Dosing Spoon Surprise

Once again, my take is different than that of most. About 70 percent of Americans measure their liquid medicines in kitchen spoons. But when smart college students were asked to pour a real teaspoon of liquid medicine into a kitchen spoon, they averaged either eight percent less or twelve percent more than the amount prescribed, depending on which kitchen spoon they used, according to a report in the January 5, 2010 Annals of Internal Medicine. This happened in a well-lit room, in the middle of the day, after having been shown the correct amount. Imagine how far off an exhausted parent might be in the middle of the night, distracted by a crying baby.

The obvious response to this data? Always use a dosing cup or dosing spoon instead of a kitchen spoon. One dose may not matter too much, but repeated several times it could quickly add up to danger or to an ineffective medicine.

My response?

  1. When possible, choose medications where there is not a tight window between what works and what is dangerous. Cough syrup in children is one great example of this. A controlled study compared a DM cough syrup versus buckwheat honey. Children aged 2 to 5 years received ½ tsp, aged 6 to 11 years received 1 teaspoon, and 12 to 18 years received 2 teaspoons. The honey worked better – at reducing the number of coughs, the severity of coughs, and the bother of coughs, and at increasing sleep for the children (and for the parents). Too much DM can cause diabetes, hallucinations, psychosis – even death. Too much honey? Not a big deal.
  2. When the dose matters, don’t trust yourself to estimate accurately. Choose a dosing spoon, dropper or syringe. Acetaminophen is one place where correct dosing really matters. It’s easy to give too much. (And remember – fever is a friend – and kids often get better faster treating a fever only when it interferes with sleep or keeping down fluids).
  3. Choose smaller spoons and plates for food and tall, slim cups for drinks. Overdosing food in children is an even bigger health problem in the US than overdosing medicines. Container size matters: In this experiment, those using the larger spoon poured 20 percent more liquid, even though they were confident they had poured the same amount. Container shape matters: The same authors found previously that even confident veteran bartenders pour 28 percent more alcohol into short, wide glasses than into tall, slender ones of exactly the same volume. Use smaller plates when you want your child to be happy eating less; use larger plates and bigger, wider cups when you want your child to automatically eat and drink more.

Wansink, B. and van Ittersum. K. “Spoons Systematically Bias Dosing of Liquid Medicine.” Annals of Internal Medicine, 5 Jan 2010, 152(1):66-67.

Paul, I.M., Beiler, J., McMonagle, A., Shaffer, M.L., Duda, L., and Berlin, C.M. “Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and their Parents.” Archives of Pediatrics & Adolescent Medicine, 2007, 161(12):1140-1146.

Wansink, B. and van Ittersum, K. “Shape of glass and amount of alcohol poured: comparative study of effect of practice and concentration.” BMJ, 2005, 331:1512-4.

Fisher, J.O., Rolls, R.J., and Birch L.L. “Children’s Bite Size and Intake of an Entrée Are Greater with Large Portions Than with Age-Appropriate or Self-Selected Portions.” American Journal of Clinical Nutrition, 2003, 77(5):1164-1170. [Discussed in Feeding Baby Green]

Published on: January 06, 2010
About the Author
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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