7 FAQs Every Parent Has About Starting Psychiatric Medications for Kids

Get expert answers to your questions about starting psychiatric medications for kids. Learn what to expect and feel confident as a parent.

Considering psychiatric medications for your child can feel overwhelming—but you’re not alone. In this excerpt from A Parent’s Guide to Starting Psychiatric Medications for Kids, three experienced child psychiatrists, Drs. Alexander Kolevzon, Pilar Trelles, and Robert Jaffe, answer the most common questions parents and caregivers have. From understanding different medication options to monitoring side effects, this guide empowers you to ask the right questions and feel confident in your child’s care journey.

FAQs About Psychiatric Medications for Kids

1. Let’s say I want to consider medication; what’s the process?

Your child would need to have a comprehensive evaluation to establish a diagnosis (or multiple diagnoses) and to identify target symptoms that medicine could potentially address. Evaluations typically consist of time spent with caregivers (depending on the age and developmental level of the child) to discuss the developmental history and present concerns. This is usually followed by meeting your child individually and using a combination of talking, playing, observation, and possibly a physical examination to gather information. Then, the next step is to meet again with you (and your child, depending on their age and developmental level) to discuss impressions and make a plan. Assuming this plan includes medications, this is where your provider would discuss risks, benefits, and alternatives, if any.

2. Do you ever evaluate a child and not recommend medication?

Great question and the answer has to be considered in the context of the fact that as medication prescribers, most people come to see us to explore medication options, among other goals. Some have waited a long time, perhaps even too long, and are fully ready to start medicine by the time they make the appointment with us. That said, there are cases where we say that medicine probably won’t help the symptoms of concern and other cases where we say medicine is absolutely necessary.

In many cases, however, medicine will likely help but there may be alternatives and its use can be delayed or potentially avoided. In these cases, it is critical to be able to have a nuanced conversation about risks and benefits with your provider. People bring different biases to using conventional medicine in general. Some want to avoid it at all costs and others are eager to do anything that is safe and effective. We do try and caution caregivers not to let their personal biases affect the well-being of their child given the vast benefits medicine can sometimes provide. What’s right for adults to do for themselves may not be the best choice for their child and this is why developing a relationship with a knowledgeable provider whom you trust is so important.

3. If it was your child, would you medicate them?

If we recommend medicine for your child, we would also give it to ours. And yes, we all have children and have survived, or are actively surviving, their childhood and adolescence.

4. Won’t medications just mask the underlying problem?

While it is true that medications treat symptoms and not diagnostic labels, the symptoms are thought to arise from an underlying disorder and are effectively treated with the medicine. We don’t see this as masking an underlying problem or simply applying a band-aid, but instead an effective tool among many that, when applied carefully, can be a critical part of a therapeutic program, including psychotherapy. Psychiatry, like many fields of medicine, has not yet advanced to the development of curative treatments. However, our goal is symptom remission—or at least significant symptomatic reduction—and, for that, medicine plays an important role.

5. If many of the medication options work the same, how do you know which one to choose?

It’s often suggested that choosing the right medication among similar ones is like throwing darts at a board. And while it’s true that within a given class of medications there is probably no clear “wrong” or “right” suggestions, we like to think that science and clinical experience play critical roles. We look at results from the published literature, previous medication experiences your child may have had, interactions with other medications your child is taking, and other variables, including pharmacokinetics, pharmacogenetics, ability to swallow pills, compliance, and age. We may also explore how effective and well-tolerated medications have been in other members of the immediate family. Finally, we rely heavily on our experience with other patients to inform decision-making. But most importantly, you have to feel confident in your provider’s assessment, judgment, and experience because above all else, this is what drives the medication recommendation.

6. My friend’s child takes a specific type of medicine for the same thing and they are happy; can we have that one, please?

It’s always interesting to learn from other people’s experiences with medicine but every case is truly unique to the individual. Friends’ success with particular treatments won’t predict your success. One caveat is that sometimes siblings and other first-degree family members respond well to the same treatment based on shared underlying genetics. The same goes for side effects—just because a friend or even sibling had a negative reaction to a particular medicine does not mean your child will.

7. If genetics are so important, why don’t you just use those genetic tests?

While genetic testing to determine a particular response to a medication (i.e., pharmacogenetics) offers much promise, the translation into clinical practice has been slow and not yet as widely useful as we would have hoped. In the current state, pharmacogenetic testing may help predict tolerability in a small subset of patients who have variations in their liver enzyme genes that are responsible for metabolizing medications. These genetic variants may lead an individual to be a slow or ultra-rapid metabolizer of certain medications and this could justify using very low doses (for slow metabolizers) or high doses (for ultra-rapid metabolizers).

But the reality in working with children is that we should always Start Low and Go Slow until we see benefits based on the clinical presentation. Doses can be increased based on the need for benefits or decreased based on the presence of side effects. While reports from pharmacogenetic testing companies may make claims that certain genetic profiles (i.e., gene variants) may predict response to certain medicines, the evidence for this remains very limited at present. With more genetic testing and results from more studies, however, these claims may eventually materialize.

Feeling Confident on Your Medication Journey

Starting psychiatric medications for your child can feel overwhelming, but asking the right questions is the first step toward confidence and clarity. The answers shared here are just a glimpse of the guidance in A Parent’s Guide to Starting Psychiatric Medications for Kids. For a deeper dive into different medications, side effects, and ongoing monitoring, this book is a trusted resource that empowers parents and caregivers to make informed decisions with peace of mind.

Get Expert Answers to Support Your Child’s Medication Journey

^{Excerpt from A Parent’s Guide to Starting Psychiatric Medications for Kids by Alexander Kolevzon, Pilar Trelles, and Robert Jaffe.}