Community > Articles
New Recommendations for Monitoring of Stimulant Medications in Children
This week the American Heart Association (AHA) published guidelines recommending a screening EKG (electrocardiogram) before any child starts stimulant medication. This bold sweeping recommendation affects many children. However, this is not a new concern. Heart related side effects have been a known informed risk of all stimulant medication. It has been listed in the side effect profile for every stimulant medication for many years.
This topic dates back to 1999 when the American Heart Association first came out with recommendations for children to have cardiovascular monitoring. At that time there were concerns and suggestions, but not the same type of specific recommendation as at present. Other medical organizations such as the American Academy of Pediatrics (AAP) and The American Academy of Child and Adolescent Psychiatry (AACAP) have supported the AHA statement but have cautioned that children should not be prevented access to ADHD medication nor should children already taking the medication successfully stop taking their medication based on the guidelines.
All stimulants have a modest effect on heart rate and blood pressure increasing both slightly. However, if someone has a known or unknown cardiac problem this small increase could result in a serious medical problem. This is why the AHA group has recommended a pretreatment screening. Most physicians do this in the form of taking a family history, performing a physical exam, and asking specific questions related to cardiac symptoms. However in spite of all of this, being at risk for sudden cardiac death can essentially be silent and an EKG adds one more level of protection. Even an EKG, however, is not infallible. An EKG is still a screening test. A more definitive evaluation by a pediatric cardiologist including a cardiac echo is not being suggested as a screening measure at this poin. This would however be indicated if there is a strong family history of heart related problems, the EKG or screening were abnormal, or a child had or has a specific heart condition as part of their medical history.
So what is a parent to do? If your child is already on stimulant medication and has had an EKG or an evaluation by a cardiologist after the age of 12 no further action is recommended. However if your child had an EKG before the age of 12 years or never had an EKG this can be ordered by the physician treating your child. If everything is normal and there are no personal or family risk factors further evaluation is unnecessary. The same recommendation applies to children who have yet to start stimulant medication. However, for a child already on a stimulant that has not had an EKG there is no cause for panic or alarm. Simply discuss the recommendations with your child’s doctor and arrange for the EKG and or cardiology consultation as indicated by your physician.
Recommendations such as these, though difficult, because of the sheer numbers of children involved, may benefit us all in the long run by contributing to the safe and careful use of medications in children and adults. However, as with all “screening tests” there will be a number of children with what we term “false positive” results. In these cases the EKG may show something that turns out to be nothing, but due to a concerning finding may result in more extensive testing and doctor visits for that particular child. As is the case with mammography and other medical screening tests this is expected to a degree. It is only when we begin doing this type of screening on a large scale consistently that we will find out the true costs and benefits to children and their families.
If you have further questions or concerns you can check the website of the American Academy of Pediatrics at www.aap.org
By Judith Aronson-Ramos, M.D., FAAP
www.draronsonramos.com
