Parents using dosing cups had four times the odds of making a dosing error, compared to when they used an oral syringe and that the most common mistake was overdosing: 68 percent of the participants gave too much medicine, rather than too little.

Children should receive their liquid medications only through milliliters to reduce dosing errors, according to a policy statement from the American Academy of Pediatrics. The AAP recommends medicine to children be administered by a syringe with flow restrictions, but cups and spoons are acceptable, as long as the dosage is marked in milliliters.

The AAP’s research found that more than 70,000 children went to the emergency room because of unintentional medication overdoses.

The AAP says parents should not be using household spoons or any other measuring device to give kids their medicine, other than measuring in milliliters (mL).

“Sadly, some may feel that liquid medication accuracy just isn’t very important. They may think, ‘It’s just cough syrup or to reduce fever,’” said Jason Evans, a pharmacist at Cook Children’s. “While an adult may be able to tolerate a huge discrepancy from a dessert spoon, a child can be seriously hurt or even killed. There have been several children fatally overdosed in this manner from mere cold medication. “

Household spoons simply aren’t accurate. Three teaspoons are in one tablespoon and a household teaspoon can vary in size. Depending on the spoon, a parent can give a child as little as 2 mL and much as 8 mL, when the intended dose was actually 5 mL. That large discrepancy is the danger that has made the AAP take this stance.

Evans said most hospitals have been using the mL standard for 10 to 20 years because it’s a much safer practice and avoids errors. Cook Children’s follows the mL system, even for oral syringes.

“We don’t have teaspoon or tablespoon markings anywhere,” Evans said. “Syringes are more accurate than dosing spoons and dosing cups. There is scientific evidence for this. Now, we just need to complete the puzzle and use the same terminology for patients at home.”

Evans gives the following advice to parents:

• Know your child’s medication in terms of the metric system.
• Ask your pharmacy for a medication syringe, not a dosing spoon or cup.
• Use a medication syringe, even if a dropper came with your prescription.
• Ask for a bottle adapter that will allow you to turn the bottle upside down to draw out the medication.
• Hand wash syringes to avoid melting or rubbing the markings off.
• Ask your pediatrician or pharmacist if you are confused about how much medication to give.
• It might not just be the parent giving the medications. If necessary, have your babysitter or other caregivers (e.g. grandparents) demonstrate to you how to measure the medication with the syringe.

Read more from the American Academy of Pediatrics on this topic here.

The obsessively clean freak with a dozen napkins at meals and the dust pan and broom standing by! I see the crumbs falling to the floor, the grape jelly graze the side of the chair, and the sticky fingers raking through the hair as my daughter enjoys her meal.

As a feeding therapist, I know as her skill in feeding develops so will the awareness of her fingers, hands, face and mouth. 

I MUST wait until she is finished before I attack with my arsenal of cleaning supplies. Sitting with her, eating with her, and having fun with her while she explores her dinner are the best things I can do as a parent.

Maybe you’re wondering, “Will my walls always be covered in food splatters?” or “Why does she continue to refuse foods I know she should be eating to have a well-rounded and varied diet?” “Does everyone’s baby require a bath after each and every meal?” “Is it normal for more food to be in her hair than in her mouth?”

Take comfort, mama. You are not alone in your exasperation when it comes to feeding your child while trying to maintain some semblance of tidiness in your kitchen.

Did you know that a baby’s mouth and hand have the highest number of sensory receptors per square inch than any other part of the human body?

That means the mouth and hands are the most sensitive parts of the body when it comes to what the brain can take in and learn.

So what does this all mean for your dinner table? Put away the fine china and good linens and get ready to embrace the mess. Researchers in the UK "found that playing with food may actually help kids overcome a fear of new flavors and eat a more varied diet, a small study suggests."

Children need the chance to explore new foods and textures with all five senses. In a perfect sensory world, your little one should have the opportunity to touch, smell, and taste new foods unabashedly. So, set the paper towels aside and join in the fun!

Your child will “learn” both good and bad habits depending on the mealtime experiences they are afforded.

For instance, if your child is given peanuts and experience an allergic reaction, he will most likely begin to refuse peanuts!

Alternatively, if broccoli and green beans are offered during a family meal in a way that is fun and supportive, you might find your little guy eating them with gusto! But, don’t be disheartened if he turns his nose up at beets the first time you present them.

Research has shown children may instinctively refuse new foods to survive simply because they are new. In addition, it can take up to 15 presentations before a food is deemed worthy in your child’s eyes. However, with good exposure, no illness or bad consequences, and repetition, children will learn many foods are safe to eat!

What can you do to help your child become a magnificently messy and healthy eater?

1. Make meal times a routine at the table, in their chairs, with NO distractions.
2. Allow your child to explore the foods that you’ve given him with the opportunity to say, “I don’t like this” without consequences.
3. Don’t set your sights on the spoon: allow him to eat with his hands!
4. Let him PLAY! Think finger painting with yogurt or building a tater tot tower.
5. Relax while he digs in and gets his hands dirty. He is learning about the different properties of the foods we eat when he touches, smells, tastes, and looks at the foods that are on his plate.
6. Keep offering the foods you desire him to eat. Remember, experts have found it may take your child 15 times of trying a food to decide how they really feel about it.
7. Lead by example! Tuck into the meal with your child. It is important for our littles to see us eating the same things we are asking them to eat.
8. Try to have as much fun at the table as possible while still enforcing the rules of “manners”. Talk about your day, talk about your food, smile, laugh, and make faces in your cheese. 

Your child may not have developed the oral motor or sensory skills to support a healthy, well-rounded, adult-like diet. Be on the lookout for the following feeding “red flags”:

• Drowsiness or sleepiness at every feeding.
• Poor oral tolerance (spits food out, shuddering, gagging, vomiting)
• Able to chew but prefers liquids
• Frequent gagging
• Coughing and/or choking

If one or more of these signs describes your child, consider talking with your pediatrician about your concerns and a possible feeding evaluation.

Satter, E. (1987). How To Get Your Kid To Eat…But Not Too Much. Boulder, CO: Bull Publishing Company

About the author

Melanie Van Noy is a speech pathologist at Cook Children's.Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury.

I must get this question three to four times a day in the office and it's one of those things that keeps you up all night wondering what you should do. The answer, "There is no fever you should go to the ER for..."

That doesn't mean that children with fever don't sometimes need to go to the ER, but the height of the fever is not an indication that a late night drive and time in the ER wait is the right thing to do.

We always want to take the fever into the context of the following questions:

1) What are the other symptoms that the child is having?

• Runny nose, cough? Probably not.
• Abdominal pain? Depends on severity an location.
• Vomiting? Not if can keep some liquids down and still peeing.

2) What is the child's behavior like? Lethargic or active. Is the child laying around all day, not even really wanting to wake up to drink or do they perk up and act like they feel better at times (especially when their fever is down). If they are lethargic, bring them in.

3) Is the child drinking and peeing?  If so, then we will almost always recommend a call to the office over an ER trip.

Common fever myths:

"The child's brain will be fried if the temperature is over 105." Ummm. No. Temperatures that the body is generating on their own as a response to illness will not cause brain damage or any of the other things that your grandmother/neighbor/best friend said they would. We commonly have children with 105-106 temps walk in and out of our office smiling cause they got their stickers for being a good boy/girl.

"If the fever gets above 103 they will have a febrile seizure." Wrong again. In fact, most febrile seizures occur when the temperature is between 102 and 103. We don't know exactly why this is but it is thought that it is related to the rate that the temperature rises and not the absolute number that the temp gets to.

"The baby felt warm so she had a fever" or "The baby was really hot so the temperature must've been about 104." Sorry to the back of grandma's hand, but judging the temperature especially trying to put a number on it by touching a child's head is incredibly unreliable. I would prefer an axillary or temporal thermometer, or in the babies less than 3 months, I'll commonly ask for a rectal temp.

"He had a low grade temp of 99" or "99 is hot for him because he usually runs 96." “Low grade temp” should really be taken out of our vocabulary. They have done studies where they took children's temperatures several times a day and have found that any temp <100.5 in a child less then 3 months and <101 in an older child should not be considered fever. These are normal temperatures that can occur during the course of the day for any child who is healthy and has no reason to be running fever.

So, what temps should I call for?

• Any temp over 100 in a baby less than 3 months.
• Any temp in a child who is not drinking well and with decreased urine.
• Anything else that has you concerned.

The ultimate point is that we should not be afraid of fever. Fever is just another symptom in a long list of possible symptoms a child can have when they are sick. It means that we need to think about what is going on and watch the child close but resist the urge to panic!

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.