Conquering Those Growing Pains
New cautions on heart problems and stimulant medications
Millions of children take Ritalin and other stimulant drugs each day to treat attention deficit hyperactivity disorder. Although the drugs have been used for more than 50 years, questions keep cropping up about their safety. The most recent concern reports of sudden death in children who were later found to have had undetected heart problems.
Last week, the Food and Drug Administration unveiled a new warning label for Dexedrine, an amphetamine, saying that normal use of the drug can cause sudden death and cardiovascular problems. This follows new, stronger warnings for Ritalin in June, and for AdderallXR, another amphetamine that is the most popular ADHD drug, and Concerta in July. The labels include admonitions that the drug should not be used in children with cardiac abnormalities, cardiomyopathy, or other serious heart problems and that use can worsen psychiatric problems. Similar new warnings are in the works for Strattera, an ADHD drug that is not a stimulant.
The FDA didn't go as far as an advisory panel that met in February and asked for the strongest "black box" warnings for all the stimulants because of increased cardiac risk. But Steven Nissen, head of cardiology at the Cleveland Clinic and a member of that advisory panel, is pleased: "This is a positive thing." Parents of children taking Ritalin or other stimulants should weigh the risk against potential benefits, he says. Unfortunately, there's no simple test for doctors to detect the rare, hidden heart problems involved in most of the deaths. "If you have a child who has minimal symptoms of ADHD, you need to think, is it really worth it?" On the other hand, Nissen says, the drugs really do help some kids. In those cases, he says, parents need to keep a close eye on the situation. "Make sure your pediatrician checks for heart murmurs and evidence of heart disease."
That incessantly loud snoring may be a sign that tonsils need to go
Until the last decade, kids typically got their tonsils out because they had recurrent sore throats, based in part on a lingering concern from the days before antibiotics when strep throat was a killer disease. Today, children who get a half-dozen or more strep throats a year are still often given tonsillectomies to minimize the chance for bacteria, food particles, or other debris to lodge there.
Now the majority of kids get their tonsils out because they have obstructive sleep apnea, which occurs when breathing is interrupted periodically during sleep because the airway is blocked or is too small. In children, it often occurs because their tonsils are simply too large. When they fall asleep, their tonsils temporarily block their throats, disrupting their breathing and often causing them to snore loudly. In obese children, however, fatty tissue rather than tonsils is generally the culprit in sleep apnea.
Obstructive sleep apnea in children can cause many problems, from daytime sleepiness and hyperactivity to high blood pressure and heart failure-and can have a long-term effect on their learning abilities. Doctors don't always make the connection. "If your child snores more than mildly, take it seriously until proven otherwise," says David Roberson, an assistant professor of otolaryngology at Children's Hospital Boston.
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