Heads-up: little typo in that headline. 2-year-olds
Toddlers are gonna do toddler things, dammit, like get super crabby, cry a lot, shout ânoâ at you a lot, get so tired they fall asleep in their dinner, refuse to go to bed, and a million other weird, but totally normal things. Any pediatrician that prescribes a drug off-label instead of telling the parents to suck it up or start doing yoga, or really take on any anti-stress activity, should lose their license.
My wife and I often joked with our kidsâ pediatrician that we really needed a script for âkiddie Ambien,â but it was just a joke. Iâve worked at a psych clinic, seen what those drugs can do, and cannot believe that anyone would prescribe them this cavalierly, particularly to small children. My faith in humanity drops another 10 points.
Unconscionable.
Isnât a lot of off-label use of punchy antipsychotics driven by the desire for something that will sedate the patient good and hard; but isnât recreationally useful enough to draw DEA attention?
Iâm pretty sure I remember reading about nursing homes with prescription patterns that would have been slightly alarming even to psych wards; who were doing that to keep the agitated and confused old people in line without costly staffing increases.
From a horrible-person perspective, I can imagine that this strategy might âworkâ in an immediate sort of sense, on children as well.
Or give them to the parents. Speaking from experience, raising kids in any city that demands double full time incomes to get by is really stressful. While doctors and parents shouldnât be let off the hook, there are powerful economic forces at work, too.
I canât wait till governments do more to subsidize affordable childcare. Itâs such a shame that so many parents canât afford to pay livable wages to qualified childcare workers.
Imagine a world where babies were expected to behave like normally adjusted adults.
âI think I may have a problem, doc. I canât stop thinking about my own motherâs tits, even in public. I constantly soil myself, and every night I wake up screaming. Oh, and I havenât trusted my father ever since that time he stole my nose and then straight-up disappeared behind his own hands.â
This addiction needs some attention too.
Baffled? Whoâs baffled? Theyâre alive arenât they? So, that means they are a viable market. It doesnât matter how old they are. We gotta sell, sell, sell! If you have a mouth, you can put a pill in it.
I never see hand-wringing about children addicted to books.
When my toddler acted abominable, I had a sure-fire prescription: a nap. Every parent I know uses this, and I expect parents seeking psychiatric help would be fairly rare. Sadly, not zero.
Babies donât come with an ownerâs manual, and even if they did, who reads the manual? If some people seek medication for their own problems, itâs not surprising they would also address their childrenâs problems the same way. But the doctors should know better. We need to prevent doctors from being incented to prescribe.
I bribed my son at 6 years old to read books, about a buck a book soâs to speak. At 25 he is still trying to hit me up for âbook reading cashâ, I get a real laugh at of that. Anyways, heâs a book a week addict, and Iâm proud of my little contribution to reading addiction.
Reminds me of how I trained my cat to use her scratching post using kitty treats. Sheâs a smart cat - very soon she would scratch twice and look up for her treat.
Boom. Exactly. Discussion of improvements and expansion of subsidized early care and education has been off the table for some reason in this country. I work for an EC non-profit, and weâll get visitors from EC councils in other countries who are flabbergasted that a developed nation can give so little care and attention to policy to support 0-8 year-olds and their parents. Head Start was actually started as a home visiting program that helped parents understand and care for their children, and even then was only for poor folks and even that was quickly chandged to just subsidized childcare, as home visiting wasnât politically popular. Trying to imagine a publicly funded system for all that includes comprehensive childcare and education (weâre just now slooowly expanding care for 4 year-olds in NYC) as well as in-home help, education and care for parents in the early years just feels unthinkable. The breathless âgubmint invades our homes, takes over our childrenâ hedlines just write themselvesâŚ
Itâs not just antipsychotics (quick reminder: the definitive mechanism of antipsychotics is their negative modulation of dopaminergic neurotransmission). I can recall a co-worker telling me about how her husband (who had late-stage Alzheimers and was now living at skilled care home) being given personality-crushing doses of valproate, a medication otherwise used for its mood stabilizing and anticonvulsant effects. Itâs like weâre revisiting the âbetter-living-through-chemistryâ chapter of psychopharmacology from the 1950s.
While I would definitely not advocate a return to Ye Olde Idyllic Past in this case, Iâd be curious to know how the timelines for availability of various dubiously-sensible child âsoothingâ agents line up; and whether there has ever actually been a âgap periodâ, or whether weâve moved through various agents as laws and mores changed.
Things like âMrs. Winslowâs Soothing Syrupâ(65mg of morphine per fluid ounce!) would certainly have soothed kiddo good and hard(available starting 1850ish, drawing distinct flack by the early 20th century; far too Schedule II to get ahold of now); and various âtonicsâ and âcordialsâ and âmedicinal extractsâ have featured the soothing goodness of alarming amounts of alcohol, sometimes in combination with opiates, for extra crazy).
Given that drugging screaming demon-children into submission is not a new practice; what Iâd be curious to know is whether it ever actually stopped/nearly-stopped at any point, or whether some mixture of regulation and sanity has prevailed for some of the classics, which creates a perverse incentive to use the (almost certainly even worse; but nice and âmedicalâ and legal, unlike feeding kiddo morphine or sweetened vodka) antispychotics to continue a practice that has been conducted by other means more or less continually.
As a public service announcement to parents: If your pediatrician/child psychiatrist suggests any of the following psychiatric drugs (U.S. brand names in parentheses):
chlorpromazine (Thorazine)
prochlorperazine (Compazine)
clozapine (Clozaril)
haloperidol (Haldol)
risperidone (Risperdal)
olanzapine (Zyprexa)
quetiapine (Seroquel)
paliperidone (Invega)
aripiprazole (Abilify)
lurasidone (Latuda)
ziprasidone (Geodon)
asenapine (Saphris)
brexpiprazole (Rexulti)
âŚdemand from him/her (1) an explanation of its pharmacological effects (this will test whether they understand its mechanisms), (2) a clinical indication for its use in pediatric patients, (3) at least one published, peer-reviewed, well-designed experimental study supporting such use, and (4) a clinical rationale, based on these findings and your kidâs own medication and psychiatric history, that necessarily rules out adding or increasing dosage of medications that are not antidopaminergic (i.e. dopamine-inhibiting) yet have similar indications/therapeutic benefits.
Then go get a second opinion from an active licensed psychiatrist, following these same criteria.
The worst thing is that we seem to be revisiting it with a much more carelessly selected patient population.
Itâs hard to say nice things about 50âs psychopharmacology; but at least, on its good days, it could claim the status of being a good-faith attempt to do something for people we previously had nothing but institutionalization and really alarming insulin overdoses and ECT and such. Sometimes it even worked to a degree.
The âimprovementsâ were not nearly as large as one would like; but compared to some of what they were trying to treat, the cure wasnât necessarily worse than the disease.
The âhardcore retro psych drugs! Like sedatives but without pesky narcotics-prescription investigations!â use case, though, is pretty damn hard to forgive.
Thatâs a lot of doctors who should be in serious legal trouble.
My 34 year old sister has been going steadily off the rails since she was a teenager and it was only recently that we found out she has been on antidepressants the whole time. She knows all the ways to trick doctors into writing a prescription. She did a degree in physiotherapy to get work in a hospital. She changed countries to dump her medical history. It sucks that medicine can be manipulated in this way and the only thing which I think would have avoided the situation would be that as parents we shouldnât just tell our kids that this pill will fix it. Sometimes you are going to be sad, or in pain and the cure is worse than the problem. Try to avoid reality and it wonât be there for you in the future.
