COMMENTARY Identifying and Advancing Best Practices for the Labeling and Dosing of Pediatric Liquid Medications: Progress and Challenges H. Shonna Yin, MD, MS; Carrie Vuong, BA; Ruth M. Parker, MD; Lee M. Sanders, MD, MPH; Alan L. Mendelsohn, MD; Benard P. Dreyer, MD; Jessica J. Velazquez, BA; Michael S. Wolf, PhD, MPH From the Department of Pediatrics (HS Yin, C Vuong, AL Mendelsohn, BP Dreyer, and JJ Velazquez), NYU School of Medicine-Bellevue Hospital; Department of Population Health (HS Yin and AL Mendelsohn), NYU School of Medicine, New York, NY; Department of Medicine (RM Parker), Emory University School of Medicine, Atlanta, Ga; Department of Pediatrics (LM Sanders), Stanford University School of Medicine, Stanford, Calif; and Division of General Internal Medicine and Geriatrics (MS Wolf), Northwestern University Feinberg School of Medicine, Chicago, Ill The authors have no conflicts of interest to disclose. Address correspondence to H. Shonna Yin, MD, MS, Department of Pediatrics, New York University School of Medicine, 550 First Ave, NBV 8S4-11, New York, NY, 10016 (e-mail: yinh02@med.nyu.edu). Received for publication April 12, 2018; accepted July 28, 2018. ACADEMIC PEDIATRICS 2019;19:1-3 WHAT’S NEW The National Institutes of Health-funded Safe Administration for Every Rx for Kids study has identified best practices for the labeling/dosing of pediatric liquid medications. Findings support use of pictographic instructions and optimized dosing tool provision, and careful selection of the unit of measurement used. PARENTS AND CAREGIVERS frequently make errors when dosing liquid medications for their children. Vari- able units of measurement (eg, milliliter, teaspoon, tablespoon) used by prescribers and manufacturers, along with lack of standardization of their associated abbreviations, contributes to confusion. For a single pre- scription, the units presented as part of medication counseling often differ from those printed on the pre- scription, the bottle’s label, or dosing tool. In addition, parents may not realize that kitchen spoons are error prone and may not know how to use standardized tools with markings to guide dosing. Over the past decade, growing attention has been paid to identifying labeling/ dosing strategies to reduce medication errors in children. In 2008, the Centers for Disease Control and Prevention launched the PRevention of Overdoses and Treatment Errors in Children Taskforce (PROTECT) initiative 1 ; standardization of liquid medication dosing has been a key area of focus. The National Institutes of Health- funded SAFE Rx for Kids (Safe Administration for Every Rx for Kids) study sought to identify best practi- ces for the labeling/dosing of pediatric liquid medica- tions to inform the development of evidence-based standards, with results presented annually to stakehold- ers at PROTECT meetings beginning in 2013. In February 2016, we submitted findings from the first phase of the SAFE Rx for Kids study to Academic Pediat- rics. We found that parents had a fourfold increased odds of choosing a kitchen spoon when presented with prescrip- tion instructions that used teaspoon units compared with parents who looked at prescription instructions in milliliters only (ie, “mL” only). 2 These findings showed that by including teaspoon units on labels, providers are inadver- tently endorsing the use of kitchen spoons. Kitchen spoons have long been recognized to contribute to parent dosing errors because they vary widely in size and shape. In this commentary, we provide readers a progress report on the topic since our original publication in this journal. In September 2016, we published additional results from a SAFE Rx for Kids experiment that sought to assess the impact of units of measurement and dosing tools on dosing errors. Parents were randomly assigned to 5 groups that varied based on the combination of units included with dosing instructions on the prescrip- tion label and the units shown on the accompanying dosing tool. Parents were asked to measure 3 dose amounts with 3 dosing tools (9 total doses). Use of the teaspoon-only label was associated with more dosing errors compared with the use of milliliter-only labels/ tools (ie, “mL” only). 3 Oral syringes were associated with fewer errors compared with dosing cups, ACADEMIC PEDIATRICS Copyright © 2018 by Academic Pediatric Association 1 Volume 19, Number 1 January-February 2019