Over the counter (OTC) liquid medications for children are packaged with a diverse set of various measuring tools. The dropper that comes with liquid acetaminophen (Tylenol) will look very different than the dropper that comes with liquid Vitamin D or infant multivitamins. Even more discrepant are all the various caps for medications used in older children like liquid Motrin or Benadryl. If your cabinet looks anything like mine, caps and syringes are scattered about and distant from the bottle with which they were originally packaged. Because of this, many of us get confused when dosing medications for children. It’s time OTC liquid medications for children were packaged with a universal dosing device. And….time that pediatricians and all physicians be required to use only one unit of measurement (whenever possible) to avoid ongoing confusion for prescription medications, too. A new study functions as a wake-up call for drug makers and pediatricians alike; we need to do a better job helping families learn how to safely dose OTC liquid medications for infants and children. Current practice isn’t going to cut it.

A recent study in JAMA found… that although the FDA recommended that all OTC medications to be packaged with a dispensing device in 2009, only 74% of the OTC medications for children come with a measuring spoon or syringe. And more, researchers found that 98% of liquid OTC medications for children have inconsistencies, excess information, or confusing dosing instructions. Clearly, clarity is an issue for nearly all OTC medications for children.

Dosing medications for children shouldn’t be this confusing. While we can easily standardize doses for adults, medications for children are based on their mass or weight. We worry about over-dosing children. But we worry about under-dosing children, too. I hate to think of families under-dosing fever reducers or pain relievers and thus not adequately treating a child. The child suffers more. We can do better for our children. But some changes are essential.


  • Only 148 of 200 OTC liquid medications studied came with a syringe or cap to dose the medicine, meaning only 74% of these medications complied with FDA 2009 recommendations for safety.
  • The 200 medications tested represented 99% of the market share of liquid medications for children.
  • Of the 148 medications that had a dispensing device, 83% of medications came with a cap, 13.5% with a dropper, and 2.7% with an oral syringe.
  • “Nearly all products examined (98.6%) contained 1 or more inconsistencies between the labeled directions and the accompanying device with respect to doses listed or marked on the device, or text used for unit of measurement.” Translation: nearly all medications had inconsistencies, superfluous information, or confusing dosing instructions. An example of excess information included medications that called for dosing in teaspoons with doses ranging from 1-2 tsp. The cap included had markings for up to 4 tsp, a dose that would never be recommended.
  • Drugs that didn’t come with a syringe or cap were often medications used for both children and adults or for gastrointestinal complaints.

Tips On Improving How You Dispense OTC Medications:

  • If you’re unsure about how to dose a particular medication for a child, call your pediatrician’s office, talk with your local pharmacist, or call the nursing line for help.
  • Don’t use a spoon from the kitchen to dose medications. Ever. There is mountain of studies that finds this is dangerous for children.
  • It’s always okay to ask! No question about dosing medications is silly, simple, or stupid. Ever. The study mentions that 1 in 3 US adults and at least 1 in 4 US parents have limited health literacy; an even greater percentage have poor numeracy. Measuring out medications with confusing instructions may be difficult for many of us.
  • Bring OTC medications from your home to the well child check or acute care visit with your pediatrician. If you have any question about how to dose them, review it. It is common to be confused (!) and the pediatrician can help you understand how to dose medications safely and effectively while instructing you with the tools/syringes/caps you have in your home.