spend hundreds of millions of dollars bringing products to market, but they don't spend very much money explaining to parents how to give this medicine to kids.

"I think a little more attention to this could provide a safer environment," he says. And maybe help parents -- and kids -- sleep a little easier.

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Transcript

GUY RAZ, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Guy Raz.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

When many of us take liquid cold and allergy medicines, we simply reach for a teaspoon from the kitchen drawer, but that is hardly an accurate way to deliver a dose of medicine. And now, a new study shows that labels on 98 percent of kids' cold medications have confusing instructions. And that, too, can lead to over- or under-dosing.

NPR's Allison Aubrey reports.

ALLISON AUBREY: Darren DeWalt is not only a doctor at the University of North Carolina, he's also the dad of two kids. And he keeps a few over-the-counter cold and allergy medicines on hand.

Dr. DARREN DeWALT (University of North Carolina): Let's see. I just grabbed out of the medicine cabinet the generic equivalents of Claritin and Benadryl.

AUBREY: The allergy medicine hasn't even been opened yet, but DeWalt says he already spots what he thinks could be very confusing.

Dr. DeWALT: So I just opened the box and on top, it has one of those little, plastic cups.

AUBREY: Meant for dosing the medicine. The directions on the label say to give one to two teaspoons for a child his son's age. But on the cup, there's all sorts of markings, including measurement lines for MLs, or milliliters.

Dr. DeWALT: There's no mention on the label of milliliters. And so those markings really don't help me unless I know the conversion from teaspoon to milliliter - which I happen to know because I'm a doctor. But...

AUBREY: But you're arguing why put them on there - because there's no directions of how to dose it in milliliters on the bottle.

Dr. DeWALT: Well, that's exactly what the FDA says. That's right.

AUBREY: The Food and Drug Administration issued draft guidelines about a year ago, aimed at fixing the problems of inconsistency and confusion in dosing over-the-counter medications.

Many experts, including researcher Shonna Yin of the New York University School of Medicine, say adopting one consistent unit of measurement would go a long way in helping.

Ms. SHONNA YIN (Researcher, New York University School of Medicine): If we could have the milliliter be the only unit of measurement used, and we teach parents about that, and physicians are consistent about giving instructions in milliliter, then I think that might be the best system.

AUBREY: It would help alleviate the problem of parents reaching for a kitchen teaspoon or tablespoon, which are often not a standard size.

The industry group that represents manufacturers of over-the-counter children's medicines, called the Consumer Healthcare Products Association, says they've already made progress since the data for the new study was collected. They've adopted voluntary guidelines aimed at making directions on the bottle match the markings on the dosing devices. And the group's Barb Kochanowski says some companies have already begun the changes.

Ms. BARBARA KOCHANOWSKI (Consumer Healthcare Products Association): It will take between now and next year to fully implement the guidelines across all the products affected.

AUBREY: Fortunately, deaths from overdoses of over-the-counter medications are very rare. But Darren DeWalt, who wrote an editorial on the issue in the Journal of the American Medical Association, says parents still need to be careful.

Dr. DeWALT: For example, if I was to give my child too much Benadryl, that would pretty much knock him out.

AUBREY: DeWalt argues that pharmaceutical companies spend millions of dollars bringing products to market. So they should be committed to spending a little more on making sure that parents have clear and accurate directions on how best to use them.

Allison Aubrey, NPR News. Transcript provided by NPR, Copyright NPR.

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