Difficulty Administering OTC Acetaminophen and Ibuprofen in Children Leads to Dosing Errors


Community pharmacists have a unique opportunity to counsel caregivers on liquid OTC children’s products.

Studies indicate that more than 40% of caregivers make dosing errors when administering liquid medications to children.1

Poorly designed dosing instruments (oral syringes, dosing cups, droppers) coupled with health literacy challenges increase the risk of improper dosing. A new study published in Exploratory Research in Clinical and Social Pharmacy validated this relationship.2 The study sampled 14 pediatric OTC acetaminophen and ibuprofen liquid products for package readability, consistency between recommended dosing and oral syringe markings, and value of supplemental online resources.2

Mother giving medicine to sick small daughter at home, coronavirus concept.

Image credit: Halfpoint | stock.adobe.com

The packaging on all sampled products included all key FDA-required sections except for a pictographic dosing chart, likely due to space constraints. In addition, the authors discovered significant inconsistencies with product package dose recommendations and accompanying oral syringe dose markings.2

The authors recommend caregiver education begins with the provider. Pharmacists and other providers should clearly explain diagnoses and indications, pharmacologic and non-pharmacologic treatment plans, and communicate updated assessment values, particularly patient weight. Furthermore, practitioners should be cognizant of rounding prescribed doses for ease of administration. In one study at a large academic medical center, a review showed that 12.5% of pediatric liquid medications were unrounded.2

Additionally, community pharmacists have a unique opportunity to counsel caregivers on liquid OTC children’s products. Caregiver health literacy challenges may include language barriers and readability of package materials, including understanding how to use the dosing instruments.2

Pharmacists should employ communication strategies such as teach-back methods and demonstrations with dosing instruments. Likewise, pharmacists can provide printouts and present caregivers with recommended online supplemental resources. For example, the American Academy of Pediatrics website healthychildren.org provides pictograph dosing charts for common liquid OTC children’s medications and tips for proper administration techniques.3

Last, the authors recommend expanding product and resource availability into other languages to assist diverse communities.2 The combination of comprehensive communication and counseling from the provider’s office to the pharmacy will improve dosing administration outcomes in pediatrics.

About the Author

Emilia Welch, PharmD, MBA, is a pharmacist at Walgreens in Connecticut.


  • Shonna Yin H, Dreyer BP, Moreira HA, et al. Liquid medication dosing errors in children: Role of provider counseling strategies. Acad Pediatr. 2014;14(3):262-270. doi:10.1016/j.acap.2014.01.003
  • Loehfelm AM, Maxfield HA, Wallace LS. Do pediatric oral suspension acetaminophen and ibuprofen product labeling and online resources facilitate intended use? Explor Res Clin Soc Pharm. 2023;12:100360. doi:10.1016/j.rcsop.2023.100360
  • How to use liquid medicines for children. Healthychildren.org. Updated October 11, 2021. Accessed December 22, 2023. https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Using-Liquid-Medicines.aspx
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