Why Are So Many Toddlers Taking Psychiatric Drugs?

MURALI DORAISWAMY: Prozac for babies?

Psychiatric drugs are now being given to infants and toddlers in unprecedented numbers.

An analysis of 2013 IMS Data, found that over 274,000 infants (0-1 year olds) and some 370,000 toddlers (1-3 years age) in the U.S. were on antianxiety (e.g. Xanax) and antidepressant (e.g. Prozac) drugs. This report also found over 1,400 infants were on ADHD drugs.

A 2014 Georgia Medicaid analyses led by Susanna Visser at the CDC (see a video of her fascinating talk) when extrapolated nationwide by the New York Times found that over 10,000 toddlers were put on ADHD treatments. (Dr. Visser is currently working on national estimates but believes that the estimate from the Georgia data is conservative.)

Prescriptions of powerful antipsychotics such as Risperdal for infants and very young children have also sharply risen. Office visits for childhood bipolar disorder have risen 40-fold over the past decade in the U.S.

Toddlers in the welfare system and those in foster homes are particularly vulnerable to receive drugs for behavior control. Had he lived today in a foster home, Dennis the Menace would probably have met criteria for Oppositional disorder, Temper Dysregulation Disorder, ADHD and/or Bipolar, and forced to take multiple drugs!

Most use in such young children is “off-label,” posing safety concerns. For example, a2013 study of 44,000 children found that antipsychotic drugs tripled the risk for developing diabetes–confirming our warning in 2001.

Are psychiatric diagnoses reliable in such young children? Why are tens of thousands of children getting drugs outside guidelines? What is the most humane way to manage behavior changes in children?

The causes are debatable but our culture of “a pill for every temper tantrum” is one culprit. While there are effective nondrug behavioral therapies for preschoolers, access and incentives are not aligned to prioritize them. We also need to invest more in building resilience.

This is a complex problem but as the social reformer Frederick Douglass noted over a hundred years ago, “It’s easier to build strong children than to repair broken men.”

Dr. P. Murali Doraiswamy is professor of psychiatry and medicine at Duke University Medical Center, where he also serves as a member of the Duke Institute of Brain Sciences and as a senior fellow at the Duke Center for the Study of Aging and Human Development.

Read the latest Health Report.