Tag Archives: medication

From the Desk of Doc Smo – Getting the Dose Right!

In the era of computerized medical records, robotic surgery where surgeons don’t touch their patients, ICD-9 databases gathering statistics on millions of people in real time, I guess it is time to give up some of the “old ways” such as measuring medicine with a teaspoon. How twentieth century can you get? Teaspoons can be quite variable in volume. Johnny and Janie’s dose of medicine shouldn’t depend on your silverware pattern, should it? This is one of the conclusions of a task force called PROTECT (Prevention of Overdose and Treatment Errors in Children Task Force). They are strongly recommending that all pediatricians, pharmaceutical companies, and parents begin immediately prescribing and delivering liquid medications in metric volumes only! Teaspoons and tablespoons are out and milliliters are in. Furthermore, they recommend that we deliver medicines with a metric syringe rather than the less accurate measuring cups that come with so many medications used by children.


I know that we cling to the familiar; such behavior is human nature and gives our world more predictability. But when the health and safety of our children are at stake, it is time to change. As the task force points out, unintentional medication errors are a big problem in a society of 350 million people. Check out the statistics that they have gathered:


• Over 70,000 emergency department (ED) visits result from unintentional medication overdoses among children under the age of 18;
• One out of every 180 two-year-olds is treated in an ED for an unintentional medication overdose;
• Over 80% of ED visits among children under the age of 12 are due to unsupervised children taking medications on their own, and 10% of ED visits in this age group are due to medication errors;
• Over-the-counter medications are involved in approximately one-third of ED visits among children under the age of 12 [1].

Source cited below


Pharmacists got past their archaic system of measuring in drams, minims, and grains, so parents and doctors should be able to go metric in the 21st century. Put away those teaspoons and get out a good metric syringe to measure your child’s medicine. As we are learning, even medicines that are readily available like acetaminophen and ibuprofen may not be so benign, especially for children and especially at the wrong dose.


Check out other task force recommendations at the link that I have provided from the CDC.



From the desk of DocSmo: More on OTC cold/cough medicines (Article)

Longtime listeners to the podcast will recall a pedcast called Spicy Feet in which I discussed the current thinking by health authorities when it comes to the use of cough and cold medicines in children younger than 4 years of age. For those of you who missed this episode, I recommend that you download it and listen. In a nutshell, complications from the use of cough and cold medicines are thought to be the primary culprits in causing about 1500 ER visits/ year in children. Over the past 20 years, cold and cough medicines are thought to have caused 123 child deaths and generated 750,000 phone calls to poison control centers. Clearly there is the potential for serious harm to come from these medicines.


At the same time, their benefit in children hasn’t really been proven. Before the advisory in 2008, parents would often ask me whether they should use these medications. My response was always, “Do you think they help?” They usually responded “No!” So why would you ever consider using them?  My opinion… marketing. Parents feel that by giving their children a “medicine,” they are doing the right thing. The images of a caring parent sitting on their child’s bed giving them a teaspoon of this or that medicine is a powerful image. Parents feel that if they “love” and “care” for their children they need to emulate this behavior.


So what has happened since the advisory was put out in 2009? Emergency visits for side effects from cough and cold medicines have dropped by half on a year to year basis in children less than 2 years of age. Visits to the ER by children over 2 years of age have not changed. Overall use of cough and cold medicines in children has dropped by 66%. Word travels fast. When they are right, they are right. Just because people have used a certain treatment or remedy for a long time doesn’t mean it is either safe or effective. In the era of computers and big data, we are about to find out what works and what doesn’t. Stay tuned.



Audio Digest, Tunkel, volume 57:08, April 2011.



A ‘How to’ Guide to Swallowing Pills for Children (Pedcast)

Doc Smo describes a simple procedure to teach older children and teens how to swallow pills and capsules. Sometimes simple things like fear of swallowing pills can reveal insight into a person’s psyche. Check out a new “Doc Smo pearl” for his view on the topic.

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