Is it possible that psychiatric medications tested on adults and meant to treat adult psychiatric disorders are now being used to treat psychiatric disorders in children younger than two years old? So it seems according to The New York Times story last week. “Still in a Crib, Yet Being Given Antipsychotics” by Alan Schwarz.

12285416_sAccording to the NYT story, “Cases like that of Andrew Rios, in which children age 2 or younger are prescribed psychiatric medications to address alarmingly violent or withdrawn behavior, are rising rapidly, data shows. Many doctors worry that these drugs, designed for adults and only warily accepted for certain school-age youngsters, are being used to treat children still in cribs despite no published research into their effectiveness and potential health risks for children so young.”

Using drugs “off-label” for treating all kinds of conditions from cancer to ADHD has become so common that almost every drug at some point is prescribed off-label. Off-label means the medication is being used in a manner not specified in the FDA’s approved packaging label or insert. Off-label prescribing isn’t necessarily bad. It can be beneficial.

In child and adolescent psychiatry, the majority of the drug prescribing is done off-label. Few medications are approved for young people, but making these valuable medications unavailable because drug companies have not tested them for all conditions and populations would cause a lot of prolonged suffering and even deaths. This is the case for hundreds of drugs, not just psychotropic medications. Studies have been coming out showing the helpfulness of psychotropic medication in young people, and hopefully, science and research will continue to catch up with clinical reality.

One problem with children under two receiving these medications is that one cannot get the feedback that you get treating older children and adults. Babies have very limited language skills and cannot participate in guiding treatment decisions. Additionally, the effects of these medications on the development of the young body of a baby are not known, and I think it is rational to worry about the high possible vulnerability of infant tissues.

As much as I believe in using drugs off-label I believe that babies should not be given psychotropic medication. Further tests are needed, and behavioral modifications should be tried first.

Still in a Crib, Yet Being Given Antipsychotics

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

Originally available here