What are doctors thinking?

[MrNurse(x2), ADN]

I have a third grader who is falling asleep in class. She has medical conditions that could be the cause, but her levels are therapeutic. I was reviewing her meds and saw Klonopin and trazadone, I assumed being given HS. After discussing with mom, the Klonopin was ordered before school for anxiety. I think we found the causative agent for her sleeping. I suggested to request the doctor halve the dose and send it to school where I could administer it on a prn basis, and repeat if necessary to keep this girl awake. It amazes me that this doctor thinks that she would get a meaningful education when going to school on these meds. It also makes me question why we always want a pill to fix everything, counseling would be such a better and safer way to go. Thankfully, the parents are very approachable and my advocating has helped with the rock star teachers we have here.Do you notice an excessive amount of meds prescribed to kids? I have a few on grocery lists that look like my hospital patients meds.

[ohiobobcat]

Klonopin and trazodone for a 8/9 year old?!? Jinkies!!!

My daughter is 15, has MAJOR anxiety and we haven't even discussed the benzo route for her. Is this child being prescribed these meds by a pediatric psych specialist, or by her PCP? I would encourage parents to see a pediatric psych specialist if they are not doing so.

When parents choose to disclose medications to me (haha), I see lots of ADHD meds (strattera/vyvanse/ritalin/focalin/concerta) and antidepressant/antianxiety meds. The only benzo I've seen/given was indicated as an anti-seizure med. I work with high school kids.

[MrNurse(x2), ADN]

Her PCP ordered it. Her parents are taking her today and addressing my concern. The nice thing about private is my administrators back me up and we can be more demanding in our requests (not needed in this instance). Our parents were really reluctant to give histories before I came, the papers were in a labeled drawer in the office where any parent volunteer had access. I have developed a free, bare bones documentation system using Word that passlock protects kids medical records and allows me to document visits. This has changed the blank forms on kids I was giving lunch doses of ADHD meds to complete histories. Much easier and reduces my need to contact parents.

[CalNevaMimi, LPN, LVN]

Anxiety? How about cognitive therapy, especially for a child? I'm not an expert, but I don't understand how that poor child can learn any coping skills while being so drugged up. Perhaps there is a therapy and med combo approach, but geez, poor kid. Reminds me of a student I had when I taught 3rd grade at a private school. Her mom was unable to attend a classroom activity and the poor kid curled up in the fetal position under one of the tables.

[Not_A_Hat_Person, RN]

What if the psych med isn't the problem? No other class of medication is more stigmatized, except maybe opiates.

[Spidey's mom, ADN, BSN, RN]

A PCP shouldn't be doing this.

I'd suggest a child specialist of some sort. Someone who is trained to deal with kids with her kind of medical issues.

And as Mimi mentioned, Cognitive Therapy first . . ...especially at this age. Way before using these kinds of meds on kids.

[Wave Watcher]

I work at a magnet school and many of our parents are "crunchy granola" types. Not a bad thing really but they tend to use therapeutic oils, natural remedies and diets to control health issues. Not too sure if that works either. Smells like lavender walking down the hallway. lol

[ohiobobcat]

What if the psych med isn't the problem? No other class of medication is more stigmatized, except maybe opiates.

I'm not sure what you mean by this? Drowsiness is a side effect of clonazepam so it makes sense to explore that clonazepam may be in fact what might be causing this child to be drowsy. I don't think that is stigmatizing an entire class of psych meds by exploring this possibility.

And not knowing this child's medical history and what other anti-anxiety meds have been tried, I feel that clonazepam should not be the 1st drug of choice to treat anxiety in a child that age. And if another drug has been tried and didn't work, then that child deserves a referral to a pediatric psych specialist of some type. I also hope that this child is receiving counseling/therapy of some type, and not just trying to treat this anxiety with meds only.

[SassyTachyRN]

I had a child last year who was taking klonopin last year for hyperactivity... She was falling asleep in school constantly. Finally got her down to a half dose this year and I am administering at school when she arrives in the am so that it lasts as long as possible. So far she's staying awake. It's also prescribed by the PCP and not a ped psych...

[MrNurse(x2), ADN]

Right now we are trying to rule out cause, I work in acute care FT over the weekends and we give benzos for sleep and agitation, hardly conducive to the alertness needed for class. The parents agree and are extremely supportive and thankful for my input. She is also on anti-depressants, I am not stigmatizing, I am going by side effects. I also am not belittling anxiety as a real diagnosis, just questioning why we must always result to meds as first line.

[EricaAngela90]

If they had to pick a medicine I would think an ssri would be more appropriate, unless the meds are used for something like epilepsy.

[anewsns]

Wow , those meds will put anyone to sleep! Is she also taking them at night ? Non pharm choices are always a good idea, but I wonder if she would be good to take them at night for now to avoid suddenly being without them . And to help her get a solid sleep. Those will be leftover in the morning as well, she may be drowsy still, but I would still think night is more realistic than morning.