Download Drugs and Their Effects on Children

Drugs and Their Effects on Children:
Maybe It’s Not Just a Bad Day
Lynette C. Klotz
Kimberly Murphy
Robert E. Owens, Jr.
State University of Geneseo, Geneseo, NY
Good questions outrank easy answers.
–Paul A. Samuelson
T
he awareness of and the ability to diagnose
and pharmacologically treat various medical
and neurological conditions are on the rise.
The overall increase in the use of medications has been
documented by the Food and Drug Administration, which
reported that pharmacists filled 3.1 billion prescriptions in
2003—60% more than 10 years ago (Pennsylvania Health
Care Cost Containment Council, 2004). Likewise, according
to the Pennsylvania Health Care Cost Containment Council
(2004, paragraph 1), “U.S. expenditures on pharmaceuticals
have increased from $82 billion in 1992 to $192 billion in
2002.” As a consequence, there are an increasing number
of individuals on a speech-language pathologist’s (SLP’s)
caseload who are using prescription drugs.
ABSTRACT: The purpose of this article is to provide
speech-language pathologists (SLPs) with a brief description, recommended dosage, common side effects, and
overdose symptoms of commonly prescribed medications
used by children who frequently receive speech-language
services in schools. Knowledge regarding medication use
is becoming more important to SLPs due to recent
studies reporting an increase in prescription drug use in
individuals of all ages. Although this article concentrates
on those drugs that are frequently prescribed for
children, a select number of drugs used by young adults
have been included in the Appendix.
KEY WORDS: prescription medicines, recommended
dosage, common side effects, overdose symptoms
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This trend is supported by a study conducted between
2001 and 2002 by the U.S. Department of Health and
Human Services’ Center for Disease Control and Prevention
and the National Center for Health Statistics, which
investigated selected prescription and nonprescription drugs
recorded during visits to physician offices and hospital
outpatient departments. In their study, the researchers
computed the number of drugs recorded per visit. Their
data estimated that out of a group of 100 individuals under
the age of 18, each person was prescribed more than three
drugs in a 2-year period (National Center for Health
Statistics, 2004). Some medications may have been
intended for short-term use (e.g., antibacterials); others
were associated with long-term care (e.g., central nervous
system stimulants), although both types of drugs alter the
chemical state of the user’s body.
According to the American Speech-Language-Hearing
Association’s (ASHA’s) Code of Ethics, Principle I, Rule B,
SLPs should “use every resource…to ensure that highquality of service is provided” (ASHA, 2003, pp. 13–15).
Due to the increase in prescription drug use among
children, it becomes necessary for SLPs to expand their
understanding of their clients. An informal survey conducted by the authors in various educational settings
suggests that between 2% to 10% of children in a regular
public school setting are taking prescription medications,
and between 70% and 90% of children in special education
settings are administered prescription drugs on a daily
basis. It should be noted that these percentages may not be
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accurate representations due to the reality that many school
nurses are unaware if, and to what extent, various kinds of
medications are administered at home.
As practicing SLPs, we must take these figures into
consideration because children with communicative impairments often have concomitant disorders or conditions, such
as attention deficit hyperactivity disorder, seizure disorders,
and various syndromes, for which medications are prescribed. In addition, young children tend to be more
susceptible to illness and/or injury that consequently results
in medical treatment to decrease the severity of the
resulting symptoms and/or effects.
Medications are managed in a variety of settings such
as schools, hospitals, day programs, and homes. Although
the vast majority of caregivers administer drugs at home
as recommended, some caregivers may intentionally or
unintentionally alter dosages. For example, parents may
modify a child’s medications in order to change his or
her behavior, such as to gain cooperation for a family
function. In other examples, a caregiver may believe that
the individual does not require the medication, disagree
with the recommended dosage, or object to the high cost
of the medication. In all of these cases, the caregiver
may withhold the prescribed medication or modify the
dosage.
The SLP may observe the symptoms of medication
side effects and/or the repercussions of medication
mismanagement during intervention. Being cognizant of
the possible side effects and symptoms of a drug can be
advantageous to both the SLP and the client. Older
children and adults may even be able to discuss changes
in their medications and report symptoms that they may
be experiencing. SLPs may be the first to learn of,
observe, and recognize the symptoms as a concern. Thus,
it is important to have access to and knowledge about
medicinal use in all settings. The purpose of this study
was to collect and organize relevant data for the most
commonly used prescription drugs into a readily available resource for SLPs.
METHOD
Thousands of drugs are prescribed for a variety of illnesses
and conditions. The authors consulted with school nurses
and a practicing physician to construct a list of the most
commonly prescribed medications for children and young
adults. The list has been sorted into the following categories based on their primary use: antibacterials, anticonvulsants, antidepressants, cardiac medications, central
nervous system stimulants, hypertension prescriptions, and
schizophrenia treatments.
In addition, informal surveys were taken from nonrelated
educational settings to assess the average number of
students enrolled in each school that use medications at any
given time. Information distributed by reputable organizations such as the National Center for Health Statistics was
examined to support the increase in prescription drug use
among children and adolescents. Previously conducted
studies were also examined to obtain insight on the issue of
use and cost of prescription drugs in the United States.
The 2004 Physician’s Desk Reference (PDR) served as
the primary resource for the information on dosage, side
effects, and overdose reactions. This information is included in the Appendix. Several medications have a long
list of possible side effects and overdose symptoms.
Decisions about inclusion of side effects and overdose
symptoms in the Appendix were judged according to the
drug’s observable manifestations. Drug attributes that were
less likely to be recognized by professionals outside the
medical field were not included in the Appendix.
RESULTS
As mentioned, 2% to 10% of regular education children
were estimated to consume prescription drugs at any given
time during a school year. The percentage of children
enrolled in a specialized education setting who use prescription drugs at any given time during a school year may
be as high as 70% to 90%. SLPs service approximately 7%
of the school-aged population; thus, the likelihood of
having a child who takes medications on their caseload is
considerable.
The goal of the authors was to provide a resource for
SLPs to reference quickly (dosage, side effects, and
overdose results) when medications may be in question
with a client. The degree of severity among side effects
from medications varies based on the specific drug and the
individual, as depicted in the Appendix.
If an SLP has concerns about a client’s prescription drug
usage, he or she should first review the client’s file. A list
of current medication(s) may reveal the source of the
sudden change in performance and/or demeanor. It also
may be useful to use other resources such as a nurse,
education provider, and/or family members to obtain this
information.
It is imperative to remember that there are variations in
dosage protocols. Critical signs of adverse reactions and/or
overdoses may also include non-observable symptoms such
as an increased or decreased resting heart rate, decreased
leukocyte count, and elevated blood pressure. The SLP
should consult reliable informants such as a school nurse,
primary care physician, and/or the PDR to learn about
additional warning signs and relevant information.
ACKNOWLEDGMENTS
The authors would like to extend a special thank you and our
gratitude to those who provided assistance with constructing this
article: Dr. Arnold H. Matlin, MD, FAAP., Linwood, NY; Linda
Momberger, RPh, Wyoming County Community Health System,
Warsaw, NY; Anne Pawlowski, RN, Lead Nurse, Mary Cariola
Children’s Center, Inc., Rochester, NY; and all the nurses within
the local public schools who kindly donated information regarding
the medications most commonly prescribed to date. We greatly
appreciate their time and efforts.
Klotz et al.: Drugs and Their Effects on Children
121
REFERENCES
American Speech-Language-Hearing Association. (2003). Code
of ethics (rev. ed). Asha Supplement, 23, 13–15.
National Center for Health Statistics. (2004). Retrieved February 6,
2005, from http://www.cdc.gov/nchs/data/hus/hus04trend.pdf#pref
On-line Medical Dictionary. (1997–2004). Retrieved February 13,
2005, from http://cancerweb.ncl.ac.uk/cgi-bin/
omd?action=Home&query=
Pennsylvania Health Care Cost Containment Council. (2004).
The rising utilization and costs of prescription drugs. Retrieved
February 5, 2005, from http://www.phc4.org/reports/FYI/
fyi26.htm
Physicians’ Desk Reference. (2004). (58th ed.). Montvale, NJ:
Thomson PDR.
Contact author: Lynette Klotz, Department of CDSc, 1 College
Circle, SUNY, Geneseo, NY 14454. E-mail: [email protected]
APPENDIX. COMMON MEDICATIONS USED BY CHILDREN AND ADOLESCENTS
Antibacterials
Name
Typical Dosage
Most Common Side Effects
Overdose
Amoxicillin
Adult: Not to exceed 875 mg
every 12 hr
Child: Not to exceed 45 mg/kg/day
in divided doses every 12 hr
Nausea, vomiting, diarrhea, erythematous maculopapular
rashes (red eruptions on skin), erythema multiforme (skin
rash), Stevens-Johnson syndrome (severe skin rash),
anemia, hyperactivity, agitation, anxiety, insomnia,
confusion, convulsion, behavioral changes, and dizziness
Interstitial nephritis (inflammation of
kidney-related tissues) resulting in
oliguric renal failure
Cefzil
Adult (13 yrs and over):
Upper Respiratory Infection:
Pharyngitis/Tonsillitis: 500 q 24 hr
Acute Sinusitis: 250 or 500 q 12 hr
Lower Respiratory Infection:
500 q 12 hr
Diarrhea, nausea, vomiting, abdominal pain, dizziness,
hyperactivity, headache, nervousness, insomnia, confusion,
somnolence, cholestatic jaundice, diaper rash, genital
pruritus (itching), and vaginitis (inflammation of vaginal
mucousa)
Diarrhea and loss of appetite
Diarrhea, dyspepsia (impaired digestion), gastritis
(stomach inflammation), abdominal pain, transient
hepatitis, cholestatic jaundice, nausea, vomiting, genital
and anal pruritus, genital candidiasis (fungal infection),
vaginal discharge, dizziness, fatigue, headache, agitation,
confusion, hallucinations, arthritis, joint disorder,
reversible interstitial nephritis (inflammation of kidneyrelated tissues), and allergic reactions in form of: rash,
Stevens-Johnson syndrome, or toxic epidermal necrolysis
(scaly skin)
Nausea, vomiting, epigastric distress
(discomfort associated with upper
and/or central abdomen region),
diarrhea, and hematuria (blood in the
urine)
Gastrointestinal disturbances, Stevens-Johnson syndrome,
toxic epidermal necrolysis, aplastic anemia (insufficient
red and white blood cell production), and hypersensitivity
of the respiratory tract
Anorexia, colic, nausea, vomiting,
dizziness, headache, drowsiness,
unconsciousness, jaundice, mental
depression, confusion, and bone
marrow depression
Child (2–12 yrs):
Pharyngitis/Tonsillitis: 7.5 mg/kg q 12 hr
Infant & Child (6m – 12 yrs):
Otitis Media: 15 mg/kg q 12 hr
Acute Sinusitis: 7.5 mg/kg q
12 hr or 15 mg/kg
Keflex
Adult: 250 mg every 6 hrs or
500 mg every 12 hrs
Child: 25 to 50 mg/kg in
divided doses
Otitis media: 75 to 100 mg/kg/day
in 4 divided doses
Septra
Pediatrics:
Weight
Dosage every 12 hrs
Lb.
Tsp.
Tablets
22
1 (5 mL)
44
2 (10 mL)
1
66
3 (15 mL)
1.5
88
4 (20 mL)
2
Zithromax
Diarrhea, loose stools, nausea, and abdominal pain
Adult (16 yrs and over): 500 mg
single dose first day followed
by 250 mg once daily for 4 days
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APPENDIX. COMMON MEDICATIONS USED BY CHILDREN AND ADOLESCENTS (Continued)
Anticonvulsants
Name
Typical Dosage
Most Common Side Effects
Overdose
Depakote
(Sprinkle
Capsules)
Monotherapy
For ages 10 yrs and older:
Should not exceed 60 mg/kg/day
Hepatotoxicity (liver destruction), headache, asthenia (loss
of energy), nausea, vomiting, abdominal pain, diarrhea,
anorexia, somnolence (sleepiness), tremor dizziness,
diplopia (double vision), blurred vision, flu, upper
respiratory infection, dyspepsia, insomnia, and nervousness
Somnolence, heart block, deep coma,
and death
Felbamate
(Felbatol)
Monotherapy
Adult (14 yrs and over):
Should not exceed 3600 mg/day
Monotherapy
Adult: Anorexia, vomiting, insomnia, nausea, and
headache
Mild gastric distress and resting heart
rate of 100 beats per minute (bpm)
Adjunctive
Child (2–14 yrs):
Should not exceed 45 mg/kg/day
Adjunctive
Child: Same as above with the addition of somnolence
Drowsiness, somnolence, agitation,
aggression, depressed level of
consciousness, respiratory depression,
and coma
Adjunctive
Adult: 1000 to 3000 mg/day
Somnolence, asthenia, infection, dizziness, abdominal
pain, bronchitis, confusion, constipation, diarrhea,
convulsions, grand mal convulsion, rash, tremor, and
vomiting
Keppra
Klonopin
(Wafers)
Adult: Should not exceed 20 mg/day
CNS depression, drowsiness, ataxia, and behavior
problems
Child (up to 10 yrs or
30kg body weight):
Should not exceed
0.05 mg/kg/day
Lamictal
Adjunctive
Child (2–12 yrs): 1 to 5 mg/kg/day
Adult (12 yrs and over):
100 to 400 mg/day
Tegretol
Under 6 yrs of age:
Should not exceed 35 mg/kg/day
6–12 yrs:
Should not exceed 1000 mg/day
12–15 yrs:
Should not exceed 1000 mg/day
15 yrs and over:
Should not exceed 1200 mg/day
Somnolence, confusion, coma, and
diminished reflexes
Dizziness, ataxia (failure of muscle coordination),
somnolence, headache, diplopia, blurred vision, nausea,
vomiting, rash, infection, diarrhea, abdominal pain,
tremor, asthenia, bronchitis, and flu syndrome
Aplastic anemia, dizziness, drowsiness, unsteadiness,
nausea, and vomiting
Death, ataxia, nystagmus (rapid eye
movement), increased seizures,
decreased level of consciousness,
coma, and intraventricular conduction
delay (abnormality in the heart’s
electrical conducting system ventricles beat asynchronously)
First signs and symptoms appear after
1–3 hours. Irregular breathing,
respiratory depression, tachycardia
(rapid heart rate), hypotension,
hypertension, shock, conduction
disorder, impairment of consciousness, convulsions, motor restlessness,
muscular twitching, tremor, athetoid
(slow) movements, ataxia, drowsiness,
dizziness, mydriasis (excessive pupil
dilation), nystagmus,
adiadochokinesia, ballism (jerking
movements of extremities),
psychomotor disturbances, dysmetria
(inability to control speed and
distance of movements), initial
hyperreflexia (exaggerated reflexes)
followed by hyporeflexia, nausea,
vomiting, and urinary retention
Continued on next page
Klotz et al.: Drugs and Their Effects on Children
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APPENDIX. COMMON MEDICATIONS USED BY CHILDREN AND ADOLESCENTS (Continued)
Name
Typical Dosage
Topamax
(Sprinkle
Capsules)
Adjunctive
Adult: Should not exceed 400 mg/day
Child (2–16 yrs): Should not exceed
5 to 9 mg/kg/day
Most Common Side Effects
Dosage: 200–400 mg/day: Somnolence, dizziness,
ataxia, speech disorders and related speech
problems, psychomotor slowing, abnormal vision,
difficulty with memory, and diplopia
Dosage 200–1000 mg/day: fatigue, nervousness,
difficulty with concentration or attention,
confusion, depression, anorexia, language
problems, anxiety, mood problems, and weight
decrease
Tranxene
(T-Tab Tablets)
Adjunctive
Adult (12 yrs and over):
Should not exceed 90 mg/day
Overdose
Convulsions, drowsiness, speech disturbance, blurred vision, diplopia, mentation
impaired (difficulty thinking), lethargy,
abnormal coordination, stupor (nearly
complete unconsciousness), hypotension,
abdominal pain, agitation, dizziness,
depression, coma, and death
Drowsiness, dizziness, various gastrointestinal
complaints, nervousness, blurred vision, dry mouth,
headache, and mental confusion
Various degrees of CNS depression ranging
from slight sedation to coma
Dizziness, somnolence, diplopia, fatigue, nausea,
vomiting, ataxia, abnormal vision, abdominal pain,
tremor, dyspepsia, and abnormal gait
N/A
Children (9–12 yrs):
Should not exceed 60 mg/day
Trileptal
Adult: Should not exceed 2400 mg/day
Child (4–16 yrs): Recommended daily
dose is based on weight:
20 kg - 900mg/day
25 to 30 kg – 1200 mg/day
35 to 45 kg – 1500 mg/day
50 to 55 kg – 1800 mg/day
60 to 70 kg – 2100 mg/day
Antidepressants
Name
Typical Dosage
Celexa
Most Common Side Effects
Tachycardia (rapid heart rate), postural hypotension
(drop in blood pressure with change of body
position), hypotension, paresthesia (abnormal
neurological sensation such as numbness, tingling,
and burning), migraine, saliva increase, flatulence,
increased or decreased weight, impaired
concentration, amnesia, apathy, depression,
increased appetite, aggravated depression, suicide
attempt, confusion, amenorrhea (discontinuation of
menstrual periods), coughing, and rash
40 mg/day
Overdose
Dizziness, sweating, nausea, vomiting,
tremor, somnolence, sinus tachycardia, and
death
Cardiac Medications
Name
Typical Dosage
Most Common Side Effects
Captopril
Should not exceed 450 mg
Tachycardia, chest pain, palpitations, myocardial
infarction (heart attack), Raynaud’s syndrome
(inadequate blood flow to the fingers and toes),
and congestive heart failure
Hypotension
Coumadin
Individualized per patient
Bleeding, hemorrhaging, paresthesia (abnormal
sensations such as numbness, tingling, or burning),
headache, chest pain, abdominal discomfort, joint
pain, muscle pain, dizziness, shortness of breath,
difficult breathing or swallowing, and unexplained
shock
Suspected or overt abnormal bleeding (e.g.,
appearance of blood in stools or urine,
excessive menstrual bleeding, excessive
bruising or persistent oozing from
superficial injuries)
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APPENDIX. COMMON MEDICATIONS USED BY CHILDREN AND ADOLESCENTS (Continued)
Digitek
Adult: Individualized per patient
(Digoxin Tablets)
Infant and Child:
Daily maintenance dosages
with normal renal function:
Age (years)
Dosage (mcg/kg)
2 to 5
10 to 15
5 to 10
7 to 10
10 and up
3 to 5
Adults: Heart block in patients with preexisting
sinoatrial or antrioventricular (AV) conduction
disorders, rhythm disturbances, atrial tachycardia with
block, abnormal or premature heart beat, ventricular
tachycardia, ventricular fibrillation (disorganized local
contraction), and cardiac toxicity
Ventricular tachycardia, ventricular
fibrillation, progressive
bradyarrhythmias, heart block, and
cardiac arrest
Infants and Children:
Cardiac arrhythmias
Central Nervous System Stimulants (Attention Deficit Disorder)
Name
Adderall
Dexedrine
(Dexadrine)
Typical Dosage
Should not exceed 40 mg/day
Pediatric (3 to 5 yrs):
Individualized per patient
Child (6 yrs and over):
Rarely exceeds 40 mg/day
Ritalin
Adults: 20 to 30 mg/day
30-45 mins before meals
Most Common Side Effects
Overdose
Cardiovascular palpitations, tachycardia, elevated
blood pressure, dizziness, insomnia, euphoria,
dyskinesia, dysphoria (excessive pain or agitation),
tremor, headache, exacerbation of motor and phonic
tics, dryness of mouth, diarrhea, and constipation
Restlessness, tremor, hyperreflexia, rapid
respiration, confusion, hallucinations,
panic states, fatigue, depression,
arrhythmias, hypertension,
assaultiveness, hypotension, nausea,
vomiting, abdominal cramps, diarrhea,
convulsions, and coma
Overstimulation, restlessness, dizziness, insomnia,
euphoria, dyskinesia (impaired voluntary movement),
dysphoria, tremor, headache, and exacerbation of
motor and phonic tics, and Tourette’s syndrome
Restlessness, tremor, hyperreflexia, rapid
respiration, hyperpyrexia (exceptionally
high fever), confusion, assaultiveness,
hallucinations, panic states, fatigue, and
depression
Nervousness and insomnia
Vomiting, agitation, tremors, hyperreflexia, muscle twitching, convulsions,
euphoria, confusion, hallucinations,
delirium, sweating, flushing (redness of
the face), headache, hyperpyrexia,
tachycardia, palpitations, cardiac
arrhythmias, hypertension, mydriasis
(excessive dilation of the pupils of the
eyes), and dryness of mucous
membranes
Children (6 yrs and over):
Should not exceed 60 mg/day
Hypertension Prescriptions
Name
Clonidine
(Catapres-TTS)
Typical Dosage
Adult (12 yrs and over):
1 to 2 patches per week
Most Common Side Effects
Dry mouth, drowsiness, fatigue, headache, lethargy,
sedation, insomnia, dizziness, dry throat, constipation,
nausea, change in taste, nervousness, and localized
skin reactions
Overdose
Hypertension followed by hypotension,
bradycardia, respiratory depression,
hypothermia, drowsiness, decreased or
absent reflexes, weakness, irritability,
and miosis (pupil contraction)
Schizophrenia Treatments
Name
Typical Dosage
Most Common Side Effects
Risperdal
(Tablets/Oral
Solution)
4 to 16 mg/day BID or QD
Extrapyramidal symptoms, dizziness, hyperkinesia,
somnolence, and nausea
Seroquel
150 to 750 mg/day
Headache, somnolence, dizziness, constipation, dry
mouth, dyspepsia, postural hypotension, and
tachycardia
Overdose
Drowsiness, sedation, tachycardia,
hypotension, and extrapyramidal
symptoms
Drowsiness, sedation, tachycardia, and
hypotension
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