Spoons give wrong medicine doses

Behind the Headlines

Thursday July 15 2010

Household spoons should not be used to give medicine

“Parents should not give their children medicine from an ordinary teaspoon,” said the Daily Express. The newspaper said that spoon size can vary greatly, leading to doses that are far too large or small.

The research behind this story measured the sizes of a sample of teaspoons collected from 25 households in Greece. These varied in size, with the smallest holding 2.5ml of liquid and the largest holding 7.3ml. A standard dosing teaspoon holds 5ml. The research also found variation in the amount of medicine participants used to fill a standard 5ml spoon.

In the UK, the NHS-prescribed medications for children come with a standard-sized spoon or measuring cup and sometimes an oral syringe. People are advised to never use a household teaspoon to administer liquid medication as they vary in size. If you are concerned about how to measure out and give medicine to your child, ask your pharmacist, who can advise you.

 

Where did the story come from?

The study was carried out by researchers from The Alfa Institute of Biomedical medicine Sciences in Greece, and received no external funding. The study was published in the peer-reviewed International Journal of Clinical Practice.

Giving liquid medicine to children

  • do not use teaspoons or tablespoons to measure out liquid medicines as they can greatly vary in size
  • instead, use an oral syringe or the dedicated medicine spoon or measuring cup provided with your medicine. Make sure you fill the spoon or cup in accordance with your medicine’s dose instructions
  • use an oral syringe if you are instructed to give a dose that cannot be directly measured with a medicine spoon, that is, an 8ml dose with a 5ml spoon
  • if in doubt, speak to your pharmacist or health visitor for further advice

The newspapers all emphasised the key message of this research, which was that household teaspoons should not be used to give liquid medicine to children. The study did not look to see if there were any adverse health effects from using inaccurate measures such as household teaspoons. The headline in the Daily Mirror said that spoons present an ‘OD (overdose) risk for kids’ but it may be unhelpful to refer to overdoses in this manner as readers might assume it means there is a risk of serious outcomes, such as death.

 

What kind of research was this?

The size of dose of liquid medication is often presented in terms of numbers of teaspoons. This Greek survey investigated the variations in the size of household teaspoons to assess whether there would be differences in the doses taken by individuals from different households due to the size of their teaspoons.

 

What did the research involve?

The researchers asked 25 women from 25 households in Attica, Greece to collect all of the different tablespoons and teaspoons that were available in their house. Two of the researchers then measured how much water each spoon could hold using calibrated syringes.

How to use an oral syringe

  • shake the bottle and draw up the required dose of medicine
  • your child should be sitting up or held upright, not lying down 
  • place the tip of the oral syringe inside your child’s mouth
  • gently push the plunger to squirt small amounts of medicine into the side of your child’s mouth. DO NOT aim for the centre of their mouth as they may choke
  • allow your child to swallow before continuing to push the plunger
  • make sure you give your child the whole dose
  • give your child a drink to wash down the medicine
  • when you have given the whole dose, wash the syringe in warm, soapy water
  • if in doubt speak to your pharmacist for advice

A standardised teaspoon to deliver liquid medications holds 5 millilitres (ml) of liquid. The researchers then asked the women to fill the standardised teaspoon with water until they felt the teaspoon was full. They then measured the volume of water in the syringe to assess whether it was 5ml. Five of the women were also asked to repeat this procedure with paracetamol syrup rather than water.

 

What were the basic results?

A total of 71 teaspoons were assessed from the 25 households as well as 49 tablespoons. The teaspoons held between 2.5 and 7.3ml of water, with an average volume was 4.4ml. The tablespoons held between 6.7 to 13.4ml and on average held 10.4ml of water.

When they looked at the ‘perception of a teaspoonful’ test, they found that the women filled the standardised 5ml teaspoon with between 3.9 and 4.9ml of water. The five women who were asked to repeat this experiment with paracetamol syrup, filled the teaspoon with between 4.8 and 5ml of syrup.

 

How did the researchers interpret the results?

The researchers said that the main finding of their study was that there was great variation in the volume of liquid that typical household teaspoons and tablespoons hold, and that there is also considerable variation in people’s perception of when a teaspoon is full.

They point out that dosing and administration for children is different from adults, as child doses are adjusted to age and body weight and children are considered more vulnerable to dosing errors than adults.

 

Conclusion

This was a small study that highlighted two potential problems that could lead to an inappropriate dose of liquid medication being delivered when the medicine was measured using a teaspoon. Firstly, household teaspoons are not a standard size and can hold a variable amount of liquid, and secondly, even if people use a standard-sized teaspoon, they may not fill it to the top. For example, they found when assessing the women’s ‘perception of a teaspoonful’ that concerns over spillages or the child pushing the teaspoon of medicine away may be possible reasons for this.

This study was carried out in Greece. NHS prescription liquid medicine in the UK comes with a special spoon or liquid measure and sometimes with an oral syringe. People are advised never use a household teaspoon to administer liquid medication, as they vary in size.

It is important to follow the dose instructions on the bottle and check with the pharmacist if buying over-the-counter liquid medications whether they are suitable for children. When using a dosing cup or a syringe always check that the units (teaspoon, tablespoon, ml or cc) match up with the units of the dose you want to give.
For example:

  • 1cc = 1ml
  • 1 standardised teaspoon = 5ml
  • 1 standardised tablespoon = 15ml

Great Ormond Street Hospital has also provided a factsheet on delivering medications to children using an oral syringe appropriately.

If you are concerned about how to give medicine to your child, ask your pharmacist. They can advise you on how to measure the medicine accurately and give the medicine appropriately.

Links to the headlines

Dangers in a teaspoon of medicine. Daily Express, July 15 2010

Syringes beat spoons for children's medicine. BBC News, July 15 2010

Spoons OD risk for kid. Daily Mirror, July 15 2010

Links to the science

Falagas ME, Vouloumanou EK, Plessa E et al. Inaccuracies in dosing drugs with teaspoons and tablespoons. International Journal of Clinical Practice, 64 Issue 9: 1185 - 1189

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Analysis by Bazian

Edited by NHS Choices