If you’re a parent, it should come as no surprise that children seemingly get sick more often than adults do. This is completely normal and occurs for various reasons, such as having thinner skin than adults (making them more susceptible to pathogens through a broken barrier), and having larger lung-volume-to-body-weight ratios that result in greater vulnerability to respiratory pathogens. While this increased exposure is beneficial for developing a robust adaptive immune system, there is a time and place for pharmaceutical intervention. Let’s explore some common childhood medications, what their side effects are, and what parents can do to combat or manage them.
BATTLING INFECTIONS
Amoxicillin is the number one prescribed childhood oral suspension antibiotic in Canada, belonging to a family of drugs known as beta-lactam antibiotics.2 Amoxicillin is the drug of choice for numerous pediatric infections, including bacterial ear and sinus infections and pharyngitis. It’s often paired with another drug called clavulanate, which is commonly known as “amox-clav.” Other common antibiotics include azithromycin, ciprofloxacin, and cephalosporin.
While drugs like amoxicillin are important, they do carry certain risks and side effects, such as rash (which occurs in up to 10 percent of people), and diarrhea (occurring in up to 20 percent of children). These side effects are not signs of a true drug allergy, although it’s important to note that amoxicillin is part of the penicillin-drug family and can cause a serious, and potentially fatal, allergic reaction.
Antibiotics & Probiotics
While it’s true that “not all bugs need drugs,” antibiotics play an important role in preventing common infections from causing rare but serious infection-associated complications. The decision to use antibiotics should be made jointly between parents and a physician, but there are still things you can do to support your child while they’re on them. First and foremost, use a child-friendly probiotic. Antibiotics effectively eliminate harmful bacteria but can also disrupt beneficial bacteria, leading to diarrhea; proven probiotic strains such as Lactobacillus rhamnosus and Saccharomyces boulardii can help mitigate this. Another way to support digestion is through probiotic-containing foods such as yogurt, as well as fibre-containing foods. Both help bulk up stool and are a source of prebiotics—the “fuel” for probiotics.
Viral Infections & Supplements
Please keep in mind that not all infections are bacterial by nature; many common childhood infections are caused by viruses. In these cases, antibiotics are ineffective. If your child is prone to viral infections, numerous evidence-informed supplements can support their immune system, such as Elderberry for colds and flu; these often come in the form of a chewable gummy. Alternatively, if your child is prone to ear infections or earaches, there are many over-the-counter standardised ear oils formulated with mullein and garlic for natural treatment.
MANAGING ADHD
In recent years, it has been estimated that attention-deficit hyperactivity disorder (ADHD) impacts up to nine percent of all children, nearly two million Canadians, and is one of the most common neurodevelopmental diagnoses in Canada. Although hyperactive and/or inattentive symptoms of ADHD are commonly focused on, children with ADHD often deal with anxiety and depression due to their struggles in the social sphere. Although ADHD is commonly treated with behavioural therapies and medication, it’s still highly underdiagnosed in Canada. First-line pharmaceuticals for ADHD are a class of drugs known as stimulants, such as amphetamine-based Adderall or Vyvanse, methylphenidate-based Concerta, or other second-line options like Straterra, Ritalin, or Dexedrine.
Drug Side Effects
In terms of side effects, each drug can produce its own unique constellation of symptoms; however, there are a handful that are common, such as:
- Appetite suppression
- Impaired sleep
- Increased heart rate and blood pressure
- Anxiety
While stimulant-based drugs can improve core ADHD symptoms by around 70 percent, these side effects can be serious, underscoring the importance of including non-pharmacological or behaviour-based interventions.
Natural Solutions
Behavioural therapy: Working with an occupational therapist or ADHD-specific therapist can have a significant impact on children with ADHD; behavioural therapy can teach skills to reduce negative behaviours in both children and parents, as well as improve self-esteem and social skills.
Exercise and meditative practices: Yoga has also been shown to be effective in improving behaviours by providing an outlet, grounding techniques, and promoting self-discipline.
Supplementation: Several supplements, such as EPA and DHA (omega-3 fatty acids), have been shown to improve learning and ADHD symptoms. Other promising supplements include phosphatidylserine, l-carnitine, and ginkgo biloba, although more studies on these are needed.
TACKLING ANXIETY & DEPRESSION
Another common area of prescribing in pediatrics is for anxiety and depressive disorders. Recent data shows that up to 19 percent and 12 percent of Canadian youth experience anxiety or depression, respectively, and that this number has nearly doubled in the last decade. The causes of anxiety and depression in childhood can widely vary, but quite often relate to a child’s experience in the social realm. For this reason, non-pharmacological options, such as counselling and behavioural therapy, are strongly recommended before and alongside pharmacotherapy. Major Canadian medical agencies, such as the Canadian Paediatrics Association, recommend psychotherapy as a first-line treatment for many child and adolescent mood disorders. Pharmacotherapy, however, can play an important role; the following are some of the most common medications recommended:
- SSRIs: Selective serotonin reuptake inhibitors (such as citalopram, fluoxetine, and sertraline) are a class of medications that modulate the neurotransmitter serotonin; these are a common drug of choice for anxiety and depression in children between the ages of 6–18. It’s important to note, however, that these drugs are used “off-label” due to risks associated with their use. Common side effects include headache, hyperactivity and/or insomnia, changes in appetite and weight, and a potential worsening of the mental state. The term “off-label” refers to the unapproved use of an approved drug. This is when healthcare providers use an approved drug for a condition it was not originally approved for.
- SNRIs: Serotonin-norepinephrine reuptake inhibitors are medications such as venlafaxine and duloxetine that modulate both serotonin and norepinephrine; they’re also used for anxiety and depression in adolescents. SSRIs and SNRIs must be used independently to prevent serotonin syndrome (a potentially life-threatening drug reaction resulting in high levels of serotonin in the body), but each can be useful in managing children with multiple mental health concerns. Side effects are similar to SSRIs, but can also include fatigue, high blood pressure, and high heart rate.
Supplemental Help
While numerous supplements have been suggested or studied for anxiety and depression, they should only be taken at the recommendation of a medical professional—especially if taken with SSRIs or SNRIs, as any substance that can impact mental state should be closely monitored. That said, there are several supplements you can discuss with your healthcare provider, such as l-theanine or lavender, which have evidence demonstrating a calming effect. Several nutrient deficiencies have also been associated with worsening anxiety and depression, such as magnesium, vitamin D, omega-3 fatty acids, and several B vitamins. Bloodwork can identify these deficiencies, and a corrective plan can be put in place by your healthcare provider.
Pharmaceuticals are often criticised for side effects and over-prescription, but it’s important to remember they play a vital role when used appropriately. Many of the drugs mentioned above are based on or inspired by naturally occurring compounds that humans have relied on for thousands of years. Before antibiotics, there were antimicrobial herbs that worked to boost our immune systems or topically stave off infections. Pharmaceuticals and natural medicines do not need to be at odds with each other, but each should be respected and used in the right place and time. Depending on the situation, they can even be used together to complement the actions of each other; however, this should only be done at the recommendation of a medical professional. When getting a second opinion or looking for support from another practitioner, make sure that you still seek out treatment from a regulated professional.
