Pediatric Prescriptions: The Specific Errors to Watch For

Medication errors in children are more common than in adults because doses vary by weight, formulations change (syrup vs tablet), and communication between parent, pharmacy, and doctor sometimes slips. A specific approach at each prescription reduces errors substantially — and none of it requires more than a minute of attention.

The specific errors that recur

• Dose calculation error — mg/kg wrong or applied to wrong weight.
• Formulation confusion — 250 mg/5 mL syrup dosed as if 125 mg/5 mL.
• Frequency error — TDS vs BD misread.
• Duration error — 5-day antibiotic taken for 3 or 10.
• Wrong measuring device — teaspoon (5 mL) vs dessertspoon (10 mL) vs syringe (calibrated).
• Two similar-sounding medicines confused at pharmacy.
• Old prescription reused for new illness.

What to verify at each prescription

• Field: Child's name and age/weight · Check: Correct child, current weight
• Field: Medicine name · Check: Salt name, not brand alone
• Field: Strength · Check: e.g., 125 mg/5 mL for syrup
• Field: Dose · Check: How much per dose
• Field: Frequency · Check: How often (times/day)
• Field: Duration · Check: How many days
• Field: Route · Check: Oral, topical, drops
• Field: Special instructions · Check: With food, timing, storage

The measuring device specific

• Always use calibrated oral syringe or measuring cup provided with medicine.
• Household spoons vary — never a reliable dose measure.
• Small doses (< 5 mL) better via syringe.
• Check calibration — some devices marked in mL, some in teaspoons.
• Rinse device thoroughly between uses.

The paediatric-specific dose rules

• Most doses calculated per kg body weight.
• Update dose as child grows — a dose right at 10 kg is under-dose at 15 kg.
• Maximum adult dose applies — don't exceed even if calculation suggests.
• Some medicines have age minimums (aspirin never under 16; ibuprofen not under 3 months).
• Some medicines age-inappropriate (codeine, tramadol not under 12).
• Antibiotic doses may be higher per kg in children than adults.

The specific antibiotic considerations

• Complete the course as prescribed.
• Refrigerate suspensions after mixing; use by expiry printed.
• Shake well before each dose.
• Don't share leftover antibiotics with siblings later.
• Watch for allergic reactions in first doses.
• Some antibiotics affect specific ages (tetracycline avoided under 8).

The pain medicine calculations

• Paracetamol: 15 mg/kg every 4-6 hours; maximum 60 mg/kg/day.
• Ibuprofen: 5-10 mg/kg every 6-8 hours; maximum 30 mg/kg/day.
• Formulations vary — check the specific product's mg per mL or mg per tablet.
• Chewables: don't crush; don't use in child too young to chew.
• Alternating paracetamol and ibuprofen: usually not necessary.

At the pharmacy — verification

• Confirm the strip/bottle matches the prescription.
• Check the expiry date.
• Ask about storage requirements.
• Confirm the measuring device is included.
• Ask any question about administration.
• Read the label at home before first dose.

What to record for each medicine given

• Medicine name and strength.
• Dose actually given.
• Time given.
• Response observed.
• Any missed doses.
• Any side effects.
• Course completion date.

The specific emergency medicine kit for children

• Paracetamol suspension appropriate for age.
• Ibuprofen suspension for children over 3 months.
• Oral rehydration salts.
• Thermometer.
• Chlorpheniramine or cetirizine for allergic reactions.
• Sterile bandages, antiseptic.
• Prescribed emergency medications (EpiPen, salbutamol) if applicable.

A well-documented medication log for a child becomes their medication history for life. What antibiotics they responded well to, which they reacted to, dose patterns — all inform future care.

References

• IAP — pediatric drug dosing
• AAP — medication safety in children
• WHO — pediatric medicines