Mistakes in administering medication most common cause of harm to children

More than 70 children died and 20,000 suffered injury or harm following lapses in medical care in 2007-08.

A review of the safety of NHS care for children found more than 60,000 incidents reported to the National Patient Safety Agency (NPSA) in which they were put at risk. Two-thirds of the incidents caused no harm but almost one in 10 resulted in moderate or severe injury, including death.

The commonest problem was "medication error" in which the amount of a drug was wrongly calculated, resulting in an overdose to the child. In 237 cases the child suffered "abuse", either by a member of staff or someone else.

The agency said yesterday that 1.9 million children under 14 were admitted to hospital and 46 million were seen in general practice in 2007-08. "Most children are treated safely," it said.

However, the true number of children harmed is likely to be higher as only 4 per cent of all incidents recorded were reported from general practice, despite the vastly greater number of children treated in the community. "Improved reporting from this area is essential," the agency said.

Among the deaths, 39 were infants aged up to 27 days and 33 were children aged from 28 days to 17 years. The report said the deaths contained "avoidable factors where an unexpected incident occurred" but it was impossible to say whether it was a key factor in the fatal outcomes.

The NPSA began collecting details of incidents in which patients were put at risk in 2003 with the aim of helping the NHS learn from its mistakes. In that time it has received more than three million reports of errors and lapses in care affecting adults and children.

Yesterday it called on all NHS staff to follow its guide to increasing patient safety, including improving the administration of medicines. The NPSA's medical director Dr Kevin Cleary said: "The majority of patient safety incidents involving children were reported to have resulted in no harm or low harm. However we're hoping this constructive feedback will support all trusts and clinicians in delivering even safer clinical care to all NHS patients in the future."

Children aged up to four had the highest number of reports of medication errors of any age group, except the over-85s. The biggest risk is getting the dose calculation wrong. Errors involving a wrongly placed decimal point have resulted in children receiving 10 times the dose intended.

Children also suffered harm as a result of delays in treatment, being given the wrong treatment, or mistakes in carrying it out. In one case, described in the report, a child admitted to hospital with a severe infection following chicken pox was not recognised to be seriously ill until it was too late and the child died. In another case, a child with haemophilia, the blood clotting disorder, was taken to an accident and emergency department following an injury and required a blood transfusion. But no one knew how to give it to a child with the bleeding disorder.

Other injuries involved children who slipped, fell or tripped while walking or running through the hospital. The report says: "Five children die every week in England from accidents and over 2,000 children a week are admitted to hospital because of accident-related injuries. It can therefore be anticipated that children will be at risk of accidents while in hospital and appropriate safeguards should be in place."