Confusion and Inconsistency in Children’s Liquid Medication Dosing

A study published Wednesday in the Journal of the American Medical Association (JAMA) found that 200 top-selling over-the-counter liquid children’s medications have inconsistent or misleading dosing instructions.

If you’ve ever tried to interpret those miniscule measuring lines on the cups that sit atop the medicine bottles, this may come as no surprise. But it’s not just your eyes. The researchers who conducted the study found that almost 99 percent of over-the-counter (OTC) products that came with dosing devices had markings or instructions that didn’t match. “Among the measuring devices, 81.1 percent included 1 or more superfluous markings,” the authors wrote.

As MSNBC reported, “problems with the dosing devices included a lack of markings for the dose that was listed on the packaging; extraneous measurements; unusual abbreviations for dosing; and the use of units of measurement that parents may be unfamiliar with, such as ccs (cubic centimeters) or drams.”

Furthermore, the researchers found that many parents forgo the dosers and use regular teaspoons, which, of course can vary widely in size. “Kitchen spoons are really inaccurate,” Dr. H. Shonna Yin, lead author on the study and assistant professor of pediatrics at the New York University School of Medicine told MSNBC.

The confusion has resulted in both under and overdosing of products such as Tylenol, Motrin, or Benadryl, and although rarely fatal, it’s still not acceptable.

Dr. Yin and her team are recommending consistency across the board: that a standardized measuring device with one agreed upon unit for measurement — such as milliliters — be included with all over-the-counter liquid products.

The researchers conducted the study in anticipation of the Food and Drug Administration’s release last November of new, voluntary guidelines for labeling children’s medications, so it’s really too early to know if the guidelines have taken full effect.

“This study is intended to establish baselines. The plan is to take another look in a year or so to see if changes have been made,” Dr. Yin said.

In the meantime, the Consumer Healthcare Products Association, a trade group for 95 percent of the OTC medicine manufacturers issued a statement in response to the JAMA study and stated “It is our goal that all OTC medicines will fully follow the guidelines by the end of 2011.”

MSNBC reported that in an editorial accompanying the study, Dr. Darren DeWalt, an assistant professor in the department of medicine and clinical epidemiology at the University of North Carolina, wrote the problems were troubling because when researchers have looked at people’s use of dosing instructions, error rates have been as high as 50 to 60 percent.

But Dr. DeWalt told MSNBC: “I don’t think the current FDA guidance is clear enough, and more work needs to be done to get the error rate lower.”



Photo by conskepical


Warren Webber
Warren Webber6 years ago

Medicine should NOT be part of a free market system!

mariah f.
mariah f7 years ago

Thanks for important informations.

Amber M.
Amber Beasley7 years ago

I agree with Maddie. it doesn't make any sense. our medicine system needs to be changed.

Maddie Wiedmer
Erin Wiedmer7 years ago

In Europe, dosing is based on per weight basis (usually kg) and a syringe is given in the medication box (cough syrup, liquid tylenol etc.) to measure the accurate dose/amount. Seems to work fine here. I'm surprised North America is so far behind on this! It doesn't make sense that a small 5 yr old would take as much medication as a large 10 yr old when he/she might weigh almost half the amount!

Pam W.
Pami W7 years ago

The misleading instructions or accuracy of the measuring cups is not good for anyone. Is this more big pharm making oodles of cash from the public? Why has is been allowed to go on for so long? Our children need to be protected.

Robert O.
Robert O7 years ago


David M.
David M.7 years ago


Mrs Shakespeare
Mrs Shakespeare7 years ago

I agree, Marilyn. VERY laughable! xD

David M.
David M.7 years ago

Thanks for info

Jen F.
Jen F7 years ago

other than the guy commenting on the different sizes of household table/tea spoons instead of realizing there is an actual measurement tool for tea/table spoons. I found the article very on top. The units need to be changed. They need a spectrum as to dosage. A large fat child compared to a thin child would need a different amount of medicine. They need a chart, including weight, age, and level of sickness. Then you figure out the proper amount for you kid.