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How to counsel caregivers on pediatric medications

Pharmacists can help reduce dosing errors when parents pick up medication for children
Gerardo Sison medical writer headshot
By | Jul. 3, 2024
A pharmacist talking to a parent with her child | pediatric medications

Key takeaways

  • Medication dosing errors are common among pediatric patients, with almost half of all caregivers making dosing mistakes.

  • Misunderstanding instructions, measuring liquid medications incorrectly, and not considering age or weight are common causes of errors.

  • Pharmacists can use strategies like plain language instructions, pictograms, and the teach-back method to prevent caregiver errors.

In this article:

Medication dosing errors are common among pediatric patients, with studies indicating that more than 40% of caregivers commit errors when administering medications to children. Dosing errors may be particularly relevant when dealing with medications that have narrow therapeutic indexes, such as digoxin and phenytoin. Even small errors in dosage can have adverse effects on a child’s health, especially for those with chronic conditions or who often juggle multiple medications.

Pharmacists can help reduce dosing errors by counseling caregivers when they pick up medication for kids. They can also teach families and caregivers proper dosing techniques and strategies to avoid mistakes, which can help ensure safety and improve outcomes for pediatric patients.

Common types of pediatric medications

Pediatric medications are drugs prescribed to children and adolescents from birth up to 18 years old. Children’s bodies may handle medications differently than adults, requiring specific formulations. As pharmacists, it’s important to consider the pharmacokinetics and pharmacodynamics in this age group to ensure that administered drugs are safe and effective.

Health conditions affecting the pediatric population can include infections, chronic conditions like asthma or diabetes, and neurological disorders. These ailments often require precise dosing based on a child’s developmental stage and body size. The following are drug classes commonly prescribed for children:

Families and caregivers are generally tasked with giving these medications to children. Therefore, they must grasp the medicine’s purpose and how to administer it, especially for chronic conditions where consistent dosing is key to managing the disease.

Causes of pediatric dosing errors

Pediatric dosing errors can occur for a variety of reasons. The lack of standardized dosing regimens for children means most medication dosing requires specific calculations. Caregivers may have low health literacy, which makes understanding prescription labels and dosing instructions even more challenging. Below are some common errors that can lead to underdosing, overdosing, or giving medicine at the wrong frequency.

Misunderstanding medication instructions

Misinterpretation of dosing instructions for pediatric medications can lead to serious administration errors. Due to complex medication schedules or unclear instructions, caregivers may misunderstand the frequency and timing of doses.

Ambiguity in prescription labels further complicates the issue, especially for those with limited health literacy. For instance, a label stating “give 2.5 mL” could be misread if the caregiver is more familiar with teaspoon measurements, potentially leading to an incorrect dose.

Confusion with dosing frequency

The dosing frequency is key in ensuring a drug is effective while preventing potential side effects. A typical error arises when caregivers confuse terms such as “twice daily” with “every 12 hours” or assume “four times daily” permits dosing at any four times in a day rather than at evenly spaced intervals. For instance, if a medication is to be given “three times daily,” it is generally intended to be given over waking hours, not within a clustered period, which might lead to overdosing. 

Difficulty in measuring liquid medications accurately

Caregivers may need help with measuring liquid medications, as some cups have graduations that are hard to read or are easily misread when filled with liquid. This can cause a caregiver to administer too much or too little medication. For example, an intended dose of 5 mL could easily become 10 mL if the cup is filled to the wrong line.

A measuring device may be marked with various units of measurement, like milliliters, teaspoons, or tablespoons, leading some people to misinterpret dosing instructions. Caregivers might choose the wrong measurement unit, such as using a tablespoon instead of a teaspoon, resulting in a threefold higher dosage.

The lack of uniformity in measurement tools can also contribute to dosing mistakes. Everyday items like teaspoons or medicine cups, often used for giving liquid medications, can be confusing because they have inconsistent volumes. For instance, a regular kitchen teaspoon may not hold the same amount as a standardized medication teaspoon, which typically measures 5 mL.

Not considering the child’s age or weight

Many medications need to be dosed based on the child’s age or weight. Age can affect the body’s ability to process medication due to organ development and metabolic rate. Weight can affect the distribution volume and the drug’s clearance from the body. Without these considerations, there is a potential for harm due to reduced effectiveness or increased side effects.

For instance, a common error may occur with over-the-counter fever reducers, such as acetaminophen, in which caregivers might administer an adult dose to a child who is smaller or younger than the recommended age or weight range suggested, which could result in liver toxicity.

Not understanding potential adverse effects

Caregivers may underestimate the possible negative effects of medications given to children, unintentionally putting them at risk. Since medications can have effects beyond their intended purpose, caregivers should be aware of potential adverse effects. A study showed that more than 40% of parents thought they understood the possible adverse effects completely, but their understanding was overstated.

A common mistake occurs when caregivers mix up side effects with the main purpose of the medication. This confusion can result in the wrong doses being given or not taking the right actions when negative effects appear. For example, a caregiver might not seek medical advice if a child experiences severe drowsiness from an antihistamine, mistakenly believing these symptoms are part of the recovery process.

Strategies to prevent dosing errors

Pharmacists can use several preventive strategies to reduce the risks of incorrect medication dosing in children. One study discovered that health literacy–informed communication strategies effectively reduce medication dosing errors by nearly 50%.

Using plain language to explain dosage instructions

When explaining dosage instructions to caregivers, communication should be straightforward and free of complex medical terms. Try using clear, simple language and opt for common words that are easily understood.

Practical instructions might involve:

  • Simple terms: Replace “administer” with “give” and say “use” instead of “utilize.”
  • Active voice: Try saying, “You should give the medicine at 8 p.m.” instead of, “The medicine is to be given at 8 p.m.”

If explaining the dosage for liquid acetaminophen to a caregiver, you might say, “For your toddler, who weighs 30 pounds, you’ll give them 5 milliliters of the medicine with the provided syringe. You will do this every 4-6 hours if they have a fever.”

Incorporating pictures or pictograms for visual aid

Pictograms can be an effective visual tool for bridging language barriers. These simple, universal pictures can illustrate dosing steps, which can improve understanding when combined with verbal or written instructions. For instance, a pictogram might show a syringe being drawn to a certain measurement accompanied by arrows indicating the direction of the draw. The pictogram might show numeric indicators to pinpoint the precise amount needed.

After explaining the dosage verbally, you might provide a visual aid displaying a syringe at the required volume, a clock to indicate the frequency of administration, and a fridge to emphasize storage instructions. By combining visual aids with explanations, caregivers can more readily recall the dosing instructions when it’s time to give the medication.

Implementing the teach-back method 

With the teach-back method, you can explain the dosing information clearly, avoiding medical jargon that might confuse the caregiver. Then, you can ask the caregiver to repeat the instructions in their own words.

For example, you might say, “I’ve shown you how to measure 5 mL of this medicine using the syringe provided. Now, can you show me how much you would give for one dose?” If the caregiver demonstrates properly, they’ve understood; if not, you’ll know to review the instructions again.

The teach-back method is a two-way process that provides hands-on experience before the caregiver administers the medication on their own. It also empowers caregivers, as they are actively engaged in learning how to give the dose correctly.

Recommending the use of dosing devices provided with medications

Stress the importance of using the dosing devices that come with the medications. Manufacturers carefully design these devices, such as oral syringes or droppers, to make sure caregivers can give the correct doses. Counsel caregivers to avoid kitchen spoons or other household items due to the potential for inaccurate dosing.

It’s important to create an environment where caregivers feel comfortable seeking clarification. You can always ask caregivers if they have questions about medication dosage, side effects, or administration techniques. If any questions or concerns come up later, let them know they can always call the pharmacy for assistance.

Other medication error risks to keep in mind

Other medication errors can occur in addition to dosing errors. Consider the following risks and counsel caregivers about them.

  • Drug interactions: Certain medications can interfere with each other, leading to reduced efficacy or increased toxicity.
  • Mislabeled medications: If medications are incorrectly labeled, errors can occur, potentially causing a caregiver to administer the wrong drug.
  • Allergies: Overlooking a child’s allergies might result in giving a medication that triggers an allergic reaction.
  • Incorrect route of administration: For example, medications intended for topical use might mistakenly be given by mouth.

Remember to explain that even over-the-counter medications can lead to severe interactions. To avoid potential problems, you might recommend double-checking labels and only giving medication as directed.

You can also reduce the risk of severe problems by making sure the child’s allergies and current medications are up to date. This will flag any potential risks of allergic reactions or drug interactions.