How to Measure Medicine, Mary Poppins

Five years later.  It’s official. Kids, I’ll no longer be asking you to take a teaspoon of medicine. I’m making the call to action for the pharmacists who prepare prescriptions for my patients to kick back any prescriptions if I forget to write in milliliters.

The  American Academy of Pediatrics  came out with the wise advice (they call it a Policy Statement) that pediatricians should only write prescriptions using metric measurements. While I suspect there are going to be some frustrated grandmothers with these new recommendations, it’s the right thing to do. Mary Poppins did sing about how “a teaspoon of sugar helps the medicine go down,” but she always did the right thing for the children.  If they would have had the kind of measuring spoons we have today, she would have been measuring milliliters of the yucky stuff instead of using a kitchen spoon.

Thanks to some important nudging, AAP experts have finally arrived at the long overdue recommendation: no more kitchen teaspoons measuring medicine for kids.  It’s simply not accurate enough to ensure kids are getting the exact dose needed. Dosing syringes with the measurement in metric milliliters are the way to go.

Why the change? For years we have known that kitchen spoons vary widely in the amount of liquid they hold. In those Mary-Poppin-days gone by, mothers had nothing BUT a kitchen spoon to give medicine. Not so today. One teaspoon is supposed to equal five milliliters.  Believe it or not, there is no consistent standard for spoon size among silverware manufacturers. Today, we have a far superior option in the dosing syringe. Thank your pharmacist!  Many actually hand out dosing syringes with prescribed medicines, and lots of over-the-counter medicines come with them, too.

Most dosing syringes are marked with BOTH milliliters and with teaspoon fractions in this time of transition. Now that the AAP has raised its very powerful voice of advocacy to ask that we write our prescriptions using metric measurements, it’s my hope that very soon, dual marking will be unnecessary. By removing the teaspoon measurement from our instructions to parents, we will remove the temptation to open the kitchen drawer.  Times change and so must your pediatrician.

It’s a staggering statistic that there are more than 70,000 ER visits for unintentional medicine overdoses.  Parents give the wrong amount of a medicine assuming they’ve gotten it close enough far more often than you’d imagine. Think about it. Could you actually measure a quarter of a teaspoon of medicine for your child before tossing the spoon into the dishwasher?  “Close enough” only counts in horseshoes and hand grenades. From now on, find the medicine dosing syringe. My prescriptions will insist that you do.

Measuring for your child’s health and brushing up on my metric equivalents, and thanking you for helping me transition on this one, I am

Gayle Schrier Smith, MD

First published on April 2, 2015

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