What are doctors thinking?

[MrNurse(x2)]

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.

[MrNurse(x2), ADN]

Talked at length with family, used for anxiety and ordered by psych, not PCP. She was so anxious in public school she had to be extracted from the car with a 30 minute crying fit. Much better here, only 2 instances in 4 months of attendance. Psych made it prn, I have the doses to give if she needs it and she is pretty good at not coming to me unless really necessary. Like when the health care team works for the good of the patient/ student.

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

If that were my child, seriously, I'd stay home with her and homeschool.

I know I sound a bit jaded here at times but sometimes I think parents push their kids and their "issues" . . .medical or psychological . . off on the schools to solve.

[mmc51264, BSN, MSN, RN]

My child was having anxiety issues starting middle school. He has ADHD and is a type 1 diabetic. Turns out he has pretty severe adverse reactions to SSRI/SNRI as I do (we both cannot take cold medications-Nyquil keeps me up for 2 days). Also we found out that SSRIs have a horrible interaction with insulin- my son was dropping to the 40s in the afternoons and we were unable to get it to come up. Needless to say, he is off of it now.

We have had an IEP meeting to address the issues he was anxious about and he sees a therapist, too. I think we have found a solution without meds. The only reason we tried was b/c neuro-ped had never seen him this stressed (has been seeing him for 5+ years). I'm not so sure about a benzo in a kid either.... (although it has the same effect on me that ritalin has on an ADHD kid: it makes me able to focus WAY better than unmedicated. I do not get drowsy at all.)

Just shows, there is no cookie cutter prescribing for people. Even more difficult with kids.

[BostonFNP, APRN]

So I am sure it will be an unpopular comment but I feel that it needs to be said, so here goes:

Nurses are trained to be patient advocates, and I earnestly believe the OP was/is attempting to advocate, and that is a good thing.

On the other side, and as a provider, there are some things that concern me about this. Questioning a medication that is causing an adverse effect is reasonable. This seemed to go further than that (and I do think it has some to do with a stigma of psychiatric medication and controlled substances but that's just me). I think my biggest concern is the overreaction without knowing the details. The nurse didn't know why this medication was prescribed or who prescribed it, and then posted about it on the internet before getting the rest of the information. That worries me a little. Most provider don't simply hand out meds to kids without a reason.

[mc3, ASN, RN]

We have a pediatrician with a very large practice in my town who I privately call the local drug dealer It seems like every child he sees in my school is on AHDH med, or is diagnosed as bi-polar. Lots of these kids are from lower income families. It makes me question what these poor kids brains are going to be like in 20 years

mc3

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

So I am sure it will be an unpopular comment but I feel that it needs to be said, so here goes:

Nurses are trained to be patient advocates, and I earnestly believe the OP was/is attempting to advocate, and that is a good thing.

On the other side, and as a provider, there are some things that concern me about this. Questioning a medication that is causing an adverse effect is reasonable. This seemed to go further than that (and I do think it has some to do with a stigma of psychiatric medication and controlled substances but that's just me). I think my biggest concern is the overreaction without knowing the details. The nurse didn't know why this medication was prescribed or who prescribed it, and then posted about it on the internet before getting the rest of the information. That worries me a little. Most provider don't simply hand out meds to kids without a reason.

Good point. Some of my best friends are providers! :)

However, as a school nurse, I do see an overabundance of medicating kids vs. working on family therapy/cognitive therapy.

I decided not to write details on my local experience with a physician but trust me when I say I have serious doubts. That doesn't mean that I think all physicians working with kids and prescribing meds are untrustworthy.

Like the term NETY . . . . I don't believe in making blanket statements about any career.

[SnowyJ, RN]

We need to keep in mind that children often will not react to a med the way an adult will.

I recently had a 2nd grader who was taking low dose amitriptyline as a migraine preventative. He went from a calm, engaging student to having severe behavioral problems..Lashing out, spitting, screaming, etc. His MD did not want to accept it could be the med! He is weaning off of it this week, thankfully. But the parents had to push for it.

I think we have to always watch the side effects for our children. It can be a lot different than what an adult may experience. As for the OT, there is a fine line between too much sedation for anxiety and just enough. Clearly needs a med review.

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

I heard this physician speak last week and I'm intrigued because I truly don't think we are doing kids a favor with being plugged into technology so much.

Reset Your Child's Brain

[BostonFNP, APRN]

CBT is great, the problem is, most people have a difficult time affording it. I encourage it for all my patients, but if they can't afford it, I do what I can with medications that are covered.

[MrNurse(x2), ADN]

I have no stigma attached to psych meds, as I have a child on them. My question to the provider, which I would have voiced for my own child, how do you expect a child to function intellectually on that med? I agree that home schooling may be the best option, but our education model at our school is seriously the next best thing. I feel for these parents, and they were thankful for my input, as was the psychiatrist, but family counseling may be the long term solution necessary for this girl. Sometimes there isn't a pill for everything.

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

. Sometimes there isn't a pill for everything.

Unfortunately . . .. ..we've kind of evolved into a society that thinks you can just pop a pill and cure your disease instead of making life-style changes.

(I'm married to one of those so I'm kinda sensitive on that issue - pills will take care of that silly old diabetes and I can drink sweet fruit punch, soda, and eat ice cream and boxes of Cheez-Its and don't have to take walks).

I don't nag anymore - I just increased his life insurance!

[MrNurse(x2), ADN]

At my hospital job, I see this more. Pt with new onset hiccups, "Do you have anything for hiccups?", I always reply, "Yeah, it's the same thing they give schizophrenics". Amazingly, most resort to their home remedies. Please don't read stigmatizing into that, my point is it is a strong med for a disease, not a simple hiccup. Had it been a beta-blocker, I would have said heart attack. Sometimes it is what it is.:)