When a spoonful becomes lethal: Hidden risks with child medication

medium nocaption120934327A child suffering from acute gastroenteritis was prescribed an Oral Rehydration Solution (ORS) by a doctor. While the prescription detailed the child’s age, weight, diagnosis, and instructions on dissolving the sachet in 200ml of water, the doctor inadvertently missed specifying a ‘paediatric’ ORS sachet. The pharmacist, unaware of this crucial detail, dispensed an adult ORS sachet, which is meant to be dissolved in one litre of water. Following the instructions on the prescription, the parents gave their child a highly concentrated dose of ORS. The child subsequently developed seizures and kidney failure and succumbed to these complications.Such scary mess-ups are more common than you think. Though there is no Indian study on this, a US study published in the journal Clinical Pediatrics in 2023 found that every eight minutes, a child in the US gets a wrong dose of medicine at home.Weight decides dose“For children’s medicines, all calculations are weight-based ones. Giving too much or too little medication can have serious consequences. But there’s scant awareness about this,” says senior paediatrician Dr Bala Ramachandran, who heads the intensive care unit at the Kanchi Kamakoti Childs Trust in Chennai. Paediatric medication errors can occur at various stages — while prescribing, dispensing, and administering — he points out, adding, “There must be constant effort from healthcare providers, caregivers, and other stakeholders to ensure that such errors don’t happen.” medium nocaption120932525The Indian Paediatrics Association has been urging the govt to standardise dosages of common liquid medicines such as paracetamol, one of the most used drugs in children to avoid such confusions. There are different concentrations of liquid paracetamol (120mg/5ml, 125mg/5ml and 250mg/5ml) available. “It’s hard to believe paracetamol is harmful but nearly 85% of patients, aged from a few months to 17 years, admitted to our hospital with paracetamol poisoning had liver injury,” says Dr Ramachandran.In one instance, a nurse had mistakenly overdosed her three-year-old with paracetamol. Her six-month-old had been prescribed Crocin drops (100mg per drop) for fever. A day later, when her three-year-old fell ill, the doctor prescribed a teaspoon of Crocin syrup (120mg). The three-year-old was given a spoonful of the drops instead of the syrup, resulting in an overdose that required over two weeks of hospitalisation. In March, the same drop-syrup confusion led to an eight-month-old boy in Kerala needing critical care.Be candid about medicationMost medication errors in kids are preventable. And often, it’s because the medicines are within the child’s reach. There have been several instances where toddlers drank up from syrup bottles because they were strawberry or cherry flavoured. “Most parents tell kids that they are giving them sweet treats for fever while feeding the medicines. Though there are child protection locks on most medicine bottles, we must admit kids are smart and learn to open them,” says senior nurse Stella Thomas from a private hospital in Chennai, who regularly advises parents to keep all medications, including over-the-counter products, vitamins, and supplements, out of children’s reach and sight. “It’s more important to tell kids they are being fed medicines and the reason for it. They must understand that medicines cannot be taken without their permission,” she adds.Parents must spend time discussing the prescription with the doctor before they leave the consultation room. If they can’t, they must talk to the chemists at the drug store for clarity. “And for this, it is always better to visit a shop physically instead of buying drugs online,” says Tamil Nadu Chemists and Druggists Association president S A Ramesh.Qualified chemists tell customers what medicines must be taken with water, what can be taken with milk or juice, and what must be taken before or after food. “It’s important to follow these instructions for drugs to work well. Most chemists, like family physicians, know the families. So, even if a customer is buying an over-the-counter product as simple as a sachet of fruit salt, which is high on sodium and not recommended for those with hypertension, they may ask them why,” he adds. ShowQuotesRead labels, follow instructionsReading labels on the bottles is crucial. The National Health Mission specifically instructs healthcare workers to read the bottle label for paracetamol and refer to the dosage chart to ascertain the volume required per dose, according to the age and weight of the child.In 2021, the American Academy of Paediatrics (AAP) had recommended that doctors educate parents on how to administer correct medicine dosages as well as store them safely. “Make medication regimens as simple as possible. Encourage the use of a standardised dosing tool with all liquid medications. Provide dose amount using millilitre units only, and avoid spoon-based or non-metric units,” AAP had said.Tamil Nadu director of public health Dr TS Selvavinayagam recently warned against picking up ready-to-drink rehydration beverages marketed in tetra packs or bottles as substitutes for ORS packets, after complaints from doctors. “Dehydration cases rise in summer, particularly among the elderly and children. We often see even hospital pharmacies offering customers tetra pack liquids that are not ORS,” he pointed out, adding that the ready-to-drink versions may not provide adequate electrolyte replenishment, and may even worsen dehydration and diarrhoea.Preventing common medication errors in kids demands collective vigilance from healthcare providers, pharmacists as well as parents, with clear communication and safe home handling. “We need to increase awareness among all healthcare providers, common people, as well as policymakers,” says Dr Ramachandran.