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Questions and dilemmas regarding treatment plans

Can taking stimulants stunt my child’s growth?

Questions and dilemmas regarding treatment plans
Not sure what to do? Read on..

This is one of the most frequently asked questions when it comes to medication treatment options.

Here’s the general consensus:

Although there does seem to be (on average) a temporary growth suppression during the first 1-3 years of treatment, the adult height of ADHD children treated with stimulants is equal to the adult height of children who are stimulant-free.   The studies finding growth suppression during the initial 1-3 years are focused on pre-pubertal growth rates, and average about 1 cm/year difference.

When reviewing this topic, I came across some non-physician-writers spinning data on studies as if to say, “See? stimulants DO stunt your growth,” when in fact these studies are in line with what we already know- that there may be temporary growth suppression.   (see “ADHD Central” article) Pay close attention when you’re reading reviews: if the author is merely reporting the data, and points out flaws or limitations of studies, then it’s likely good information.  If, however, an author gives a summary of previous long-term findings, and then points out one study is seemingly out of alignment and uses this to make a point, take it with a grain of salt.   People have all sorts of agendas when it comes to psychiatry and psychotropic medication.

Possible caveats

There is some evidence that ADHD children may be larger than non-ADHD children, and some speculate that even though the adult height of ADHD children is equal to peers, perhaps they would be taller if they had not been on stimulants.    However this is just speculation, and even if it were true, is it relevant?  From my experience, children with ADHD often have horrible diets and crave carbohydrates, so it’s also possible that the “larger” ADHD adults may be larger than average due to dietary influences, such as large quantities of cow’s milk and red meat, which are laden with hormones.

On the other hand, there is other evidence suggesting that children’s brains with ADHD are developmentally immature, and this may correlate to hormonal development as well.   Many children in my practice, whether they are on stimulants or not, are not only developmentally immature, but physically as well.  This may be due to the brain itself, or simply due to stress.  Children under a great deal of stress seem to grow more slowly, even if they have adequate food intake, as if the stress takes such a toll that the body uses it’s reserves just for daily functioning.  When the stress calms down, growth resumes.

Things to consider

When I get this question with a child already on a stimulant medication, I ask the parent if the child has “fallen off the growth curve”.  For example,  if your child was in the 50th percentile for height and weight, is he now in the 10th?  If he was previously in the 90th, is he now in the 70th?  Etc .  Sometimes weight falls but height does not, which is not a cause for worry.  Your child’s pediatrician typically tracks height, weight, and BMI (body mass index)  in the yearly exam, and you can ask for a copy and track it yourself.  You can also download growth charts here and track this at home (this is a good idea, to reassure yourself!)

A typical weight loss when starting a stimulant is 5-10 lbs in the first few months to a year, and then it seems to taper off.   Sometimes children will skip their lunch, so it is imperative that they have a good, solid breakfast with lean protein and healthy fats. (eggs are a “perfect food!”)   A protein shake is better than a meal high in refined carbs (like pop-tarts, most breakfast cereals, bagels, and muffins.)  Pack your child some snacks like zip lock baggies of nuts, trail mix, or nutrition bars that they can snack on throughout the day.  (These snacks are also good because they won’t go bad sitting in a backpack!)

Keep in mind stimulants have been used safely for over 60 years, so we do have good long-term data on them.    Drug holidays over the summer can help with weight gain, but discuss this with your doctor first.  Sometimes the benefit of maintainence treatment outweighs any benefit of putting on a few pounds.  For example, if your child is so impulsive he or she frequently puts themselves in harm’s way,  then it’s likely that they are better being treated, even during the summer.  A  lot kids have summer school or tutoring, so take this into consideration as well.

Some children have so much stress due to their attention problems that even if they don’t need the medication to learn, they function much better and are calmer, less anxious, and happier with the medication.  Get feedback from your child, too- some kids are unaware  of medication’s effects, while others can clearly announce, “it helps me stay calm, ” or “I can think better, ” or, conversely, “it makes my stomach hurt.”

The bottom line

Look at the big picture.  Consider side effects, and then benefits noticed by yourself, your spouse, your child, teachers, coaches, clinicians- including how medication affects their peer relations, since this this relates to quality of life and social development.   Discuss a risk/benefit analysis with your doctor.  No solution will be perfect, but take heart in the fact that the overwhelming evidence shows that there is mild, if any growth suppression during the first couple of years, and that final adult height is normal.  This appears to be the case whether they continue to take medication throughout adolescence or not.

The Nutrition Factor

Finally, consider that many ADHD kids have poor appetites and poor diet anyway.  Throw a stimulant in the mix, and then may not be getting much nutrition at all!   I always recommend a high-quality, complete and preservative-free children’s multi-vitamin.   There is mounting evidence that we’re all overfed and undernourished, and mental illness or neurological syndromes compound this issue in 2 ways, aside from dietary factors.  1) Stressed brains work harder and therefore burn through nutrients faster than non-stressed brains, and 2) many psychological and neurological syndromes, including ADHD, show evidence of reduced efficiency when both using nutrients and recycling them.  Therefore, these kids need even more supplementation than the average child.    To read more about the brand I recommend in my practice, click here, or email me for some articles.

The products run about $12/month for the children’s version and $18/month for the teen version.  If you cannot afford this, any multivitamin is better than nothing! Try an OTC brand such as GNC.     I also sometimes use the Juice Plus children’s chewies, which run about $23/month.  (juice plus flash-freezes and condenses whole fruits and vegetables into chewies or capsules. Email me to order or to obtain more info. )

Sidebar: The side effects that would make me consider discontinuation with stimulants are the following: persistent, significant insomnia; stomach pain or discomfort that does not resolve; increased anxiety/agitation/jitteriness; depressed mood; heart palpitations or heart “racing”; and frequent headaches/migraines.

For more review on this growth and stimulant medication, see these links:

http://pedsinreview.aappublications.org/cgi/content/extract/23/2/67

http://pediatrics.aappublications.org/cgi/content/abstract/63/6/847

http://www.sciencedirect.com/science

Children’s Multivitamin Product Info:

Usanimals for ages 3-12

Bodyrox for ages 13-18.

(To place an order, visit www.drdunckley.usana.com or call me at (714) 926-4796.  I encourage people to call or email me to ensure they get not only wholesale prices but the preferred customer discount. )

Victoria L Dunckley, M.D.