Medicating Children?

[shahseh22]

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As I go through fellowship, I'm a bit surprised as to how many child psychiatrists tend to overmedicate children at higher doses than I see for adults at times. I've also been surprised that psychiatrists tend to not be firm regarding need for DBT for Borderline Personality Disorder as opposed to just putting them on SGA's and Mood Stabilizers. Is it because parents push for meds? I've had an incident recently where a 3 yo who was somewhat hyperactive and mom was pushing me to start a stimulant, I had to put my foot down in that case, but I could feel mom's frustration with me.

Is this the norm in C&A Psychiatry? I don't want to be pushed into a corner all the times.

 

[TexasPhysician]

No field is perfect. Prescribing and requests also differ by setting and physician.

I’ve seen 6 yo kids with adhd admitted inpatient with diagnosis of bipolar and given zyprexa. Mother was happy to see her hyperactive son sleep 10 hours at night, take 3-4 hour naps, and be calm all day.

In another setting, I battle with getting parents of severe kids to try any medication.

 

[hamstergang]

Is this the norm in C&A Psychiatry? I don't want to be pushed into a corner all the times.

Based on the patients I get from other psychiatrists over-prescribing does seem too common, but of course that's a huge selection bias.

In any case, you don't ever have to prescribe when you don't think it's appropriate. I've had no problem telling parents their kids don't have ADHD or bipolar disorder and then not giving meds for such diagnoses. I work for a hospital system with bosses who would care about patient satisfaction, and I've never gotten any pressure to respond differently in such situations.

 

[Crayola227]

It's interesting, the dichotomy you see. Being outside psych, I probably see way more patients that are against pills of all sorts, particularly for mental health issues. A lot of them are the parents against vaccines and very pro-herbals. God I hate herbals.

Side note, I'm studying for boards and just ran across a whole list of herbals I'm expected to know what magical purposes patients use them for, and what harm they actually do. Why? Because this is what people do to themselves, and so now I'm responsible for the fallout. I suppose that's true for all the other ways patients kill their liver or whatever, but once upon a time this was not a form of magic physicians had to concern themselves with. Grumble grumble, sorry.