Many parents reach for a kitchen spoon when giving their kids liquid medication-it's quick and handy. It can also lead to a dosing error, as shown by a recent study. A move to a milliliter-only standard for medication has met with some resistance in the United States, mainly because of concerns that American parents would be confused. But this study suggests that the opposite is true.

The authors analyzed data collected from two pediatric EDs in New York City over a period of 15 months; parents were asked to report what the prescribed dose was and then to perform an in-office demonstration of dosing. About 32% of parents who completed the study made an error regarding the prescribed dose, and about 40% made errors both in knowledge of the dose and in demonstrating the dose. About one in six used a kitchen spoon rather than a standard dosing instrument. And compared with parents given milliliter-only instructions, parents given teaspoon or tablespoon units had more than twice the odds of making a dosing mistake. They were also more than 30 times as likely to use a kitchen spoon instead of a measuring spoon or other standardized dosing instrument.

The study authors suggest numerous reasons for the parents' mistakes. Teaspoons and tablespoons, although familiar, are often confused for one another, and their abbreviations are easily mixed up. What's more, those terms may suggest implicit endorsement of the use of kitchen spoons-which vary widely in shape and capacity. Parents with low levels of health literacy or limited English proficiency are at particular risk for making dosing errors. Inconsistencies in labeling-different units of measurement on the prescription and on the medication label-were also found to add to the confusion.

The authors conclude that limiting dosing terms to one standard unit could reduce dosing errors among all parents, especially non-English-speaking parents and those with inadequate health literacy. They also call for routinely providing standardized, milliliter-only dosing instruments to parents to facilitate the transition.-Laura Wallis

Reference