Yesterday, the FDA put out a warning for parents regarding the risk of over-dose in infants receiving Vitamin D supplements. Seemingly scary, especially since nearly every infant is recommended vitamin D supplementation. But hold on a minute. As you likely know, I recommend giving 400IU (1 cc) of Vitamin D to all breast-fed and/or partially breast-fed infants every day. My blog posts about why and the research.
The FDA warning really gets to the heart of a bigger issue: how we understand dosing liquid medications as parents. So, let’s keep this warning in perspective. When you give Vitamin D to an infant (or your babysitter, nanny, or mother does), make sure you have a dropper with “1 cc” etched on the side. The warning is really rooted in how we use the tools we’re given to dose medications. This is a problem that crosses all education and socioeconomic lines. Particularly in the case of medications that can cause life threatening complications in an overdose situation. For example, when O was given pain medication for his broken leg last week in California, the Rx said: “Give 1/2 tsp every 6 hours.” But the pharmacist gave us a 5 cc syringe. Would you know what to do? The husband had to double check…
I was a middle school science teacher; in the spirit of safety (playing along?) please do the pop quiz below. Post your responses to the questions. Be bold. And as I told my 9th-grade science students in Oakland some 10+ years ago, if you think the test is easy, “Well, good for you.”
Answers will arrive later today with rationale & explanations of why I am forcing you to do this. Now, get out your #2…
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Pop Quiz: Conversions & Other Necessary Info For Giving Meds To Children
#1 How many cc are in a mL?
#2 How many mL in a teaspoon?
#3 Without looking it up, tell me how you’d give your child 1 1/2 teaspoons of medicine using a 5 cc syringe the pharmacist gave you?
#4 If the doctor told you to give your child 1 tsp of medicine, twice a day, for 10 days, and the pharmacist gave you 100 cc of medicine, will you have enough?
#5 Your pediatrician tells you to give your child 1/2 tsp of Children’s Motrin for pain. You lose the cap on the top of the bottle. You pull out a teaspoon from the silverware drawer. Filling up half way will likely work. Yes or No?
#6 Your pediatrician tells you to give your child 1/2 tsp of Children’s Motrin for pain. You lose the cap on the top of the bottle. You pull out a set of measuring spoons from the drawer. You pick the “1/2 teaspoon” spoon. Will this work? Yes or No?
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Claire says
Here goes!
#1 1
#2 5
#3 1.5 syringes full ( 5 then 2.5). Though I would look it up first!!
#4 Well, there is never enough! I always run out before the final dose…but that is not what you are asking. This depends on me being right about the mL to tsp conversion…Don’t want to lose points twice!
#5 No – might be fine, but I would find a syringe or dropper. We always have something better than a spoon around.
#6 Yes, I think so – though I would still go for a dropper b/c I could never get it into my son’s mouth with an actual measuring spoon.
Jonathan says
1. 1 cc = 1 ml
2. 5 cc i n 1 teaspoon
3. Give 1 and 1/2 syringes full
4. Well, not if you account for spillage and missed targets.
5. Probably not. Most silverware spoons aren’t actually 5 cc’s. And if they were, I still wouldn’t know how much was half.
6. It will give you the right amount but a syringe is so much easier to deliver the dose.
Shelly says
Ok, going to admit that I think I’m smart but would have to look most of this conversion up or ask my husband (who although never good at math, remembers all the conversions). Point well made and taken! I won’t be dosing much out at home without a laptop nearby and that’s sad isn’t it:)
shelly Butler says
I’m the second “shelly” to answer this post today. SHELLY POWER!! WE ROCK AT TESTING!
ok, on to the math part. Prepare to watch me FAIL.
#1- um, no idea. what does “cc” stand for, anyway. I have a feeling it aint “carbon copy”.
#2- see first sentence of my answer to question #1.
#3- I have 3 syringes at my house that I’ve kept from my kids’ various illnesses over the years. I would go and look at my other syringes and see if I had the right one somewhere in my arsenal. If I didn’t, I’d go online and do a conversion. And I’d b%#*h quietly while doing it.
#4- No idea. So what I’d do here is I’d just start giving it to him and eyeball it as the days went on. If I thought it looked like I wasn’t going to have enough, I’d probably ask my husband if he thought it was enough and if he didn’t seem to know, I’d call the pediatrician’s office and ask for more, if applicable.
#5- Probably NOT, technically, but I could see myself doing it anyway. Especially if it were in the middle of the night. Or I’d go back to my dropper arsenal and see if I had the right one around somewhere.
#6- I would think so. but the fact that you are asking it makes me think the proper answer is “no”.
The fact is, I often “eyeball” my kids’ medications. (Yikes, I know.) Or I fill the dropper PRETTY DARN CLOSE to the right dose. (sometimes you gotta tip the jar and it’s so hard to nail it just right.)
I’m prepared to receive your wrath now, Dr. Wendy Sue. xo! S
suzan says
1. 1
2. 5
3. one and a half syringes
4. you technically should have exactly enough
5. No- not too accurate
6. yes, if you can get it in your kid that way
ok I think I got em all right but I have an advanced degree and a chemistry minor… HOW DO WE EXPECT parents to know this stuff? great topic mamadoc!
Natalie says
Without looking at anyone else’s answers….
#1 How many cc are in a mL?
1
#2 How many mL in a teaspoon?
5
#3 Without looking it up, tell me how you’d give your child 1 1/2 teaspoons of medicine using a 5 cc syringe the pharmacist gave you?
5cc +2.5cc
#4 If the doctor told you to give your child 1 tsp of medicine, twice a day, for 10 days, and the pharmacist gave you 100 cc of medicine, will you have enough?
yes
#5 Your pediatrician tells you to give your child 1/2 tsp of Children’s Motrin for pain. You loose the cap on the top of the bottle. You pull out a teaspoon from the silverware drawer. Filling up half way will likely work. Yes or No?
nope
#6 Your pediatrician tells you to give your child 1/2 tsp of Children’s Motrin for pain. You loose the cap on the top of the bottle. You pull out a set of measuring spoons from the drawer. You pick the “1/2 teaspoon” spoon. Will this work? Yes or No?
not sure, probably?
Lynette RN says
As a nurse I know the answers, so I decided to test my husband. My husband answered correctly. He answered #3 as “1 1/2 syringes or 5 ml + 2.5 ml . Total dose 7.5 ml, making sure I get the air bubbles out of the syringe” and #4 as “Yes, if you measure correctly, use the right tools and don’t spill any of the medicine.”
I’m an RN and when my husband and I had our first child I taught my husband about measuring medicine and using the right tools correctly. He originally thought it was okay to hold the little clear 15 ml measuring cup up in the air as he poured the liquid medicine into it.
I showed him that a better technique was to place the little measuring cup on the counter and to bend down to look at it at eye level to ensure the liquid would be level with the desired mark . He didn’t think it was that big of a deal until he realized he was consistently adding an extra half a teaspoon of liquid unintentionally by holding the cup in the air. He didn’t realize he had been tilting the cup back just a bit as he poured the liquid medicine into it.
He also learned that he needed to get the air bubbles out by flicking the syringe with the back of his finger and then pushing the air out to see the actual measurement of the liquid otherwise the dose was inaccurate.
As a parent, I’m pretty relaxed about most things, but when it comes to medicine dosages I think it’s important to be accurate.
Hope these tips help other new parents!
Ellen says
My patients and I are in big trouble if I get this wrong!
1. 1
2. 5
3. Fill to 5 and then 2.5
4. Yes, unless you spill
5. No
6. Better but not great
I work with patients from an underserved community. Many of their parents have both low literacy and low numeracy. Every time I tell a family how much medication to give I worry that the child will get the wrong amount. If writing a prescription for a medication that comes in multiple concentrations (tylenol, amoxicillin, many others) I NEVER tell families a volume, in case the pharmacy substitutes a different concentration. If I am giving a medication syringe (from our clinic supply) for a specific medication I try to find a Sharpie and mark the dose, that way there is not guessing involved.
Grandma says
Well gosh, this IS a test. I’d had to use the internet to find the proper answers to #1-5. But #5 & #6 are confusing, ’cause have no idea why the cap is important to the 1/2 tsp. dosage question…unless it is used as a measuring tool. Agree with @Jonathan that the syringe method (alt. to spoon, or cap?) delivers liquid medicine best to children.
Evelyn Hsu says
1. 1
2. 5
3. give 1.5 syringe-fulls (7.5 ml)
4. yes
5. no
6. yes
love the quiz!
Erin says
Future pediatrician here…let’s see how much I know!.
1. 1 mL
2. 4.928 = ~5cc
3. You’d fill one syringe (5cc) and then you’d fill half of another (2.5cc), which would give you your 7.5 cc dose.
4, You’d have exactly enough.
5. No. You’re risking inaccuracy.
6. Yes. Though, even still, using devices that aren’t designed to measure medicine is dangerous. Simply for inaccuracies. Too much of the dose could harm the child just as much or more as not enough.
Wendy Sue Swanson, MD says
Strong work, everyone. Thanks for taking the time to do the quiz and the time to think about the complexity that we present to patients by interchanging “tsp” with “cc” or “mL.”
Answer key is up and ready for your perusal. And yes, Shelly, you need to stop with the eye-balling…
Karen Stern says
Now that the answers are out….all those years of being a veterinarian (a lot like a pediatrician, as you know!), did help with the unit conversions. In medical school I always was amazed that dosing by weight mostly went away as we become adults (all animals are dosed by mg/kg body weight, no matter their age–of course puppies and other babies get lower doses per kg). Why would you and I need the same dose as a 300# football player? Guess it depends on the drug and its metabolism. Anyway, hope little O is recovering well. Fun quiz!
Paul Herman says
Oh lord, I drink too much wine for this kind of test. And I never could convert a cc to a ml or a tsp. But I know how to use a spoon. I have so many of those caps lying around, I would never have to resort to a spoon in the drawer. And I have so many syringes and stuff, too. I am very guilty of sloppy dosing on ibuprofen and stuff for my kids. But I was much more concerned with precision when they were younger. (Also, for the record, I cook and bake a lot, but I still have to check conversions and amounts and how much of this goes into that and how many of those make up another thing, so I don’t feel too bad that I can’t keep the mls and the ccs in my head.) xoxox
Kenneth says
I am a chemist, and had no idea how many cc are in a teaspoon. My usual answer to such a question is “who cares?” I have actually bugged nurses to tell me what I need to do in metric before – all the eyedroppers I’ve seen on all my kids meds are marked in metric. Doctors should never use any other units, IMO, to avoid just this confusion (and temptation to use a “tea spoon” from the kitchen.)
Nice quiz, which I’d have gotten maybe 2 answers right on, due to not knowing how much a teaspoon is (I was guessing 3-ish, thinking there were 3 teaspoons in a tablespoon, and 3 tablespoons in an ounce, then trying to remember how many ml to an ounce. I’d have gotten it right if I’d had remembered there are only 2 tablespoons in an ounce…)
A. Ayyappan says
5 ml or 5 cc is a teaspoonful?
Correct or wrong?