I am frequently asked by parents for my opinion, as one parent to another, on the use of medications for children with mental health issues.   This is a source of anxiety for many parents, as they are uncertain about the long-term risk versus benefit of certain drugs, the rationale for using them, and the lack of information on their use in children.

As parents, this is often a very emotional decision, as we all want to do what is best for our children.  Most of us are not health care professionals, pharmacists or researchers, and it is sometimes not easy to defer to the expertise of others who do not have the same emotional investment in our kids that we do.   I myself have faced this dilemma over the years with two of my own children, and understand the difficulties in weighing the pros and cons.   All drugs have benefits and risks, and because young children cannot refuse or consent to treatment, this is a decision that falls to parents on their behalf.  It is a serious responsibility and should be made based on fact and not pseudoscience or emotion.   Above all, it must be clearly in the child's best interests.

It is important that parents get accurate information in order to make the most informed decision regarding any therapy, including drug therapies.  This generally starts with asking questions of the doctor prescribing the medication.  It can be helpful to do your own reading ahead of time so you have an idea of questions to ask, but it's best to stick to reputable web sites such as hospitals or university affiliated ones.   Some things to discuss with your child's doctor might include:

• Why he/she recommends the medication, how it can be expected to work, and what are the side effects. Will side effects go away in the short term? Are there longer term side effects (for example, weight gain, fatigue, etc?) Some drugs are prescribed at lower dosages and gradually increased to a higher dose to avoid side effects.
• Find out how long it should take before you should see positive effects - some drugs take several weeks before the full effect kicks in. Also, once started, how long should drug therapy last?
• Ask how long the drug has been on the market and if it has been approved for use in children. Is it a relatively new drug? Are there any reports of negative effects? Are there other similar drugs that have more of a track record and that are equally effective?
• Make sure your doctor knows what other medications your child is taking, including vitamins, supplements, or any other over the counter drugs, and if your child has any allergies.
• Discuss any reservations you have about prescription drugs for your child, and ask your doctor for his or her personal opinion and experience with prescribing this drug to other children.
• Parents are often concerned about long term effects of certain drugs on brain development. Ask what is known about this and about any potential effects on other organs (heart, etc).
• Ask if there are other, non-drug related treatments that have been studied and shown to be effective, and if these might be an option for your child, either in combination with or instead of drug therapy .

Parents are often concerned when the suggestion to use medication seems to be coming from a source other than a health care professional  (such as the school ).  They sometimes perceive this as being more for the school's convenience in handling unruly behaviour, rather than for the health and wellbeing of the child himself.  The bottom line here again should be whether the medication will clearly be a net benefit to the child (and not just to those around him), in that it will have the potential to improve his quality of life, ability to function, etc, and whether this outweighs any known potential risks.   Parents might also be open to a trial period to see if the medication helps or not.  This too should be discussed with the doctor.  If parents feel that medication is not in the best interest of their child, they should be open to exploring  other treatments and interventions.  All such decisions are ultimately up to the parent, and again, accurate and up to date information is key, as an informed parent is an empowered parent.