Dr. Henry Paul, MD

Psychiatrist, Author and Educator

WHAT YOU’LL NEED TO KNOW BEFORE STARTING YOUR CHILD ON MEDS (Part 3)

May 29th, 2015

If you have been told that your child would benefit from taking medication there are some things you need to know. In my latest book, “When Kids Need Meds; Everything You Need to Know about Psychiatric Medication and Youngsters” I have prepared a 13-step guide that will help you alleviate some of your concerns and answer your questions about the medications. I am sharing the guidelines in a three blog series this week. This is the third, and final, blog in the series. Below is a link to the first two blogs. Please share the series with others who have concerns about medications prescribed for their children and teens and email me your questions and concerns.

(The guidelines listed are a continuation from my two previous blogs).

10. Tell your child’s doctor about any other medications, supplements, or home remedies your child is receiving to be sure there are no adverse interactions with the prescribed medication. Remember even natural remedies can cause interaction problems.

11. Never compare dosages in milligrams between medications; they all differ and cannot be compared because of potency differences in the manufacturing process. Thus, one milligram of one medication might equal in efficacy ten milligrams of another. For example, I recently had to explain to a patient that the new medication I was giving was measured in one-half to two-milligram dosages and was replacing one that measured about thirty milligrams. It was simply another compound whose potency was measured differently.

12. Be prepared for your child’s doctor to recommend more than one medication. This use of multiple medications has become more common, as it sometimes gives better results. There are, however, risks to this practice that your doctor will need to explain. Risks include medication interaction, increased safe side effects, as well as decreased compliance because of the difficulty some patients have with multiple prescriptions. Always find out why your doctor is prescribing multiple medications and ask specific questions about the benefits and risks of such prescribing.

13. Always trust yourself and all the knowledge you have about your child. No one knows your child better than you! Making you the best resource for observing side-effects, therapeutic effects, and the overall well-being of your child. Don’t be intimidated. Call your psychiatrist with any concerns.

This is the final blog in a three-part series.
Link to blog 1
Link to blog 2

As part of National Mental Health Awareness Month I am offering free copies of my book. Please email me if you’d like a copy.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT YOU’LL NEED TO KNOW BEFORE STARTING YOUR CHILD ON MEDS (Part 2)

May 27th, 2015

If you have been told that your child would benefit from taking medication there are some things you need to know. In my latest book, “When Kids Need Meds; Everything You Need to Know about Psychiatric Medication and Youngsters” I have prepared a 13-step guide that will help to alleviate some of your concerns and answer your questions about the medications. I am sharing the guidelines in a three blog series this week. This is the second blog in the series. Below is a link to the first blog. Please share the series with others who have concerns about medications prescribed for their children and teens and email me your questions and concerns.

(Read blog 1 for steps 1 – 4)

5. Make sure your child’s doctor, or a covering professional, is available twenty-four-hours-a-day, 365 days a year, for any concerns you have about your child. Anything less is unacceptable.

6. Understand why the great majority of psychotropic medications given to young people are off-label, which means they haven’t been specially approved for use by children. You will want to ask your prescribing psychiatrist what their particular experience is with the medication, as well as what studies have shown about the medications use in children and teenagers.

7. Find out from your doctor what time of the day and how to give your child the medication – with meals, all pills at one time, on a full or empty stomach? Although many pharmacies now include a written summary of various aspects of the drug, follow the prescriber’s recommendations over those of the pharmacy. Call the doctor if there is a difference.

8. Determine what the mediation will cost. Are there ways to cut the cost? Your pharmacist is the best source for that information. Cost should never force a decision. Sometimes insurance companies make it difficult to get medication. Be persistent and get help from your psychiatrist to be sure your child gets exactly what the doctor ordered; generic or brand, the correct quantity, and refills, too.

9. Ask if there is a difference between generic and brand name drugs. I have not seen much of a difference between their effectiveness. Generic is usually okay. Some patients demand brand name medications, and I go along with it, but with the caveat that these will cost more money with little research showing a beneficial effect.

This is the second blog in a three-part series.
Link to Blog 1

As part of National Mental Health Awareness Month I am offering free copies of my book. Please email me if you’d like a copy.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT YOU’LL NEED TO KNOW BEFORE STARTING YOUR CHILD ON MEDS (Part 1)

May 26th, 2015

If you have been told that your child would benefit from taking medication there are some things you need to know. In my latest book, “When Kids Need Meds; Everything You Need to Know About Psychiatric Medication and Youngsters” I have prepared a 13-step guide that will help you resolve your concerns about the medications. I will share it with you in a series of three blogs this week. Please share it with others who have questions and concerns and email me with questions.

Have your doctor explain your child’s diagnosis in as much detail as possible. Is there a known cause for the difficulty? What course might the disorder take if not treated? For example, if a child with ADHD doesn’t get treatment, the chance of substance abuse increases as the teenage years approach. Teenagers not treated for depression have an increased suicide risk. What positive effects of the medication will the psychiatrist be looking for? How long should it take? What will he do if it doesn’t work? While there is no medication which totally cures everything, your child’s prescription should target specific symptoms.
Make sure your child gets other forms of treatment along with medication. What does your doctor recommend? Individual talk therapy? Special school interventions? Behavioral therapy? Family counseling? Be wary of the practitioner who simply gives you a pill and wishes you good luck.
Make sure you child is physically healthy. If not, then the prescribing psychiatrist needs to be familiar with a medical condition. To this end, the doctor should take a detailed medical history of your child. Also, I like to see a report of a recent physical examination from the child’s pediatrician. I also suggest a routine 12 lead electrocardiogram in most cases. The blood tests and EKG will not only give signs of present conditions but will serve as baseline readings. Some medication affects blood tests and the EKG, and if we don’t have a baseline it will be difficult to know if future abnormal readings are caused by a medication or were always present.
Have a clear understanding of the medication’s side effects. Most side effects are fleeting and mild and don’t interfere much in your child’s life in any way, but they can be specific depending on the medication. You should know what they are so you don’t get worried. Serious or long lasting side effects for child and teenage psychotropic drugs are rare, but again, you should be told of the signs. If you read information from the Internet, be careful about the websites you choose. Don’t jump to the conclusion that the information you find online is more accurate than you psychiatrist’s years of clinical prescribing experience.

As part of National Mental Health Awareness Month I am offering free copies of my book. Please email me if you’d like a copy.

PROM – A RIGHT OF PASSAGE

May 22nd, 2015

This is the weekend for many high school proms across the country. Teenagers are eagerly awaiting this “adult” night out with friends. The dress is bought, the tux is rented, tickets are bought and the perfect flowers are ordered. But, the unspoken about prom night is what I’m concerned about. Parents need to talk to their kids about staying safe. They need to know what their child’s plans are for prom. Who is driving, where they are going, and what they are doing after the prom.

All too often, parties are a part of prom night. With them come drinking and drugs, particularly marijuana, and inexperienced drivers. Make sure they understand the dangers of distracted, drugged and drunk driving. A sobering reminder to parents – teenagers, cars, texting, alcohol and drugs are a deadly mix. Here are some things to keep in mind and to discuss with your children about prom night.

First, remember teenagers never set-out to hurt their friends when they drive high or drunk, no one does. But the tragic truth is that drugged driving does kill!
Substance abuse is on the rise in the United States, particularly, amongst teens and young adults in their 20’s.
Statistically, teens think that driving drunk is much worse than driving high. Make sure they understand that “drugged” driving is as bad as drunk driving. Both are illegal, and both can be deadly.
Talk to your kids about driving high. Smoking pot is not a “rite of passage” for teenagers. The stakes are much too high!
While you’re at it – remind your teenagers that almost 6,000 people die each year due to distracted driving, according to the National Highway Traffic Safety Administration. Make sure they know – no texting and driving.
Educate yourself about the other dangers that are out there for teens. MOLLY, synthetic heroin, powdered caffeine, powdered alcohol (a powdered form of alcohol called Palcohol is now approved for sale in the United States), “skittle bowls” and Raves.
Remember, to enjoy prom night and all that comes with it for you and your child. Be sure your teen knows that they can call you no matter what! Most important – keep the lines of communication open. Happy (and safe) prom to all!

WEIGHT GAIN IN KIDS TAKING PSYCHOTROPIC MEDICATIONS

May 20th, 2015

What to do about weight gain in kids on psychotropic medications seems to be one of the leading concerns of parents. Some antipsychotic medications and antidepressants cause weight gain.

First, I want to make clear that these medications in many instances are very helpful in treating children with mental health disorders. Weight gain does not occur in all young people who take them. In some cases, the medications are life-saving. As a parent, you have to weigh the benefits. Usually, the benefits outweigh the risks of side effects including weight gain.

Having treated thousands of children in my career, I know that gaining weight itself comes with its problems — self-esteem, social acceptance, and of course one’s physical health.

If your child has been prescribed a medication that is known to cause weight gain, here are some things you can do. The first is to consult with your pediatrician to establish what a healthy weight is for your child. Keep track of your child’s weight. If weight is being gained, then a common sense cutback in calorie consumption is necessary. Work with your child to create a healthy lifestyle of eating and exercise and try to limit calorie content of foods as much as possible. It has been my experience that high fat and sugar snacks are often the culprits for kids on medications. Help your child to cut down noshing, and only nosh on low-calorie foods and decrease overall intake of calories.
The best thing to do is to work with children to teach them better eating habits. Encourage them to be hands-on in the decisions about what they eat. Have them help you in the kitchen. Take them food shopping. More importantly, be an example. If you are eating junk food, of course, they will want it too. Make outings more about doing things rather than about going out to eat or going for ice cream.

In the end, when your child is on antidepressant or antipsychotic medications weight should be watched. There is no magic here and no magic mechanism. As parents, we have to watch what we and what our children eat. Parents need to set a good example and help their children make good choices.

TRANSGENDER CHILDREN & TEENS AND ACCEPTANCE AT SCHOOL

May 15th, 2015

As children reject their birth gender at younger ages, schools districts large and small, conservative and liberal, are working to help transgender students fit in without a fuss.

Statistics show that young, transgender children and teenagers face more discrimination than LGB’s. The victimization of these students results in missed school, lower grades, and poor self-esteem. And, they are often the victims of bullying.

A study in 2009 by Harsh Realities: The Experiences of Transgender Youth in Our Nation’s Schools reported an “urgent need for educators, policymakers and all who care about safe schools to address the disproportionate victimization of transgender students in school and to improve the knowledge and understanding of all members of the school community about issues related to gender and gender expression. This report also highlights the continued need for focused research so that all of us committed to creating safer schools for all students can more clearly understand the realities for specific student populations. Such understanding is critical as we work toward the development and implementation of effective policies, programs and resources.”

In 2014, California became the first state to implement a law spelling out the rights of a transgender student in public schools, including the ability to use restrooms and to play on sports teams that match their expressed genders. This is a great step forward. It is important that these type of policy changes continue to keep all youth safe in our schools.

YOUNG CHILDREN AND GENDER IDENTITY (GENDER DSYPHORIA)

May 12th, 2015

“People who have gender dysphoria feel strongly that they are not the gender they physically appear to be.

For example, a person who has a penis and all other physical traits of a male might feel instead that he is actually a female. That person would have an intense desire to have a female body and to be accepted by others as a female. Or, someone with the physical characteristics of a female would feel her true identity is male.

Feeling that your body does not reflect your true gender can cause severe distress, anxiety, and depression. “Dysphoria” is a feeling of dissatisfaction, anxiety, and restlessness. With gender dysphoria, the discomfort with your male or female body can be so intense that it can interfere with the way you function in normal life, for instance at school or work or during social activities.” (WEDMD, 2015)

Gender dysphoria is another term for Gender Identity Disorder. Whether-or-not young children who express transgender issues can really be believed is a hotly debated issue right now. Is this ever just a phase? How do you respond when your toddler daughter’s first sentence is that she’s a boy and she says it over-and-over, day-after-day? What do you do when your three-year-old son insists on wearing nail polish like mommy, and a dress to pre-school?

How young is too young to know? In March 2015, a Medscape study looked at the usual patterns for development of gender identity. According to the study, “Several studies by Milton Diamond of the University of Hawaii indicate that gender development reaches a critical point during childhood, after which it becomes extremely difficult to modify in most individuals. While there may be a number of children who do not clearly fit into a neat binary model of gender in which the polar extremes of behavior are reserved for those with clear sex and gender congruence, it is increasingly clear that gender identity is at the very least an intrinsic characteristic that emerges during early development.”

For parents, dealing with a child’s gender identity issues can be overwhelming. It also brings on a flood of questions. What causes it? What treatment will help? What should parents do or not do?

The first thing is not to panic. Love your child. Talk with your child’s pediatrician and seek out a child psychiatrist, if necessary. Many very young children express gender dysphoria and turn out not to be transgender when older. Thus, it is considered risky to support any permanent changes (name, gender reassignment surgery,etc.) until a child is older. Also, with gender identity there are usually underlying conditions, known as co-morbidities, which need to be addressed. These co-morbidities include such things as depression, anxiety and suicidal tendencies. Remember, that supportive parenting practices are key to strengthening a child’s self-esteem. Listen, learn and keep the communication open. Those are the first steps!

UNDERSTANDING TRANSGENDER CHILDREN

May 8th, 2015

Children and teenagers are grappling with a very grown-up issue that suddenly has everyone talking because of the Bruce Jenner interview last month. What is it? Gender Identity! It is when a person’s gender identity does not correspond to that person’s biological sex assigned at birth. It is when the body says one thing and the mind clearly says another.

CBS News did a story in 2014 that I recommend you watch. Born this way: Stories of young transgender children looks at what it is like to be young and transgender in America. It begins interviewing 12 year-old Zoey, who says she always knew she was a girl even though she was born a boy. She told interviewer Rita Braver, “I would be like, ‘No, I’m not a boy. I’m a girl. You know, like, I like the color pink, I scream like a girl. I act like a girl. I breathe like a girl. I’m not a boy.””

Zoey’s mom tells about her fear after Zoey told her she was a girl, and how she finally accepted Zoey’s decision to live as an openly-transgender girl. But, make no mistake it wasn’t easy. Although, Zoey tells Braver she was supported by many friends and family, she still endured cruel treatment.

Thirteen year-old Venice, tells Braver how he is taking testosterone because he was born a girl but always felt like a boy. His mom and brother were supportive from the start, but his father struggled with Venice’s decision. His father actually went so far as to hire a therapist to convince Venice to remain a girl. Both parents, even though they were separated, joined a support group for parents of transgender children.

For the parents of six year-old Mati, it started when she was two. Mati, born a boy, wanted to be a girl. Her parents decided that her happiness was most important and so they supported her transition. Many people have criticized their choice. They tell Braver why they feel it was right.

All of these children and their families should be applauded for doing the interview with CBS and Braver. It is their voice that will help others. Click here to watch the interview.