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Children and adolescents are particularly vulnerable to the potentially harmful side effects of drugs and medical devices during important stages of physical and mental development. The amount of mental health drugs prescribed to youth has increased at an alarming rate, and each comes with its own risk. Over-the-counter medications should be taken with similar caution, and parents should not always give children and adolescents the same drugs as adults.
During childhood and adolescence, humans go through rapid changes in physical and mental development. As the brain develops, children are able to understand increasingly abstract ideas, form meaningful relationships, increase in maturity and develop their own identity.
At young ages, some children distance themselves from their parents in search of their own identity, turning to friends for support. Many children feel anxious, self-conscious and sensitive about the changes their bodies go through.
During puberty, girls begin to develop breasts as young as eight, grow body hair at an increased rate and begin menstrual cycles about two years after they begin developing breasts. Growth spurts tend to peak around the age of 11 and conclude around the age of 16.
Boys see genital growth around the age of nine, their voices begin to change and they begin to grow body hair at an increased rate around age 12. Growth spurts peak around the age of 13 and slow around 18.
During these important changes in physical and mental development, adolescents are vulnerable to numerous harmful side effects of drugs that are normally safe for adults. Both prescription drugs and over-the-counter drugs can be dangerous and even deadly if children take them or are exposed to them improperly.
Two of the most important aspects regarding children’s health and development are nutrition and exercise. Many parents introduce children to sports and physical outdoor activities at a young age, setting the foundation for exercise throughout their lives. Children should also be encouraged to try a variety of healthy foods and practice portion control.
Mental health and social well-being are also important aspects to focus on as children age. National health development guidelines indicate children should be able to focus on a topic for 15 minutes at a time by age six and for one hour by age nine. Children also begin to face challenges at school, like bullying and peer pressure, as they age.
Some children suffer from attention-deficit hyperactivity disorder (ADHD), severe depression, severe anxiety and other mental health problems. Drugs used to treat such problems often carry potentially dangerous side effects, and doctors have prescribed drugs to treat mental health issues at an alarming rate.
ADHD diagnoses increased at an alarming rate during the 2000s. Doctors diagnosed 6.4 million children ages 4-17 with ADHD, a 41 percent increase from 2003-13.
Doctors usually treat children with ADHD with stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine). Side effects from the drugs include decreased appetite, sleeping problems and headaches. Less common but more severe side effects include the development of tics and personality changes.
Children with a history of heart conditions may have a higher risk of strokes, heart attacks and sudden death when taking stimulants. Studies have also found rare cases of children developing hallucinations – such as hearing voices and increased suspicion without reason – or becoming manic.
From 2005-08, 3.7 percent of Americans ages 12-17 took antidepressants. Significantly more girls took them than boys, with 4.6 percent of females and 2.8 percent of males in the age group taking antidepressants.
However, studies linked some of the most popular antidepressants – selective serotonin reuptake inhibitors (SSRIs) – to an increased risk in suicide in children. Overall, SSRIs are usually effective in children, but in rare cases they can cause abnormal behavior including thoughts of suicide.
The only SSRI approved by the FDA for use in children is Prozac (fluoxetine), which is only approved for children older than eight years old. The FDA issued a black box warning indicating the antidepressant may increase the risk of suicide in young adults. Serotonin-norepinephrine reuptake inhibitors (SNRIs) carry many of the same risks to children as SSRIs.
The number of prescriptions of antipsychotics for children also increased drastically in past decades. From 1995-2002, prescriptions of antipsychotics to children ages 2-18 jumped from to half a million to 2.5 million. A USA Today report of one pharmacy benefits management company found the rate of prescriptions increased 80 percent from 2001-05 in people under 19 years old.
However, new kinds of drugs called atypical antipsychotics can have serious side effects in children like drastic weight gain, sedation and involuntary movements like dystonia and tardive dyskinesia (TD). People with dystonia have involuntarily slow, painful muscle contractions and people with TD have fast, involuntary muscle movements.
Antipsychotics include Abilify (aripiprazole), Thorazine (chlorpromazine), Risperdal (risperidone) and Invega (paliperidone). Risperdal and Invega also include a side effect called gynecomastia, a condition where boys develop breasts.
Many over-the-counter and prescription drugs are not recommended for use in children.
Aspirin is not recommended for anyone younger than 20 because of the risk for Reyes syndrome - a condition involving swelling of the liver and the brain. Cough and cold medicines containing antihistamines aren’t recommended for children without first consulting a doctor.
Other drugs and medical devices with a history of problems in children and adolescents include Tylenol, Depakote, Yaz, Testosterone and Knee and Hip Replacements.
One of the most popular pain relievers in America, Tylenol (acetaminophen) is the top cause of acute liver failure in the U.S. Parents commonly use Tylenol to treat fevers, minor pain, headaches and body aches in children and adolescents.
It is available over the counter in regular strength and extra strength forms. Its manufacturer, Johnson & Johnson, added a warning label regarding the risk of liver failure to the caps of extra strength bottles. Parents should monitor the amount of Tylenol their children consume during 24 hour periods and be sure not to combine the drug with other products containing acetaminophen.
The anti-seizure drug Depakote is approved for use in children 10 and older for the treatment of seizures and in adolescents 16 and older for the prevention of migraines. Doctors often prescribe it off label, or for uses not approved by the FDA, for children with bipolar disorder.
The medication has a black box warning for increased risk of liver failure and pancreatitis in children and adults. The most common occurrences of liver damage occur during the first six months of use.
Young women beginning to use birth control should work with their physician to choose a prescription carefully. Yaz birth control pills carry many severe possible side effects, including uncontrollable uterine bleeding, kidney disorders, migraines, hair loss and weight gain.
Additionally, many young women suffered heart attacks after taking Yaz. The pill raises potassium levels, and too much potassium can lead to cardiac arrest and death. Experts warned young women on Yaz that drinking sports drinks or eating foods high in potassium could put them at an increased risk.
Men with low testosterone (Low T) use testosterone therapy to treat symptoms, including osteoporosis, loss of muscle mass and loss of coordination. Other men use testosterone products to enhance physical performance and treat sexual dysfunctions.
The primary risk to children and adolescents comes when a man using testosterone products exposes the drug to them, often accidentally. It usually occurs when a man taking a gel – like AndroGel or Testim – accidentally transmits it to a child through skin-to-skin contact.
The number of adolescents undergoing knee and hip replacement surgery increased in the past decade, causing concern about how implants will hold up in more active patients. Studies indicate young people have unrealistic expectations for knee replacements. Additionally, replacements usually last 15 to 20 years, requiring younger patients to undergo additional replacement or revision surgeries later in life.
Knee and hip replacements are not without risk. Zimmer NexGen knee replacements have a reputation for failing prematurely, and some doctors called for their removal from the market. DePuy knee replacement products have undergone both voluntary and mandatory recalls. Multiple manufacturers of hip replacements have recalled devices and suffered high failure rates.
Doctors can prescribe medications to children without FDA approval if the drug is approved for use in adults. However, pharmaceutical companies may not market the drug to doctors, healthcare providers or the public for use in children without FDA approval. Sometimes, Big Pharma markets drugs for use in children anyway.