THIS THREAD IS CLOSED

Lisa,
I talked with my child psych fellows. They said that medication in such young children is definitely a very last resort. These docs are seeing the worst of the worst, of course, because it is a university setting. They said that one example of using an antipsychotic in a young child would be if the child is harming himself–i.e., banging his head on the floor hard enough to cause brain injury–or injuring others, biting, hitting, tearing things up. One of the docs said that there is a guideline they follow which begins with behavioral interventions, parental interventions, etc., with medication being the last step. Usually Risperdal, bec it is indicated in kids 5 and up. Now, these are severely autistic kids, not your run of the mill infant.

As for the ADHD drugs, he said it is usually hyperactivity that they are treating the young, young kids for. I did not ask him for a definition of hyperactivity. Again, there are parenting and behavioral interventions that they follow first.

One of the docs said that some of his colleagues are quick to use drugs–he was trying to be non-judgemental, but I think he disapproved. He did say, unequivocably, that no pharma rep has ever talked to him about medicating children this young. If you think about it cynically for a moment, there really isn’t much of a market there. If I have 45 seconds with a doctor, I am not going to talk about a 3 year old getting antipsychotics–there’s no return on investment there, not to mention it’s off-label.

I think you need to be careful about taking anecdotes of a couple of kids on antipsychotics and generalizing to assume that it is happening rampantly. What Patrick has to say is just nonsense. We shouldn’t throw the baby out with the bathwater. I can’t imagine what it would be like to have a child that is giving himself traumatic brain injury from banging his head against the floor or the wall at 2 years of age. I have seen older kids in helmets and restraints because of self-injurious behavior. Of course, they are usually MRDD and autistic and have severe problems. I would say that our doctors and our parents have to have some medication tools to deal with this.

So when are the lawmakers going to bring down the hammer on these scum bags?

For futther information on this issue go to cchr.org

Patrick Dunaway

I’ve assembled a Not FDA-Approved for Pediatric Use page at http://www.psychdrugdangers.com/NotApprovedForPediatricUse.html listing those psychiatric drugs that are explicitly not approved for pediatric use by the FDA. It includes a link in the Medicaid Drug Uses and Payments menu for the Oct 2006 NJ Medicaid payments report that Laurie York obtained where approx 6,900 Rxs were reimbursed for these “off-label” uses (I know off-label is legal, but I don’t think the taxpayers should be forced to pay for them through Medicaid claims).

And see the Vermont Medicaid reports which clearly show that ADD and ADHD are common diagnoses in preschool children.

As for ADHD, they said that what they see mostly in really young kids is hyperactivity, not inattention. Again, it has to be an egregious case–not just your typical rambunctious kid.

They all uniformly said that drug reps are not talking to them about these cases. Which makes sense–reps are going to talk about the situations where they have a chance to get significant sales. There is really no market for the very young child–from a purely cynical perspective, it would be a waste of time to talk about that area.

One of my docs did allude to some of his peers being very quick to jump to drugs. He was trying to be non-judgemental, but I think the implication was that maybe some are not exhausting the non-medication alternatives before they use drugs. Of course, this will happen with all age groups and all disease states, but I agree with you that it is particularly disturbing in the case of kids.

My point is that you may be jumping to conclusions based on one or two reports of these medications being used in kids. From what my docs were saying, at least here, it is not common. It surely is not desirable, but I don’t think you can say that it should never happen. If you have a child who is intent on injuring himself, it may turn out that medication is your only option. When I sold Zoloft, I was in the autism clinic and saw kids wearing helmets and restraints so that they could not hurt themselves. It is surely a terrible, no-win situation for the parents.

You are absolutely corrrect in questioning the use of psychotropic drugs in any child under school age. I cannot imagine what a 2 year old would present with to merit treatment with an anti-psychotic. Given this, I can assure you, almost guarantee you, that pharma is not pushing this. There are some places we just won’t go–I think I can safely say that about most of my colleagues. I have an antipsychotic which is not indicated for kids, so we don’t talk to child providers. Still, I know most of the drug reps with other companies, and I talk to the docs about what they are saying, and no one is talking about this age group of kids. Again, I would have to say this is bad parenting and bad doctoring–so don’t be too quick to push it all on pharma. I will make a point of asking my docs about this, because you have me curious. I just can’t imagine what is going on here.

As for dosing, you have to remember that psychotropic drugs act far differently than something like heparin. Kids metabolize drugs very quickly, so sometimes adult doses are used. Again, I am not selling my drug to child docs, so I wouldn’t know about the dosing of it (they are using it, although not to any great extent). I’ll have to ask. I know that my son takes an adult dose of Abilify==10 mg. The dose range goes from 2.5 to 30, so he is at the low end.

You have got me curious. I am seeing a group of psych residents for lunch. Several of them are doing child fellowships, and work at a very famous autism clinic here in town, as well as the state hospital. Of course, the hospital does not have kids under age 6, but the clinic might have patients that young. I will ask them about this and let you know what they say.

The thought of giving a 2 year old an antipsychotic gives me the chills.

You mentioned children.. according to NJ Medicaid Psychotropic Drug Data: 0-12mos, 1 to 4 year olds are being prescribed at alarming rates, Antipsychotics, off-label for ADD/ADHD. I have one Question, Why? What are Physicians telling parents, and why is the Industry promoting antipsychotics for unapproved uses?

Extrapolating adult data for pediatrics. You wouldnt give an adult dose of Heparin to a child, so why give an adult dose of Zyprexa to a 2 year Old. Defies logic to me.

No fight here,..I did mention the word “politely” in my earlier post.