🧒 Psychiatric Medications in Children: Special Considerations, Safety & Best Practices
Treating mental health conditions in children is different from adults—not just medically, but developmentally, ethically, and emotionally. Parents often fear psychiatric medications for children due to myths like “It will change their personality”, “They will get addicted”, or “They will outgrow it.”
While counselling and behavioural therapy are always first-line, medication becomes necessary when symptoms affect learning, behaviour, sleep, safety, or family functioning.
🌟 Why Children Need Special Care in Psychiatric Prescribing
Children are not small adults—their brains, liver, kidneys, hormones, and emotional development are still evolving. Therefore:
| Factor | Why it matters |
|---|---|
| Brain is still developing | Medicines can affect neurodevelopment → must use only when benefit outweighs risk |
| Higher metabolism | Children may need weight-based dosing; some drugs clear faster than in adults |
| Communication limitations | Children may not express side effects clearly |
| School & family ecosystem | Teachers, parents, caregivers must be part of treatment |
| Long-term impact | Need to monitor growth, hormones, learning, appetite, sleep |
🧠 Common Psychiatric Conditions Where Medicines Are Used in Children
| Condition | When is medication considered? |
|---|---|
| ADHD | When behavioural therapy alone is not enough |
| Autism | For irritability, aggression, hyperactivity, self-harm |
| Depression | Moderate to severe cases, suicidal thoughts |
| Anxiety/OCD | When counselling & ERP alone do not help |
| Bipolar disorder | Severe mood swings, aggression |
| Psychosis/Schizophrenia | Hallucinations, delusions |
| Tourette’s/Tics | Severe tics interfering with social/school life |
💊 Common Psychiatric Medications in Children & Key Precautions
| Medication Group | Example | Special Considerations in Children |
|---|---|---|
| Stimulants (ADHD) | Methylphenidate, Amphetamines | Monitor appetite, weight, BP, heart rate |
| Non-Stimulant ADHD meds | Atomoxetine, Guanfacine | Liver enzymes, sleep quality |
| SSRIs (Depression, Anxiety, OCD) | Fluoxetine, Sertraline, Escitalopram | Start low, monitor for increased anxiety or rare suicidal thoughts initially |
| Antipsychotics | Risperidone, Aripiprazole | Weight gain, blood sugar, prolactin levels, extrapyramidal symptoms |
| Mood Stabilizers | Valproate, Lithium, Carbamazepine, Lamotrigine | Liver, kidney, thyroid tests, hydration, blood levels |
| Sleep Medications (rarely used) | Melatonin | Short-term use; ensure sleep hygiene first |
✅ General Principles Before Prescribing
✔ Detailed diagnosis – using history, school reports, rating scales
✔ Rule out medical causes – thyroid issues, seizures, anemia, nutritional deficits
✔ Psychoeducation to parents and (age-appropriate) child
✔ Involve teachers/school when necessary
✔ Start low and increase slowly (weight-based dosing)
✔ Monitor growth, appetite, sleep, mood changes, vitals
✔ Avoid polypharmacy unless absolutely needed
⚠️ Risks & Side Effects Parents Should Know
| Drug Class | Possible Side Effects |
|---|---|
| Stimulants | Loss of appetite, headaches, irritability, delayed sleep |
| Antipsychotics | Weight gain, sedation, high prolactin, diabetes risk |
| SSRIs | Nausea, anxiety at start, rare suicidal thoughts in teens |
| Mood Stabilizers | Tremors, weight gain, liver/kidney impact (rare) |
However — untreated illness can be more harmful than side effects:
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Depression → suicide, academic decline
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ADHD → school failure, accidents, low self-esteem
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Autism aggression → self-injury, family burnout
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Psychosis → permanent cognitive damage if delayed
👪 Counselling Parents – Key Points
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Medicine is not a punishment or sedative
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It does not change the child’s personality if used correctly
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Combine with therapy, parenting strategies, school integration
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Stop only under medical supervision — sudden withdrawal is harmful
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Regular follow-ups are essential
🎯 When to Seek Urgent Medical Attention
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Child becomes very drowsy or agitated
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New suicidal thoughts or self-harm behaviour
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High fever, neck stiffness (Neuroleptic Malignant Syndrome)
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Sudden facial movements, tongue rolling (Tardive Dyskinesia)
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Severe rash (Stevens-Johnson Syndrome with Lamotrigine)
🌟 The Goal of Treatment
The aim is not to sedate children—but to help them:
✔ Focus better in school
✔ Control anger or impulsiveness
✔ Reduce panic, fear, or depressive thoughts
✔ Build healthy relationships
✔ Develop into independent, emotionally strong adults
👨⚕️ About the Author
Dr. Srinivas Rajkumar T
Consultant Psychiatrist – Child, Adolescent & Family Mental Health
Mind & Memory Clinic – Apollo Clinic (Opp. Phoenix MarketCity), Velachery, Chennai
📞 +91-8595155808 | 🌐 www.srinivasaiims.com
Expert in ADHD, autism spectrum disorders, childhood anxiety, school refusal, behavioural issues, adolescent depression and safe psychiatric medication practices in children.