Children are not small adults

Paediatric medicine use is not a matter of scaling an adult dose down, and it is worth understanding why.

Children's livers and kidneys mature at different rates, which affects how medicines are processed and eliminated. Body composition differs from adults and changes rapidly through childhood. Developing brains can respond differently to medicines acting on the central nervous system. And children — especially young children — cannot reliably describe what they are experiencing, so caregivers are the monitoring system.

This is why paediatric dosing is prescriber-directed and typically based on weight rather than age alone, and why a prescription written for one child at one weight may not be right for the same child six months later.

Measuring liquids properly

Dosing errors with liquid medicines are among the most common medication errors involving children, and they are almost entirely preventable.

The kitchen spoon problem

Household spoons vary enormously in volume. A "teaspoon" from a cutlery drawer may hold anywhere from noticeably less to considerably more than a measured teaspoon, and the difference matters far more for a small child than for an adult.

What to use instead

The device supplied with the product, or an oral syringe from the pharmacy. Pharmacies will normally provide one on request, and they are the most accurate option for small volumes.

Getting it right

  • Check the units. Millilitres and teaspoons are different, and confusing them is a known source of tenfold errors.
  • Read at eye level on a flat surface.
  • Shake suspensions well before every dose — the pamoate oral suspension is a suspension, and unshaken doses are inaccurate.
  • Never estimate between markings.
  • Write down each dose and the time, especially if more than one caregiver is involved.

That last point prevents a specific and common scenario: two caregivers each giving a dose because neither knew the other had.

Paradoxical excitation

Some children respond to sedating medicines with agitation, restlessness or excitability rather than drowsiness. This is a recognised phenomenon described in labeling for sedating medicines.

It is easy to misread. A caregiver expecting a calming effect may conclude the dose was too small, or that the child is being difficult. Neither interpretation leads anywhere good.

The correct response is to report it to the prescriber. A paradoxical reaction materially changes whether a medicine is a good fit for that child, and it is exactly the sort of observation clinicians need from caregivers.

Never share, never substitute

Two rules that seem obvious and are broken constantly, usually with good intentions.

Never give a child medicine prescribed for someone else, including a sibling. A prescription is written for one person after assessing that person, and children's doses depend on weight and age. A sibling's prescription is not a shortcut, even for the same symptom.

Never use an adult product for a child by splitting or estimating, unless a clinician has explicitly directed it. Adult formulations have different concentrations, and some products are not appropriate for children at all.

If a child needs treatment, that is a call to a clinician or pharmacist. Both are usually reachable faster than people expect, and pharmacists will advise on over-the-counter options without an appointment.

Storage and accidental ingestion

Accidental ingestion by young children is one of the most common medication emergencies, and it happens quickly.

Storage

  • Up, away, and out of sight. Height alone is not enough if the container is visible — a determined child will find a way.
  • Child-resistant caps slow children down; they do not stop them. Always re-secure the cap fully.
  • Watch the places people forget: handbags, visitors' coats and bags, bedside tables, and pill organisers, which are usually not child-resistant at all.
  • Never call medicine "sweets" to persuade a reluctant child. It works once and teaches something dangerous.

If it happens

Contact Poison Control at 1-800-222-1222 in the United States immediately. It is free, confidential, and staffed 24 hours a day by trained specialists. Do not wait to see whether symptoms develop, and do not try to induce vomiting unless specifically instructed.

Call emergency services instead if the child is unresponsive, having difficulty breathing, or having a seizure.

Save the Poison Control number in your phone now, before you need it.