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Medications for Kids: How Much is Too Much,

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There are so many more medications for children today than there were just a generation or two ago. Parents want the best for their children, but sometimes they wonder whether their kids are getting too much of a good thing. We talked with Pamela Oatis, M.D., a pediatrician in the Mercy Health Partners Northern Region, about the common medications that pediatricians prescribe today and what parents need to know about these drugs.

 

Asthma and allergies

“Two of the most common conditions for which children take medications are asthma and allergy,” says Dr. Oatis. Often, when children get started on asthma treatment, they need to take quite a few medications to get their condition under control. This can be difficult for parents to accept. At this stage, explains Oatis, parents don’t always realize their children are as sick as they are. “The child might cough a little and cough at night, and it doesn’t seem that serious,” she says. “But the child is really just used to feeling that way. A pulmonary function test may reveal that there’s a real problem.”

Children with asthma need to take what are called “controller” medications to do just what the name implies—to control and prevent symptoms. “Parents sometimes have a hard time accepting that their child needs the controller medications for asthma,” says Dr. Oatis. “They can’t immediately see that it’s helping. Controller meds control and prevent. It’s much better if children can take these before the problem arises. The medications that relieve symptoms (called agonists) are actually more dangerous, so the goal is to prevent the symptoms and avoid the agonists. If a child has to take the symptom relievers, it means the asthma is not well controlled.”

Allergy medications, on the other hand, are a little easier on parents, says Dr. Oatis. “If you can predict what the seasonal allergies are and take the mast cell stabilizers before symptoms begin, it’s good. These drugs have basically no side effects.”

 

What about over-the-counter cold medications and over-use of antibiotics?

Generally speaking, OTC cold and allergy medications are, according to Dr. Oatis, “a waste of money. They’re hard on the liver and they don’t really work. Children who have colds need love, good food, tenderness, contact, a smoke-free home, a cool, moist environment in the winter.”

Dr. Oatis explains, “Tylenol does nothing to cure an illness, it simply blunts the symptoms. There is data to suggest that fever is part of the body’s immune response, and if you block the fever’s symptoms, you block the body’s ability to fight infection. Even in therapeutic doses, it can be toxic, especially if taken over time. If you’re concerned about fever, call your doctor, because we need to know what’s causing the symptoms.”

Regarding antibiotics, Dr. Oatis says, “Parents are correct in their concern about over-use. It sets children up for resistance. Kids don’t need antibiotics for a cold. For ear infections, the ear should be bright red and bulging and the child should have a fever, be sick and in pain in order to need an antibiotic. A little bit of a dull ear is not a reason to take antibiotics.”

 

Emotional and behavioral medications—a controversial issue

Other medications that often concern parents, says Dr. Oatis, are the emotional and behavioral drugs, especially those for attention deficit/hyperactivity disorder (ADHD) and depression, the stimulants and anti-depressants. There are doctors who believe that these types of medications can be beneficial, doctors who don’t prescribe them at all and doctors who fall somewhere in the middle. Dr. Oatis falls into the second category. She believes, she says, that it’s more important to “meet kids’ needs, not control their behavior.”

 “Based on my extensive reading,” says Dr. Oatis, “I believe that the risks of these drugs outweigh the benefits. We don’t know the consequences of these drugs on a developing brain. Brains do continue to develop physically into the early twenties. We’re conducting an uncontrolled experiment.”

Most of the time, she believes, if kids are exhibiting behavioral problems, “they’re upset or scared or sad about something.” Oatis says she believes it’s most important to “give them a hand with what’s going on in their life.” She says she agrees with the guidelines of the American Academy of Pediatrics, which states, she says, that having been abused as a child excludes that child from an ADD or ADHD diagnosis.

Utkarsh Joshi, M.D., a child psychiatrist in the Washington, D.C., area, agrees that this is a controversial issue, but he does say that each child needs to be reviewed on a case-by-case basis. “Abuse,” he says, “does not effectively rule out a diagnosis of ADHD, although abuse certainly can very much present symptoms of ADHD, like many other conditions and/or situations.” He points out that guidelines of the American Academy of Child and Adolescent Psychiatry state that impaired vision or hearing, learning disability, head trauma, seizures, acute or chronic medical illnesses, poor nutrition, insufficient sleep, realistic fear and depression are just some conditions that can cause children to display behavior that might mimic ADHD. That’s why it’s important, Dr. Joshi says, for children who are displaying ADHD symptoms to have a thorough evaluation by a child psychiatrist.

Dr. Oatis says that there are resources for parents who are interested in finding information that may go beyond the more traditional medical viewpoints. “Parents do hear ‘Take this, take that,’ ” she says, “but there’s plenty of information that can round out their education, beyond what they get from drug companies. And parents need to know that children have a legal right to an education, so a school can’t bully a parent into making a child take a drug to go to school.”

She suggests that parents visit the Web site of Peter Breggin, M.D., (http://www.breggin.com/) a psychiatrist in Ithaca, New York. In 1972, Dr. Breggin, founded The International Center for the Study of Psychiatry and Psychology as a nonprofit research and educational network.  The Center is concerned with the impact of mental health theory and practices upon individual well-being, personal freedom, and family and community values.

 

What is a parent’s role?

Parents, says Dr. Oatis, need to be the experts in their child’s health. They need to educate themselves by talking with doctors, nutritionists and exercise experts in order to teach themselves about their child’s health. They need to trust their own instincts and trust their doctors as well. “Parents have a right to question decisions about their children’s health,” she says. “They need to be able to discuss these issues with their child’s doctor.”



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