When your child gets a new prescription, the label might say 10 mL - but that number alone doesn’t tell you if it’s safe. What matters is the milligrams of medicine, not the volume. A dose that looks tiny to an adult could be perfect for a 20-pound toddler. And one wrong decimal? It could mean a dangerous overdose.
Every year, thousands of children in the U.S. and New Zealand face preventable harm because dosing errors slip through. The Institute for Safe Medication Practices found that kids get medication errors three times more often than adults. Half of those errors are dosing mistakes - not because doctors are careless, but because the math is easy to mess up. Weight conversions, concentration confusion, rounding errors - they all add up. But you don’t need to be a pharmacist to catch them. Here’s how to confirm pediatric dosing on a child’s prescription label, step by step.
Start with the child’s weight in kilograms
The first thing you should see on the label is the child’s weight - but not in pounds. It has to be in kilograms (kg). Since 2024, the American Academy of Pediatrics has required all pediatric prescriptions to include the weight in kg. If you see only pounds, ask the prescriber or pharmacist to rewrite it.
Why? Because all pediatric doses are calculated in mg/kg. That means milligrams of medicine per kilogram of body weight. If the label says “40 mg/kg/day,” and your child weighs 10 kg, the total daily dose is 400 mg. If the weight is wrong, the dose is wrong. A 2022 study showed that 22.4% of dosing errors came from incorrect weight conversion - like using 1 kg = 2 lb instead of the correct 1 kg = 2.2 lb.
Double-check the weight yourself. If your child was weighed at the clinic, ask for the exact number. If you’re unsure, use a home scale and convert: divide pounds by 2.2. A 33-pound child is 15 kg (33 ÷ 2.2 = 15). Write that down. Keep it on your phone or in your wallet.
Find the dose in milligrams - not milliliters
Many parents think “10 mL” means 10 mg. It doesn’t. That’s like thinking a cup of water is the same as a cup of sugar. The volume (mL) tells you how much liquid to give. The milligrams (mg) tell you how much medicine is in it.
Look for two numbers on the label:
- The total dose per administration - e.g., 200 mg
- The concentration - e.g., 80 mg/mL
If the label only says “Give 10 mL,” stop. That’s not enough. Ask: “What’s the total milligram dose?” If they can’t tell you, it’s not safe. In a 2022 BMC Pediatrics study, 43.5% of preventable adverse events in children happened because someone confused mL with mg.
Example: Amoxicillin for an ear infection. The prescription says: “Give 10 mL of 80 mg/mL.” That’s 800 mg total. But if your child’s dose is supposed to be 200 mg, that’s a 4x overdose. The label should also say: “Dose: 200 mg per dose.” That’s your safety net.
Verify the dose matches weight-based guidelines
Now that you have the weight (kg) and the dose (mg), check if it fits standard ranges. For common antibiotics like amoxicillin, the typical dose is 40-90 mg/kg/day, divided into two or three doses. For acetaminophen, it’s 10-15 mg/kg/dose every 4-6 hours.
If your child weighs 15 kg and the dose is 300 mg every 6 hours, that’s 1,200 mg/day. Divide by weight: 1,200 ÷ 15 = 80 mg/kg/day. That’s within the safe range for amoxicillin. If it’s 500 mg per dose? That’s 1,333 mg/kg/day - way too high.
Use the Davis’s Drug Guide or the American Academy of Pediatrics dosing charts as your reference. Many pharmacies have printed versions. If you’re unsure, call the pharmacy. Pharmacists are trained to catch these things - and they’re required to double-check every pediatric dose.
Check the concentration - it changes between brands
This is where most parents get tripped up. The same medicine can come in different strengths. Amoxicillin, for example, is sold as:
- 250 mg/5 mL (50 mg/mL)
- 400 mg/5 mL (80 mg/mL)
- 125 mg/5 mL (25 mg/mL)
If the prescription says “200 mg,” and you grab the 80 mg/mL bottle, you need 2.5 mL. But if you accidentally pick up the 25 mg/mL version, you’d give 8 mL - a 3x overdose. That’s not a mistake you can afford to make.
Always read the concentration on the bottle. Write it down. Match it to the label. If the label says “80 mg/mL” but the bottle says “25 mg/mL,” do not give it. Call the pharmacy immediately. The CDC found that 37.2% of liquid medication errors in children under 2 happened because of concentration confusion.
Use the right measuring tool - never a kitchen spoon
Every pediatric liquid medication comes with a syringe, cup, or dropper. Use it. Never use a teaspoon, tablespoon, or any kitchen utensil. A teaspoon holds 5 mL, but it’s rarely accurate. A tablespoon? That’s 15 mL - and if the dose is 10 mL, you’re giving 50% too much.
Pharmacists are trained to give you the right tool. If they don’t, ask. Make sure it’s marked in milliliters, not fractions. Some syringes have lines for 0.1 mL - use them. If the dose is 1.8 mL, don’t round it to 2 mL unless the pharmacist says it’s safe.
Why? Because rounding matters. Cerner and EPIC electronic systems have rules: doses under 10 mg are rounded to the nearest 0.1 mg. Above 10 mg, they round to the nearest 1 mg. But that’s for computers. For parents? Always give the exact amount. If the dose is 1.6 mL, give 1.6 mL - not 1.5 or 2.0.
Ask the three critical questions
When you pick up the prescription, ask these three questions out loud:
- “What is the exact dose in milligrams, not milliliters?” - This forces them to state the mg amount.
- “Is this dose appropriate for my child’s current weight?” - This triggers the pharmacist’s verification step.
- “Can you show me how to measure this dose with the provided device?” - This ensures you understand the tool and the volume.
These questions aren’t rude. They’re lifesaving. A 2023 Reddit analysis of 1,247 parenting threads showed that 68% of parents felt unsure if the dose was right. Only those who asked these questions caught errors before giving the medicine.
One mother in Auckland found a 2.5x overdose because she asked: “What’s the total mg?” The label said “10 mL,” but the concentration was 80 mg/mL. The correct dose was 200 mg - meaning only 2.5 mL. She caught it because she asked.
Know when to call for help
You don’t have to be an expert to spot danger. If any of these happen, stop and call:
- The dose looks too small or too big for your child’s size
- The label doesn’t list the weight in kg
- The concentration isn’t clearly printed
- You’re asked to give a dose in mL without knowing the mg
- The pharmacy gives you a new bottle without explaining the change
Call your pediatrician, your pharmacist, or the national poison control line. In New Zealand, it’s 0800 POISON (0800 764 766). They’re used to these calls. They’d rather you call five times than miss one mistake.
Technology can help - but don’t rely on it alone
Hospitals now use AI tools like DoseSpot and smart EHR systems that check doses against 15,000+ guidelines. These systems are 99% accurate. But they’re not in your home. Your phone doesn’t have them. Your pharmacy’s printer might not show the full calculation.
That’s why your eyes and your questions matter more than any app. You can download dosing apps like Medscape or Epocrates, but they require you to enter the weight and concentration manually. If you enter the wrong number, the app gives you the wrong answer.
Use tech as a backup - not your only safety net. Your brain, your checklist, your questions - those are your real tools.
Parents who saved their kids
A mother in Wellington noticed her 18-month-old’s acetaminophen label said “160 mg/5 mL.” But the bottle she had at home said “80 mg/0.8 mL.” She thought they were the same. She didn’t realize the second one was more concentrated. If she’d given the same volume, it would have been a 3x overdose. She called the pharmacist. They showed her the difference. She kept the right bottle.
A dad in Christchurch saw his 4-year-old’s amoxicillin dose was written as “10 mL.” He calculated the mg: 80 mg/mL × 10 mL = 800 mg. His child weighed 16 kg. 800 ÷ 16 = 50 mg/kg/day - way over the 40-90 mg/kg/day limit. He called the clinic. The doctor had meant 10 mL of 40 mg/mL, not 80 mg/mL. A simple typo. Saved by a dad who did the math.
These aren’t rare stories. They’re common. And they’re preventable.
You don’t need to be a doctor. You just need to know what to look for - and the courage to ask.
