Current utilization and challenges of pediatric administration devices in China: a nationwide survey

Background Medical administration devices are essential for the safe and accurate delivery of pediatric medicines yet handling and dosing errors remain common in clinical practice. Whilst European surveys have documented healthcare professional (HCP) perspectives on oral and respiratory administration devices, no equivalent data exist for China.Objectives This study aimed to examine the views, practices, and experiences of Chinese hospital-based HCPs regarding oral and respiratory pediatric administration devices, and to identify challenges, age-appropriate device use, and priorities for improvement.Methods An electronic self-administered questionnaire, adapted from the validated EuPFI HCP survey, was distributed to pediatric HCPs across 23 provinces and municipalities in China. The survey covered device administration practices, frequency and type of devices supplied, age-appropriateness of devices, training and demonstration practices, adequacy of instructions, and reported difficulties. A total of 600 questionnaires were distributed, of which 107 valid responses were retained for oral device analysis and 104 for respiratory device analysis. Statistical analysis was performed using SPSS version 22, GraphPad Prism 10 and WPS, with chi-square tests, Fisher’s exact tests, Mann–Whitney tests, Friedman tests, and Kruskal–Wallis tests applied as appropriate. A thematic coding approach was applied to open-ended responses. A sensitivity analysis was conducted on several key data after excluding Shanghai.Results 41.1% of respondents reported routinely supplying oral administration devices to pediatric patients, compared with 87.5% for respiratory devices. In contrast to European findings where oral syringes predominate, measuring cups were the most frequently supplied oral device in China (mean 9.8 times per week versus 4.7 for oral syringes, p = 0.0009), a pattern reflected in the parallel Chinese caregiver survey. Doctors supplied oral devices significantly more frequently than pharmacists (60.0% versus 24.6%, p = 0.0003). For respiratory devices, solution for nebulization and/or nebulizer was the most frequently provided across all age groups, with facemask for inhaler or nebulizer considered appropriate from birth and dry powder inhaler emerging as the predominant device in children aged nine years and above. Age-dependent patterns of device use were broadly consistent with international recommendations. Only 15.0% of HCPs always explained or demonstrated oral device use to patients, compared with 43.3% for respiratory devices (p = 0.0036). The most frequently reported difficulties with oral devices were trouble measuring the correct dose (52.3%) and inability to identify correct graduations (41.1%), whilst for respiratory devices, instructions difficult to follow and device too complicated to use were each cited by 36.5% of respondents.Conclusions This study identifies significant gaps in oral and respiratory administration devices, type of device supplied, and training practices in Chinese pediatric hospital settings, with measuring cup dominance representing a particular patient safety concern given the established superiority of oral syringe for accurate pediatric dosing. Respiratory administration device is considerably more developed, though usability and technique-related challenges persist. Improving oral device supply standards, clarifying professional roles in device counseling, and developing culturally appropriate instructional materials are priorities for enhancing the safety of pediatric medicine administration in China. These findings complement existing European data and contribute to the growing international evidence base informing pediatric administration device development and regulatory guidance.