This study analyses the difficulties and errors made by parents when administering oral medication to their children at home. Erroneous practices have been discovered through our study, such as the use of inappropriate tools to give medicine to children, the use of over-the-counter medications, the administration of medications at incorrect intervals, and incorrect practices when the child did not like taking oral drugs, such as mixing the drugs with food or opening tablets.
The study results showed that children liked taking tablets less than liquid drugs. 55.5% of the children refused to take liquid medicine, and only 25.2% refused to take tablets. Boztepe et al  reported that 24.5% of their participants had children who did not like taking oral liquid drugs, whereas only 19.4% did not like taking tablets. Accordingly, tablets were refused less frequently than oral drugs. All participants of the study had tried liquid medication for their children aged between six months and ten years, but only 39.2% had tried tablets for the same age group.
A child’s adaptation to their drugs may be adversely affected by many factors, including the unpleasant taste , and this maladaptation could create difficulties for the parents when giving medications to their children. Parents try to overcome the problem using many alternatives, such as mixing the drug with milk or with their children’s favourite food or juice. In our study, 7.5% of the participants tried mixing tablets with food, and 5.2% tried mixing the liquid drug with food. Drug efficacy and food absorption may be reduced when mixing drugs with certain foods [26, 27]. 21.5% of the participants in our study tried mixing liquid medicines with juice, which may have adverse effects on the absorption, bioavailability and serum concentrations of some medicines. Kane and Lipsky  conducted a study about grapefruit-drug interaction, and reported that the serum concentrations of some drugs, such as cyclosporine, tacrolimus, and carbamazepine, were elevated if they interacted with grapefruit juice; these drugs have severe side effects depending on the dose, so the alteration of serum concentrations due to interaction with grapefruit juice may have side effects.
A collection of 60 drugs or more was established to have side effects if taken at the same time as, or even many hours after, taking a small amount of grapefruit juice . 30.2% of the participating parents with children who did not like taking tablets crushed the capsules in order to administer them to their children. Treatment effectiveness can be altered when crushing tablets, which may alter the absorption of the drug, therefore increasing or decreasing its serum level, which may lead to serious side effects .
Dosing errors in children are common, because dosing for children needs to be assessed individually based on many factors, such as the patient’s age and weight . In this study, it was established that 21.7% of the participating parents used a teaspoon to give liquid medicine and 7.1% used a tablespoon, which may result in incorrect doses. Falagas et al  recommended that tablespoons and teaspoons should not be used due to their inaccuracy in dosing. In addition, 12.4% of the participating parents gave medicines with doses greater than that prescribed by the doctor in order to treat their children more quickly, which may in most cases lead to minor side effects, but also to hospitalisation or fatal side effects. Strenuous efforts are essential to prevent drug overdoses, which have recently become a leading cause of hospitalisation .
91.9% of the participating parents in our study reported using drugs without a prescription from a doctor for their children, with antipyretics being the most common. 36.8% of those using OTC medicines had given influenza drugs to their children and 28.2% cough drugs. Gunn et al  studied the toxicity of over-the-counter cough and cold drugs over a thirteen month duration; they showed that one in three cases presenting adverse events ended with death due to the use of over-the-counter cough and cold drugs, which means that these drugs are significantly associated with morbidity and mortality; If used acutely in overdoses or even chronically in correct doses. The use of non-prescribed antibiotics (26.4%) is also a serious issue because it may mask underlying infectious processes, and contribute to the global emergence of antibiotic resistance. Antibiotics use has recently become a problem, especially in developing countries .
Surprisingly, when the participating parents were asked how to give a drug three times a day, only 19.5% know that it should be given every 8 hours, which means that the other 80.5% give the medications at incorrect intervals. Drug administration at incorrect intervals is a form of medication administration error. To ensure that serum drug levels are therapeutic, parents should administer drugs at the correct time .
This study has several limitations. The ability to generalise the study’s results to all Palestinians is limited because it was conducted only in Nablus. Different areas of Palestine should therefore be included in future studies for more representative results. Secondly, certain phenomena, such as the effect of the researcher being present when answering questions, may result in biases which cannot be controlled. This is also a cross sectional study and causal relationships between variables could not be established. Lastly, the use of convenience sampling may have led to bias in the conclusions.