Children and Medication

[illusion88]

I worked at a summer camp for Jewish kids (tawonga). I worked fourth session, which is to say I worked the last four weeks of the summer and worked with the eldest crowd (ages 6-16, mostly in the higher end of that). I worked in the infirmary, and one of my primary functions was to hand out medications to children. Just as a little background, I am an EMT licensed in the state of California. I worked with another EMT (who had finished college and was on his way to med school) a Nurse and a doctor. The doctor rotated weekly, so I never saw the same doctor twice.

Now, lets get off this background mumbo-jumbo and discuss.

While I was there, I would hand out medication 2 sometimes 3 times daily (and the few 4 times daily). I saw many kids on different types of medication. The most common was Stratera and Concerta. Actually it was a combination of both that was seen most often. These are drugs designed to help the symptoms of ADD and ADHD. It seemed to ?work? well. We had a kid who just started concerta (he was on stratera for a while, and just recently added a dose of concerta) and told me one day ?I don?t think I need my medication anymore?. Of corse this is only sign of the drug working, if he were to stop, usual ?symptoms? of ADHD would appear withing 24 hours.

I also saw children, no more then 14 years old on a twice daily dose of prozac. This concerns me. What are we doing to our children that would require such powerful drugs? Or perhaps they are fine, and we prescribe them illness? Another girl could not sleep without taking a benedryl before bed. HE dad started giving them to her when her mother died at the age of 6 (she was 13 when I met her). Well camp is no time to star the reversal of such a habit, and certainly not through a lowly EMT but it still concerned me.

Perhaps parents are attempting to make the perfect child? The worst case I saw was a boy who I injected with HGH every night. He wasn't a very small child, but he was below average in size. He was 10 years old. 1.6mg of HGH every night so he can be a strong boy. What happened to a healthy diet?

I am concerned that we are overmedicating our children. What will the ramifications to this be? Are we breeding a race of humans who would rather take a pill then work through something? If you have a problem, there is a pill for it, and starting our children at a younger age seems to encourage this sort of behavior.

 

[BaliBabyDoc]

Not to be too harsh . . . but it's hard for me to believe you gave the SAME child daily doses of Strattera (atomoxetine) AND Concerta (methylphenidate). Any MD that prescribes the use of these drugs together should have their license revoked. It makes no sense clinically or pharmacologically to use them together.

Next item, "twice daily Prozac" is also odd. Prozac (fluoxetine) has quite a long half-life. It's almost always used once daily. In fact, I've NEVER heard of it being used twice daily except for dose-splitting in VERY sensitive patients getting doses above 20mg per day.

Benadryl (diphenhydramine) for sleep is a very common use of this cheap OTC antihistamine. Obviously, proper sleep etiquette is far more effective for treating insomnia but very few clinicians know how to teach it and even fewer parents get it right. I seriously doubt a doctor recommended 7 years of nightly diphenhydramine. Unfortunately, the popular message these days is that medicine/healthcare is just another consumer product . . . and all you need is the Internet and "conservative" values to treat yourself and your family.

The hGH case is certainly interesting. While I'm a vocal opponent to such "endocrine engineering" in children, I'm a vocal proponent for such use in adults. hGH (in trained hands) is one of the safest and powerful agents in the arsenal. It's little wonder why any professional athlete with good sense and nice bank . . . will pay the $1-2k per month for injections. hGH is good stuff. If I didn't have a kid, I would do hGH myself.

"Overmedication" is a simplification. The truth is "inappropriate medication." Many children that NEED healthcare/meds don't have appropriate access to the system (bad doctors, no doctors, wrong drug/dose, poor followup). On the flip side, other children have TOO much access to the system. Bad doctors and misguided parents that treat below average height, below average test scores, or above average weight as medical "problems."

Point of fact is that EVERYBODY does a little better with a stimulant on board. Most people would see some incremental benefit from low dose SSRIs as well. Mother Nature gives most people a hardwired reserve of ability. It should be expected that "aggressive" parents will seek such advantages for their children.

 

[conjur]

A photoshopped Calvin and Hobbes expresses this rather well.

 

[impeachbush]

Originally posted by: BaliBabyDoc
Not to be too harsh . . . but it's hard for me to believe you gave the SAME child daily doses of Strattera (atomoxetine) AND Concerta (methylphenidate). Any MD that prescribes the use of these drugs together should have their license revoked. It makes no sense clinically or pharmacologically to use them together.

I don't personally believe kids should be on any of these, with the possible exception of hgh (his body might not have been producing it to begin with). But, the combination Srattera and Concerta, although unnecessary, should be safe. Concerta is slow release ritalin, while strattera is an SNRI. They were giving the kid a stimulant, and then trying to get an added benefit by boosting norepinephrine levels. Again. I think its very unnecessary, but not life threatening.

 

[BaliBabyDoc]

Originally posted by: impeachbush

Originally posted by: BaliBabyDoc
Not to be too harsh . . . but it's hard for me to believe you gave the SAME child daily doses of Strattera (atomoxetine) AND Concerta (methylphenidate). Any MD that prescribes the use of these drugs together should have their license revoked. It makes no sense clinically or pharmacologically to use them together.

I don't personally believe kids should be on any of these, with the possible exception of hgh (his body might not have been producing it to begin with). But, the combination Srattera and Concerta, although unnecessary, should be safe. Concerta is slow release ritalin, while strattera is an SNRI. They were giving the kid a stimulant, and then trying to get an added benefit by boosting norepinephrine levels. Again. I think its very unnecessary, but not life threatening.

Well, I'm a research fellow in Child Psychiatry and Molecular Pharmacology. The majority of neurotransmitter systems are in a state of flux throughout development. Only fools tinker with them without a very good rationale. Concerta is indeed a graduated release of methylphenidate which acts PRIMARILY by blocking dopamine (and norepinephrine) reuptake. Strattera is more selective for norepinephrine but a real pharmacologist would explain to you that it's "selective" from a marketing standpoint . . . not necessarily mechanism of action.

Regardless, the use of methylphenidate and atomoxetine together is contraindicated b/c it can potentiate hypertension (high blood pressure) and tachycardia (rapid heart rate) moreso than the typical max dose application of either drug alone. The likely culprit is that atomoxetine inhibits the activity of 2D6 enzymes which are REQUIRED by atomoxetine for proper metabolism.

Further, atomoxetine has been on the market only for a few years (2002). It's current list of adverse events and toxicity is shorter primarily due to it's short market life . . . not necessarily inherent characteristics of the compound. In fact, Eli Lilly just updated the package insert b/c of 2 cases of liver toxicity.

It's bad medicine to use them together. The MD that prescribed them is either ignorant or a moron. Regardless, his license needs to be revoked.

There are NO safe drugs. It's always a question of how much risk (for minor or major bad events) are we willing to tolerate for a given benefit. Considering there's no benefit to be extracted from using atomoxetine and methylphenidate together . . . doing so is just wrong.

 

[illusion88]

Originally posted by: BaliBabyDoc
Not to be too harsh . . . but it's hard for me to believe you gave the SAME child daily doses of Strattera (atomoxetine) AND Concerta (methylphenidate). Any MD that prescribes the use of these drugs together should have their license revoked. It makes no sense clinically or pharmacologically to use them together.

Escentialy they are the same drug, only on different timers. A 24 hour timer and 12 hour timer. Seeing both of them together was the most common way to fight ADHD that I saw. If I could i'd pull files and show you but thats not for me to do. You will just have to tkae my word for that one. The children on the combination were the ones that saw the most "benefit" from the drug.

Next item, "twice daily Prozac" is also odd. Prozac (fluoxetine) has quite a long half-life. It's almost always used once daily. In fact, I've NEVER heard of it being used twice daily except for dose-splitting in VERY sensitive patients getting doses above 20mg per day.

Benadryl (diphenhydramine) for sleep is a very common use of this cheap OTC antihistamine. Obviously, proper sleep etiquette is far more effective for treating insomnia but very few clinicians know how to teach it and even fewer parents get it right. I seriously doubt a doctor recommended 7 years of nightly diphenhydramine. Unfortunately, the popular message these days is that medicine/healthcare is just another consumer product . . . and all you need is the Internet and "conservative" values to treat yourself and your family.

No doctor recomended it. Or perhaps it was recomended at the time of her mothers death but certiantly not any more. The point beign was she wad dependent on it. The girl could not sleep without it. On her backpacking trip her counsler forgot to give it to her and she stayed awake nearly all night (she woke them at about 4AM the report said). OT danm those counslers for forgetting meds, even something that shouldn't be given. What if they forgot a girls amoxicillin or depakote?

The hGH case is certainly interesting. While I'm a vocal opponent to such "endocrine engineering" in children, I'm a vocal proponent for such use in adults. hGH (in trained hands) is one of the safest and powerful agents in the arsenal. It's little wonder why any professional athlete with good sense and nice bank . . . will pay the $1-2k per month for injections. hGH is good stuff. If I didn't have a kid, I would do hGH myself.

The HGH case was interesting. because the kid obviously didn't need it. Granted he was smaller then most children but he wasn't a runt. And he was only 10 years old, perhaps waiting until after puperty would have been the better pathway. Every doctor said that he didn't NEED it and would probably grow to a normal height at the end of puberty.

"Overmedication" is a simplification. The truth is "inappropriate medication." Many children that NEED healthcare/meds don't have appropriate access to the system (bad doctors, no doctors, wrong drug/dose, poor followup). On the flip side, other children have TOO much access to the system. Bad doctors and misguided parents that treat below average height, below average test scores, or above average weight as medical "problems."

Point of fact is that EVERYBODY does a little better with a stimulant on board. Most people would see some incremental benefit from low dose SSRIs as well. Mother Nature gives most people a hardwired reserve of ability. It should be expected that "aggressive" parents will seek such advantages for their children.

This doesn't address my question and perhaps I wasn't so good at articulating it, so allow me to ask again. Does this create a generation where people will rather take a pill rather then work their way around something? I'm thinking more of the pyscological effects of this rather then the phisiological perspective. What are we doing to our children?

 

[Legend]

What are we doing to our children that would require such powerful drugs?

It's the food.

It doesn't stop with poor diet. Even produce and other healthy foods are loaded with pesticides/herbicides and aren't as nutritious as they were decades ago due to poor farming.

You'd have to go out of your way and carefully buy organic foods, which are limited in some areas to counter this.

I think the biggest thing that kids aren't getting today are Omega 3 fats. The average American diet only has traces, but your brain needs about 1:1 Omega3: omega6 to function normally. Cow milk doesn't have DHA (an Omega3) but Human milk is loaded with it. There's a reason for that -- Humans need more brain development.


I took Ritalin for ADD, and Allegra D, Flonase, and allergy shots for allergies/sinuses for 10 years. I started taking comprehensive dietary supplements for a few months and I've had much better results.

 

[impeachbush]

Add/adhd can be broken down into three main areas of deficits... Inattention, hyperactivity, impulsivity. Some kids have more of a problem with one, some with two, and others all three. The docotor who prescribed ritalin and atomoxitine together was probably trying to target a particular area of deficit (and probably severe). An increase of higher blood pressures, rapid heartbeat, heart murmurs etc. with ritalin are fairly normal. The addition of atomoxetine may add to this effect to a small degree, but not moreso than increasing the childs dose of ritalin. yes, I agree its a bit riskier, but the childs case was probably more severe and warranted the additional risk.

The findings of atomoxetine liver toxicity doesn't suprise me, and I'm suprised its only 2 cases within 2 or 3 years. I'm not a fan of using any of these drugs in children, especially to the levels used today. I'm merely trying to explain why I think the doctor did what he did. I don't see any negligence here just viewing the story from the cover.

 

[impeachbush]

This doesn't address my question and perhaps I wasn't so good at articulating it, so allow me to ask again. Does this create a generation where people will rather take a pill rather then work their way around something? I'm thinking more of the pyscological effects of this rather then the phisiological perspective. What are we doing to our children?

I think the problem goes deeper than this. One would be that parents are working instead of parenting, and the work hours have been on a rise for some time now. This has a tremendous impact on the mental health and stability of kids..(tangent..thank you Bush! :| ) The prescription drug market needs an ass kicking... GET THE DAMN COMMERCIALS OFF THE AIR. The commercials have caused a general attitude that a pill can solve all of lifes problems, so just go to the doctor and get the one you need. What's really nice though is that soon we will have meds that work so well, our kids won't even notice slaving away 80 hours a week to pay off our debt!

ADD must be kicking in.. that paragraph held no coherency what so ever... wheres my Rit...

 

[Legend]

The idea of parenting ADD out of a kid is a bunch of crap. There's a nutritional deficiency there that has to be addressed. Being strict won't help. Giving drugs help but create problems.

Can you dicipline scruvy?

You could treat the person's symptoms...but why do that when you can give them vitamin C?


The links between fat deficiencies and ADD are being made:

http://borntoexplore.org/omega.htm
http://www.askdrsears.com/html/4/t040400.asp#T040408


Of course, there's little profit to be made in ending all these prescription drugs so the push toward the truth will be slow.

 

[f95toli]

Another reason why the use of this type of medicin is increasing is of course also that more kids are diagnosed with ADD and ADHD.
AFAIK there is no evidence that ADD and ADHD is increasing, it is just that people are aware of the fact that these conditions do exist nowadays.

I seriously doubt that there is a simple "explanation" for these conditions, it is more likely to be similar to dyslexia; a condtion that has been around for a long time but was never properly diagnosed before.

Being able to read and write in order to get a job has been neccesary for how long? 30-40 years? Before that you could probably find a job or become an apprentice without much theoretical education; droping out of school was not a disaster (and was also probably what happened to a majority of these kids)

The problem is that type of career is almost impossible nowadays.

 

[slurmsmackenzie]

this just in!

nothing you do is your fault!
it's a disease!
and for $200 a month for the rest of your life, you can curb the effects of these diseases such as:

obesity
ADD aka too much refined sugar, television, lack of exercise
erectile disfuction
depression
small boobs
small penis
big a$$
smoking
drinking

don't waste countless minutes exploring the psychological factors! save time = waste dollars!

some side effects may include hack job doctors who can save hassle by writing a prescription instead of doing their job, low bank funds, depression (don't worry, there's a pill for that, though), and anal leakage.

 

[Legend]

ADD aka too much refined sugar, television, lack of exercise

While I agree too many people won't take responsibility of their actions, this is bullshit.

It ISN'T entirely the fault of public. There is a lot of blame to be put on corporate America into pressuring farmers to take these drastic measures to increase yield while sacrificing food quality. The government should help and regulate farming methods more strictly.

There is blame to be put on so-called nutritional experts and advertising for getting people to think low fat diets are healthy.


My diet was prior to taking supplements was near flawless (I exercise 45 minutes, 5days/week, and I watch about 5-8 hours of TV a week)...but it lacked DHA/Omega3 (I hate fish). I take fish oil supplements. Knocked my ADD and allergies out in days.

 

[Trevelyan]

Originally posted by: conjur
A photoshopped Calvin and Hobbes expresses this rather well.

LOL that's hilarious!

On a side note, it's nice that I actually smiled when reading one of your posts, conjur.

 

[Genx87]

Originally posted by: illusion88
I worked at a summer camp for Jewish kids (tawonga). I worked fourth session, which is to say I worked the last four weeks of the summer and worked with the eldest crowd (ages 6-16, mostly in the higher end of that). I worked in the infirmary, and one of my primary functions was to hand out medications to children. Just as a little background, I am an EMT licensed in the state of California. I worked with another EMT (who had finished college and was on his way to med school) a Nurse and a doctor. The doctor rotated weekly, so I never saw the same doctor twice.

Now, lets get off this background mumbo-jumbo and discuss.

While I was there, I would hand out medication 2 sometimes 3 times daily (and the few 4 times daily). I saw many kids on different types of medication. The most common was Stratera and Concerta. Actually it was a combination of both that was seen most often. These are drugs designed to help the symptoms of ADD and ADHD. It seemed to ?work? well. We had a kid who just started concerta (he was on stratera for a while, and just recently added a dose of concerta) and told me one day ?I don?t think I need my medication anymore?. Of corse this is only sign of the drug working, if he were to stop, usual ?symptoms? of ADHD would appear withing 24 hours.

I also saw children, no more then 14 years old on a twice daily dose of prozac. This concerns me. What are we doing to our children that would require such powerful drugs? Or perhaps they are fine, and we prescribe them illness? Another girl could not sleep without taking a benedryl before bed. HE dad started giving them to her when her mother died at the age of 6 (she was 13 when I met her). Well camp is no time to star the reversal of such a habit, and certainly not through a lowly EMT but it still concerned me.

Perhaps parents are attempting to make the perfect child? The worst case I saw was a boy who I injected with HGH every night. He wasn't a very small child, but he was below average in size. He was 10 years old. 1.6mg of HGH every night so he can be a strong boy. What happened to a healthy diet?

I am concerned that we are overmedicating our children. What will the ramifications to this be? Are we breeding a race of humans who would rather take a pill then work through something? If you have a problem, there is a pill for it, and starting our children at a younger age seems to encourage this sort of behavior.

Yes this has been ingrained into our minds by the medical profession backed by the big drug companies.

If you have a problem, dont deal with it, medicate yourself instead.

Where people used to drink and become a problem for society and people knew about it before. They down 4 pills a day and walk around in a haze and nobody knows the difference.

 

[Cerb]

Originally posted by: illusion88

Originally posted by: BaliBabyDoc
Not to be too harsh . . . but it's hard for me to believe you gave the SAME child daily doses of Strattera (atomoxetine) AND Concerta (methylphenidate). Any MD that prescribes the use of these drugs together should have their license revoked. It makes no sense clinically or pharmacologically to use them together.

Escentialy they are the same drug, only on different timers. A 24 hour timer and 12 hour timer. Seeing both of them together was the most common way to fight ADHD that I saw. If I could i'd pull files and show you but thats not for me to do. You will just have to tkae my word for that one. The children on the combination were the ones that saw the most "benefit" from the drug.

Next item, "twice daily Prozac" is also odd. Prozac (fluoxetine) has quite a long half-life. It's almost always used once daily. In fact, I've NEVER heard of it being used twice daily except for dose-splitting in VERY sensitive patients getting doses above 20mg per day.

Benadryl (diphenhydramine) for sleep is a very common use of this cheap OTC antihistamine. Obviously, proper sleep etiquette is far more effective for treating insomnia but very few clinicians know how to teach it and even fewer parents get it right. I seriously doubt a doctor recommended 7 years of nightly diphenhydramine. Unfortunately, the popular message these days is that medicine/healthcare is just another consumer product . . . and all you need is the Internet and "conservative" values to treat yourself and your family.

No doctor recomended it. Or perhaps it was recomended at the time of her mothers death but certiantly not any more. The point beign was she wad dependent on it. The girl could not sleep without it. On her backpacking trip her counsler forgot to give it to her and she stayed awake nearly all night (she woke them at about 4AM the report said). OT danm those counslers for forgetting meds, even something that shouldn't be given. What if they forgot a girls amoxicillin or depakote?

The hGH case is certainly interesting. While I'm a vocal opponent to such "endocrine engineering" in children, I'm a vocal proponent for such use in adults. hGH (in trained hands) is one of the safest and powerful agents in the arsenal. It's little wonder why any professional athlete with good sense and nice bank . . . will pay the $1-2k per month for injections. hGH is good stuff. If I didn't have a kid, I would do hGH myself.

The HGH case was interesting. because the kid obviously didn't need it. Granted he was smaller then most children but he wasn't a runt. And he was only 10 years old, perhaps waiting until after puperty would have been the better pathway. Every doctor said that he didn't NEED it and would probably grow to a normal height at the end of puberty.

"Overmedication" is a simplification. The truth is "inappropriate medication." Many children that NEED healthcare/meds don't have appropriate access to the system (bad doctors, no doctors, wrong drug/dose, poor followup). On the flip side, other children have TOO much access to the system. Bad doctors and misguided parents that treat below average height, below average test scores, or above average weight as medical "problems."

Point of fact is that EVERYBODY does a little better with a stimulant on board. Most people would see some incremental benefit from low dose SSRIs as well. Mother Nature gives most people a hardwired reserve of ability. It should be expected that "aggressive" parents will seek such advantages for their children.

This doesn't address my question and perhaps I wasn't so good at articulating it, so allow me to ask again. Does this create a generation where people will rather take a pill rather then work their way around something? I'm thinking more of the pyscological effects of this rather then the phisiological perspective. What are we doing to our children?

Ruining them.
http://www.linuxjournal.com/article/8280
Oddly enough, a very related article.

Hyperactive? Stop giving the kids sugar and additives. pre-packaged foods--out! Coca-cola--out! Etc..
Can't pay attention? Let them exercise their mind daydreaming, or give them something interesting to do.
Can't sleep? let them suffer from insomnia for awhile, until they relearn to sleep.

Add some OJ, lime, and some greens in the diet, and let them do something interesting, rather than treating the kids like chattle.

I'm anything but healthy, but I've been worse. So far the only drug I haven't been able to kick yet is Zyrtec. Remember that you're bretahing posion, likely drinking poison, eating poison, and taking pison in the form of a pill. I still haven't recovered fully from my time of being medicated. Just stay away from any quick fixes--they won't work.

 

[tweakmm]

We live in the paxil/xanax/adderal nation.

Zombies are much more agreeable.

Better living through chemistry.