Tuesday, July 2, 2013

Managing Your Child's Medications: A Lay-Parent's Guide

originally posted on whac-a-mole life 
We're on drugs. Yep, you name it (duh, legally prescribed drugs), we've probably tried it. I can't say I'm as drug-savvy as Nancy Botwin, and we certainly don't grow or sell them, but we do manage them. Doses, prescriptions, times, counter-effects, interactions, half-lives - it's a lot to take in when you're just trying to keep a kid from scratching your eyes out.

This post is NOT about the pros and cons of medicating children. It's a highly personal, emotional issue for many of us, and I don't wish to debate that here. Obviously, medications are not always the answer. Medications alone rarely are the answer. And unfortunately identifying the RIGHT medications and dosages often can feel like chasing a carrot: just when you think you've nailed it -bam! - the kid has a growth spurt; or completely new symptoms; or they stop making THAT pill in THAT dose; or something else.

Nonetheless, I chose to add medications to our treatment plans, and any reservations I had quickly dissipated after witnessing undeniable, SIGNIFICANT results.

Of course, that doesn't mean I love doling out psychotropic medications any more than I like my kid's melatonin habit. However, I defer to the age-old wisdom: if your child needs a wheelchair, you provide the wheelchair. Yes, you also offer therapy, rehab, counseling, sporn flushing, and so on, but you must provide the wheelchair.

Anyhoo, I've become somewhat of a preachy busybody on this topic because I screw up a lot, and it makes me feel much better to pretend I've learned something from it. So, as much as I support the use of  psychiatric medications when needed, I am militant about the following pointers. If you have others, please share them below, because I'm pretty sure we will continue to be a poster household for Big Pharma for many years to come.

  • ONE PHARMACY: Try to stick with one pharmacy for all of the obvious reasons (automatic refills; location; medication interaction flags), but also because they will get to know you. And this is critical when it is Labor Day weekend and the pharmacy is about to close and you are out of refills on your rx and your doctor is on vacation in Aruba. If they know you as well as ours knows us, they just MIGHT be willing to advance you enough pills to take you through Tuesday. (I'm just guessing here.)
  • ONE SPECIALIST: There are many wonderful doctors out there, and many are capable of writing perfectly legal prescriptions. Maybe your neurologist prescribes anti-seizure meds; and your developmental ped recommends an SSRI; and then your pediatrician  scribbles out an ADHD scrip...you can see that this is going to get ugly. Select one doctor to prescribe (or at least manage) your medication cocktail. And, at some point, you will want to consider whether that person should be a psychiatrist, preferably one who is educated, experienced and reputable when it comes to pharmaceuticals - but not in bed with big pharma. It's okay to ask that dev ped or that neurologist who they recommend and discuss adding a specialist to the team. I've had people tell me they are afraid of offending their doctor. I'm sorry: GET OVER IT. Focus on what's best for you and the kid!
  • CHOOSE WISELY: Perhaps your pediatrician is your drug dealer of choice. (Again, as long as they source or know they are the ones "managing" the meds, fine.) Whomever you choose, choose wisely. Think about these questions:
    • Is this their specialty?
    • Do they stay current with the latest research on medications - including off-label uses - and do they have an academic and practical understanding of interactions, dosing and side effects.
    • Are they easily accessible for questions, concerns, issues, and even last-minute, emergency refills - the bane of everyone's existence? Our psychiatrist actually emails us responses to questions and feedback on minor medication changes. I love him!

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