Dealing with ADHD in Child

November 16, 2016

If your child has problems paying attention, is always on the go and is always talking, then it is possible your child may have ADHD (attention deficit hyperactivity disorder).

The National Institute of Mental Health (NIMH) states that most symptoms of childhood ADHD begin between the ages of 3 and 6. However, ADHD can go on throughout the child’s teenage years and adult years. According to the CDC (Center for Disease Control and Prevention), 11% of childhood cases of ADHD were diagnosed between the ages of 4 and 17 in 2011.

There are three types of ADHD:

  • hyperactive-impulsive (constant talking, always interrupting others in conversation, and always on the go)
  • inattentive (problems finishing tasks, following directions, and focusing)
  • combination of both hyperactivity-impulsivity and inattention

The ADHD Diagnosis

The CDC estimates that the number of children diagnosed with ADHD has increased steadily from 2003 to 2011 (from 7.8% to 11%).  FDA representative and child psychiatrist Dr. Tiffany R. Farchione says the increase in ADHD diagnoses is due to more knowledge available about psychiatric conditions.

Dr. Farchione also adds that ADHD diagnoses are more prominent among males (13.2%) than females (5.6%).  This discrepancy also may be due in part to boys typically having the more active type of ADHD–the hyperactive-impulsivity type—than the quieter type (inattention) that is harder to identify.

Get your child evaluated by the family physician if you believe your child has ADHD. That way, you can eliminate other culprits of inattention (i.e., hearing and vision problems). Some pediatricians opt to give a referral to a mental health professional if they do not do the evaluation themselves.

Treatments

Stimulants and non-stimulant drugs for children as young as 6 years old are approved by the FDA as suitable medications for relieving ADHD symptoms and for promoting optimum functioning.

When most people hear the name stimulant, they often think that’s the wrong type of medication to give an already overactive child, but these type of medications actually have the opposite effect on children with ADHD. Stimulants contain amphetamine and methylphenidate, which increases dopamine levels in the brain. The increased dopamine has a calming effect on children because dopamine is a neurotransmitter that is responsible for human attention, motivation and movement.

Children sensitive to stimulants are still able to get medical treatment for their ADHD symptoms. Strattera (atomoxetine), Intuniv (guanfacine), and Kapvay (clonidine) are approved by the FDA as non-stimulants that effectively treat ADHD symptoms. So discuss with your child’s physician the available options for your child concerning stimulant and non-stimulant medications.

ADHD: Adults Can Have it, Too

Research has shown that adults can also be diagnosed with ADHD if it can be proven some symptoms of the disorder were present when the adult was a child (as early as age 7). The 4% of the adult population diagnosed with ADHD exhibit a lot of the same symptoms children exhibit with ADHD. However, adults have slightly different ways of exhibiting inattention and hyperactivity, such as having difficulty with activities required a lot of focused attention, difficulty resting during times of rest, difficulty multi-tasking, and difficulty managing time.

Vaccines for Children

November 5, 2016

The beginning of the school year marks a time period when parents and other caregivers are swamped with paperwork to complete from their children’s school, and many of them have concerns about their children’s vaccine schedule.

Dr. Marion Gruber, director of the office of Vaccines Research and Review for the Food and Drug Administration (FDA), states that, “Parents should know that vaccines protect children from many serious illnesses from infectious diseases. The risk of being harmed by vaccines is much smaller than the risk of serious illness from infectious diseases,” she says.

The biggest complaint most children experience from vaccination is soreness around the site where they were injected. Other than that, there are no serious effects; and if they are, the instances are very rare.

Benefit of Vaccination

Childhood diseases like measles, Hib (Haemophilus influenzae type b) and diphtheria have become rare occurrences thanks to vaccines. Vaccines have worked wonders to make childhood diseases like smallpox and polio nonexistent in United States. Thus, the use of vaccines has prevented many children in the United States from having to suffer and die from various diseases that were once commonplace in childhood.

According to Gruber, just because vaccination has made childhood diseases of the past a very rare phenomenon, parents cannot dismiss the possibility these diseases can still occur—especially if people elect not to have their children vaccinated.

Guidelines to Follow When Having Your Child Vaccinated

Review the vaccine information sheets

The following material contains information required by law that healthcare professionals have to provide on the pros and cons of using vaccines.

Discuss the pros and cons of having your child vaccinated with your child’s physician.

It’s important to know the risks taken when parents decide not to let their children have vaccines. For example, diseases that are preventable because of vaccines (i.e. pertussis, diphtheria and measles) are known to be fatal or cause lasting harm for some children.

Notify the doctor about your child’s medical history prior to getting them vaccines.

If your child has a medical history of previous illnesses or has had an allergic reaction to vaccines in the past, then your child’s healthcare provider needs to know that. Also, tell the doctor of any known allergies your child has. If your child is allergic to eggs, then a flu vaccine could prove to be harmful or fatal to your child since eggs are used to produce flu vaccines.

People sensitive to latex may have a problem taking vaccines that are packaged in latex material. Also, you should let your child’s doctor know about vaccines your child should avoid because of a weak immune system.

Report adverse reactions

The FDA and the Center for Disease Control and Prevention (CDC) recommend all parents report any adverse reactions or other problems from taking a vaccine to the Vaccine Adverse Event Reporting System.

Teens and Steroids

December 2, 2014

The abuse of anabolic steroids can cause both temporary and permanent injury to anyone using them. Teenagers, whose bodies are still developing, are at heightened risk. An alarming number of them are trying steroids in hopes of improving their athletic prowess or their appearance. Ali Mohamadi, M.D., a medical officer in the Food and Drug Administration’s Division of Metabolism and Endocrinology Products, warns teens and parents about the dangers of steroid use.

Q: What are anabolic steroids and how many teens use them?

A: They are drugs that mimic the actions of the male sex hormone testosterone. This includes promoting the growth of cells, especially in muscle, and maintaining or increasing male physical characteristics. Various studies have been conducted and generally reflect the findings of a Youth Risk and Behavior Surveillance System study, which estimated that among U.S. high school students, 4.9% of males and 2.4% of females have used anabolic steroids at least once in their lives. That’s 375,000 young men and 175,000 young women.

Q. What are the side effects of taking anabolic steroids?

A: They are known to have a range of serious adverse effects on many organ systems, and in many cases the damage is not reversible. They include fertility problems, impotence, high blood pressure and cholesterol, and heart and liver abnormalities. Boys may experience shrinkage of the testes or the development of breast tissue; girls may experience menstrual irregularities and development of masculine qualities such as facial and body hair. Both may experience acne. Both boys and girls may also experience mood swings and aggressive behavior, which can impact the lives not only of those taking steroids, but of everyone around them.

Q: Are prescriptions needed to get steroids?

A: Yes, in fact anabolic steroids are classified as Schedule III Controlled Substances by the U.S. Drug Enforcement Administration with strict regulations, meaning that not only is a prescription required, but there are extra controls. For example, it is illegal to possess them without a prescription in the United States, and in most circumstances the prescription must be in written form and cannot be called in to a pharmacist. Labels on some steroids recommend testing of hormone levels during use.

The number of FDA-approved uses is limited. Most are prescribed as a replacement for sub-normal levels of steroids. They are also prescribed for conditions such as muscle wasting, poor wound healing, and very specific pulmonary or bone marrow disorders.

A health care professional can prescribe steroids off-label, meaning for conditions other than those that are FDA-approved. But children, particularly teens, are getting access to steroids and taking them for reasons far outside of their intended use.

Q: So how are teens getting access?

A: Some get prescriptions from a licensed practitioner for such purposes as introducing puberty to boys who are “late bloomers” or to stimulate growth among teens who are failing to grow. Some may be dealing with unscrupulous clinics or street dealers on the black market. Unfortunately, a number of vendors sell anabolic steroids online without a prescription. Individuals should also be aware that some dietary supplements advertised for body building may unlawfully include steroids or steroid-like substances, and the ingredient statement on the label may not include that information.

Q: What is the FDA doing to prevent those illegal sales?

A: FDA is taking a number of steps to discourage these practices. Action has been taken against illegal online distributors who sell steroids without valid prescriptions, but an ongoing problem is that you can take one site down and another pops up.

The challenge is intensified by the fact that many online providers don’t accurately advertise the contents of the products they sell, they may be operating outside the U.S., and the drugs aren’t prescribed by a licensed practitioner who can help individuals weigh the risks and benefits. In such cases, individuals may have no idea what they are taking, what the appropriate dose should be, or what levels of control and safety went into the manufacturing process. These facts make the risks of taking anabolic steroids bought without a prescription even greater than they otherwise would be.

Q: What would you say to a teen you knew was tempted by steroids?

A: I would emphasize both the short and long-term potential for serious harm to their health. Rather than making you look or perform better, steroids will more likely cause unfavorable results that could affect you for life. I would also remind them that there are a number of ways to increase muscle mass and athletic performance, including a sensible regimen of exercise and diet, without resorting to extreme and dangerous therapies.

Q: What would you like to say to parents?

A: Parents tend not to believe their teens would consider taking anabolic steroids, but the truth is that the frequency of steroid use in this age group is far greater than many would guess.

During this time of year, when children are in school and getting back into their athletic routines, parents should watch for potential signs of abuse. Mood swings are among the first side effects to show up, and steroid use may lead to mania or depression. Acne is also an early side effect and can be followed by breast development in boys or increased body hair in girls. A surprising gain of muscle mass should also raise questions. It’s a problem that is as real as it is surprising.

Babies Spitting Up

August 14, 2014

Anyone who’s ever taken care of an infant knows that babies spit up. And spit up. And then spit up again.

It’s easy to understand why some parents and other caretakers are concerned. Is the infant getting enough nourishment? Is frequent spitting up a sign of a more serious illness? Does the baby need medicine to treat the problem?

According to Andrew E. Mulberg, M.D, a pediatrician and pediatric gastroenterologist at the Food and Drug Administration (FDA), frequent spitting up is absolutely normal in most cases and not a symptom of poor health. As long as the child is alert, reasonably content, gaining weight, and not showing other signs of illness, this is not usually a cause for concern, he says.

So what is causing the baby’s food to come back up so frequently?

In infants, the ring of muscle between the esophagus and the stomach—the lower esophageal sphincter (LES)—is not fully mature, allowing stomach contents to flow backward, Mulberg explains. In time, the LES will mature and open only when the baby swallows and will remain tightly closed the rest of the time, keeping stomach contents where they belong.

“By the time the child is 18 months of age or younger, the problem—known as gastroesophageal reflux (GER)—usually resolves itself,” Mulberg says.

In a small number of cases, a more serious condition known as GERD (gastroesophageal reflux disease) may exist. GERD also can cause excessive spitting up, but requires treatment to avoid additional health complications, such as tissue damage in the lining of the esophagus. A health care professional should be consulted immediately if a baby shows such symptoms as spitting up blood, blood in the stool, weight loss, failure to thrive including lack of weight gain and persistent coughing or wheezing, Mulberg says.

Ways to Cope With Normal Spitting Up

Once a more serious disease is ruled out by the health care professional, there are a number of things parents and other caretakers can do to help prevent babies from constantly spitting up. These include:

  • Holding the baby in an upright position when feeding.
  • Feeding the baby smaller portions at a time.
  • Making a switch to a different formula.

“It’s understandable why new parents, especially, are worried when their child seems to be spitting up nonstop,” Mulberg says. “Generally, the parents are pretty sleep deprived, too—which doesn’t help the situation.”

When infants or young children need surgery, does anesthesia affect their developing brains?

With more than 1 million children under age 4 requiring anesthesia for surgery in the United States each year, the Food and Drug Administration (FDA) and other health organizations are working together to answer this question.

Previous scientific studies in young animals have shown that commonly used anesthetics can be harmful to the developing brain. However, results have been mixed in children. Some studies of infants and young children undergoing anesthesia have reported long-term deficits in learning and behavior; other studies have not.

These conflicting results show that more research is needed to fully understand the risks anesthesia may pose to very young patients.

To close these research gaps, FDA and the International Anesthesia Research Society (IARS) started an initiative called SmartTots (Strategies for Mitigating Anesthesia-Related neuroToxicity in Tots). SmartTots seeks to ensure that children under age 4 will be as safe as possible when they need anesthesia during surgery. Studies have shown that this is a period of significant brain development in young children.

“Our hope is that research funded through SmartTots will help us design the safest anesthetic regimens possible,” says Bob Rappaport, M.D., director of the Division of Anesthesia, Analgesia and Addiction Products at FDA. “This research can potentially foster the development of new and safer anesthetic drugs for use in pediatric medicine.”

According to SmartTots steering committee co-chair James Ramsay, M.D., young children usually do not undergo surgery unless the procedure is vital to their health. “Therefore, postponing a necessary procedure may itself lead to significant health problems and may not be an option for the majority of children,” Ramsey says.

Ongoing Research

SmartTots was launched in 2010 in part to fund research that would build on the work done at FDA and several universities.

Since 2003, Merle Paule, Ph.D., director of the Division of Neurotoxicology at FDA’s National Center for Toxicological Research (NCTR), and colleagues have been exploring the effects of ketamine—an anesthetic commonly used on children-on the brains and learning ability of young rhesus monkeys.

“Earlier research has shown that exposing young rat pups to ketamine caused learning problems when they became adults, but we wanted to see what would happen with primates,” said Paule. Primates, such as the rhesus monkey used in this research, more closely resemble humans in physiology and behavior. All animal procedures were approved by the NCTR Institutional Animal Care and Use Committee, and conducted in accordance with the Public Health Service Policy on the Humane Care and Use of Laboratory Animals.

“The learning of concepts such as matching (see a triangle, match it with another triangle from among other symbols) took much longer in the ketamine-treated monkeys And even after basic concepts were learned, the ketamine-exposed animals performed less accurately than animals in the control group,” Paule says.

The same holds true for the test monkeys even today, Paule says. Six years after their ketamine treatment, they’re still showing below-normal brain function.

What might that mean for young children who have been exposed to ketamine or other anesthetics during surgery?

“We can’t know with certainty at this time,” says Rappaport, a member of the steering committee that coordinates, manages and oversees the SmartTots initiative. “We need to definitively answer the questions of whether anesthetic use in children poses a risk to their development and, if so, under what circumstances.”

FDA and other health-related organizations recognize the importance of learning more on this topic. For example, do other forms of anesthesia similarly affect the brain’s ability to, learn and remember? How long might these deficits last?