Pediatric Medication Safety: Special Considerations for Children

Every year, 50,000 children under age 5 end up in emergency rooms because they got into medicine they shouldn’t have. Many of these cases aren’t accidents-they’re preventable mistakes rooted in assumptions that work for adults but are deadly for kids. Children aren’t just small adults. Their bodies process medicine differently, they can’t tell you when something feels wrong, and even a tiny mistake in dosage can turn a lifesaving drug into a lethal one.

Why Kids Are at Higher Risk

Children’s bodies are still growing. Their kidneys and liver, the organs that break down and flush out medicine, aren’t fully developed. That means even a correct dose for an adult could build up to toxic levels in a baby. A 2-year-old weighing 12 kilograms needs a completely different amount than a 14-year-old weighing 60 kilograms. That’s a five-fold difference in body weight-and if you get the math wrong, you’re not just off by a little. You’re off by a life-threatening amount.

One of the most common errors? Mixing up teaspoons and milliliters. A teaspoon holds 5 milliliters. If a parent gives 1 teaspoon thinking it’s the same as 1 milliliter, they’ve just given a five-times overdose. That’s not rare. It happens every day. And it’s not just about liquid meds. Pills, patches, eye drops-even vitamins and diaper rash cream-can kill a child if they get into them.

What Happens in Hospitals

In hospitals, pediatric medication errors are the leading cause of serious harm. The Joint Commission reports that 42% of all serious pediatric medication incidents are caused by weight-based dosing mistakes. That’s because many hospitals still use pounds instead of kilograms when calculating doses. One wrong decimal point, one misread number, and you’ve got a child on the wrong dose.

Top children’s hospitals now use strict rules to stop this:

• Weight must be entered and calculated only in kilograms
• Electronic systems block doses above safe upper limits
• High-risk drugs like morphine or insulin are prepared in distraction-free zones
• Two trained staff members independently check every dose before giving it

These aren’t suggestions-they’re now standard practice in over 78% of children’s hospitals following the 2018 American Academy of Pediatrics guidelines. But in general hospitals with fewer than 100 pediatric patients a year, error rates are 3.2 times higher. Why? Because staff aren’t trained often enough. They don’t see kids often. And they don’t have the systems built for them.

Home Medication Mistakes Are Even More Common

Most pediatric poisonings happen at home. Not in the ER. Not in the pharmacy. In the kitchen cabinet. On the nightstand. In the purse.

The CDC’s PROTECT Initiative found that 75% of children who get into medicine do so from storage locations their parents thought were “safe.” A locked cabinet? Great. But if it’s at eye level, or if the child climbed on a chair to reach it, it’s not safe. A study showed kids can open a child-resistant cap in under 30 seconds if it’s not fully clicked shut.

And it’s not just pills. Parents don’t think of cough syrup, eye drops, or prenatal vitamins as dangerous-but they are. One pill of a heart medication can stop a baby’s heart. A few drops of an opioid patch can cause breathing to stop. Even a single chewable vitamin with iron can cause organ failure in a toddler.

What You Should Never Do

There are simple rules that can save a child’s life:

• Never call medicine “candy.” Saying “this will taste sweet” or “it’s like gummy bears” teaches kids to seek out pills. That’s why 15% of accidental ingestions come from children who think medicine is food.
• Never use kitchen spoons to measure medicine. A teaspoon from your drawer holds anywhere from 3 to 7 milliliters. Always use the dosing cup, syringe, or dropper that came with the medicine.
• Never give cough or cold medicine to kids under 6. The FDA and American Academy of Pediatrics agree: these drugs don’t work for young kids and carry serious risks. The same goes for kids under 2-no exceptions.
• Never leave medicine out. Even if you’re just going to the bathroom. Even if you think your child can’t reach it. A child can climb, crawl, or pull down a bag in less than a minute.

How to Store Medicine Safely at Home

Safe storage isn’t about locking it up-it’s about making it impossible for a child to find or reach.

• Store all medicine, including vitamins and topical creams, up and away-not on counters, nightstands, or in purses.
• Use locks on cabinets. But don’t rely on child-resistant caps alone. They’re not child-proof-they’re child-resistant. And if they’re not snapped shut, they’re useless.
• Keep a list of all medicines in the house, including what’s in the bathroom, garage, or car. Check it monthly.
• Dispose of old or expired medicine properly. Don’t flush it. Don’t throw it in the trash. Take it to a pharmacy drop-off or a community disposal event.

How to Give Medicine Correctly

When it’s time to give medicine, follow these steps:

1. Check the label. Is it the right name? Right dose? Right child?
2. Use the device that came with the medicine. If it’s a syringe, use the syringe. If it’s a cup, use the cup.
3. Give the dose slowly, aiming toward the back of the cheek-not the tongue. This helps avoid choking and ensures the full dose is swallowed.
4. Write down what you gave and when. Use a chart or phone app. If you’re tired or stressed, you’ll forget.
5. Ask the pharmacist: “Is this safe for my child’s age and weight?” If they don’t know, get a second opinion.

Studies show that using pictogram-based instructions-simple pictures showing when and how to give medicine-improves correct dosing by 47% in families with low health literacy. Ask for them. They’re free.

Teach Your Child About Medicine

Kids learn by watching. If they see you take medicine every day, they’ll want to do it too. That’s normal. But you can turn that curiosity into safety.

• Teach them: “This is medicine. It helps grown-ups feel better. It’s not candy.”
• Keep medicine out of sight and reach-even when you’re home.
• If you use a pill organizer, keep it locked or in a high drawer.
• Don’t leave medicine in the car. Kids see it. They think it’s okay.

What to Do If a Child Gets Into Medicine

If you think your child swallowed medicine, don’t wait. Don’t call your doctor first. Don’t Google symptoms. Don’t try to make them throw up.

Call Poison Control immediately: 800-222-1222. That number should be saved in every phone in your house. Program it into your cell, your landline, your smart speaker. Keep it on the fridge.

Have this ready when you call:

• What the child swallowed
• How much
• When
• How old they are
• How much they weigh

Even if they seem fine, call. Some drugs take hours to show effects. And poison control experts know exactly what to do. They’ve seen it all.

What’s Changing in 2026

New rules are coming. The FDA now requires all new pediatric medications to come in standardized concentrations. That means no more “10 mg/mL” and “50 mg/mL” versions of the same drug. Just one. Fewer chances for mix-ups.

Pharmacies are also starting to dispense liquid medicines only in milliliters-with no teaspoons or tablespoons on the label. And more hospitals are training all staff-not just pediatric teams-on how to safely handle kids’ meds.

But the biggest change? Awareness. More parents are learning that medicine isn’t just something you take. It’s something you protect.

Final Thought

Medicine saves lives. But it can also take them-if we don’t treat it with the respect it deserves. For children, safety isn’t about being careful. It’s about being systematic. It’s about checking, storing, measuring, and talking about medicine like it’s a loaded gun. Because in the hands of a curious child, it is.