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General Information

Studies have shown that medication is effective in treating the symptoms of ADHD alone or in combination with behavioral interventions. There are several types of medications, and they are grouped into 2 major categories: stimulants and non-stimulant medications. Most children are initially treated with stimulants, although there are reasons why your doctor may choose to treat your child with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different doses or switch to different medications to find the best choice. Discuss any family history of heart disease, high blood pressure, or substance use with your doctor.

Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. Stimulant medications come in short-acting preparations that need to be given 2 or 3 times per day and long-acting preparations that are given only once a day. Although the medications are similar, each child may experience different benefits and side effects with different medications.

Stimulant medications should be given at the same time of the day, and you should never give 2 doses at the same time to make up for a missed dose. Non-stimulant medications may take up to 2 or 3 weeks before a beneficial effect is seen.

Follow-up

Currently, there is no way to know which medication will be best for any particular child. To make sure that your child is receiving the dosage that gives the best effect with the least amount of side effects, your doctor will need to start at a low dose and increase the dose until a good effect or fewer side effects are seen. To judge whether the medication is helping, your doctor will obtain completed rating scales of your child's symptoms from you and your child's teachers when your child is at baseline (without medication) and is taking different medication doses. If there is no beneficial effect at the maximum recommended dose, your doctor will usually try another stimulant medication. Approximately 80% to 90% of children will respond to one of the stimulants.

Side Effects

There are several side effects that can be associated with stimulant medications. These include stomachache, headache, decreased appetite, sleep problems, and increased symptoms as the medication wears off (known as rebound). Preschool children may also experience emotional outbursts, repetitive behaviors or thoughts, or irritability. Usually these effects are mild and often decrease after the first 1 to 2 weeks. Your doctor will adjust medications or discuss other strategies at follow-up visits if these side effects continue. It is helpful to observe the time of day when side effects occur. Serious side effects are rare, but you should contact your doctor's office if your child experiences dizziness, fainting, severe irritability, tics, or serious behavioral changes.

Setting a Follow-up Plan

Your child will need to be seen frequently during the initial treatment phase. After a satisfactory dose has been found, your child will be scheduled for a follow-up visit at regular intervals, usually every 2 to 3 months.

At follow-up visits, your doctor will review rating scales from you and your child's teachers and will check weight, blood pressure, and emotional status and review any medication side effects.

Parent's follow-up responsibilities include

  • Discuss your child's treatment program with appropriate school personnel.

  • Bring copies of completed parent and teacher follow-up rating scales to all follow-up visits.

  • Schools may be willing to fax completed follow-up rating scales to your doctor's office.

  • Inform the doctor before the next scheduled visit if your child is experiencing serious medication side effects.

  • Ask your child how he or she feels on the medication.

  • Schedule follow-up visits.

Your doctor will set up an anticipated follow-up schedule with you at the time medication is started. They are more frequent, typically weekly at the beginning since there is the need to increase dose until the most effective dose is achieved. There should be a visit within 14 to 30 days after any change in medication and dosage. Once that stabilization occurs, the frequency of routine follow-up stretches out.

Remember: If you have any questions or if you see side effects that cause concern, do not wait for the next scheduled visit. Call and speak with the doctor, and the doctor will arrange an appropriate immediate or interval follow-up.

The recommendations in this resource do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Original resource included as part of Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians , 3rd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.

© 2020 American Academy of Pediatrics. All rights reserved. AAP Feed run on: 9/23/2024 Article information last modified on: 8/6/2023

Sleep Problems in Children

Children may wake up or not sleep well during the night for different reasons. Here is information from the American Academy of Pediatrics about common sleep problems and how parents can help their children develop good sleep habits. Common sleep problems include nightmares, night terrors, sleepwalking and sleep talking, and bedwetting.

Keep in mind that children differ in how much sleep they need, how long it takes them to fall asleep, and how easily they wake up. If you have any questions about your child’s sleep habits, ask your child’s doctor.

Nightmares

Nightmares are scary dreams that often happen during the second half of the night, when dreaming is most intense. Children may wake up crying or feeling afraid and may have trouble going back to sleep.

What You Can Do

  • Go to your children as quickly as possible.

  • Assure children that you are there and will not let anything harm them.

  • Encourage children to tell you what happened in the dream. Remind them that dreams are not real.

  • Allow children to keep a light on if it makes them feel better.

  • Once children are ready, encourage them to go back to sleep.

  • See whether there is something scaring your children, like shadows. If so, make sure it is gone.

Night Terrors

Night terrors occur most often in toddlers and preschoolers and take place during the deepest stages of sleep. Deepest sleep usually happens early in the night, often before parents’ bedtime. During a night terror, children might

  • Cry uncontrollably

  • Sweat, shake, or breathe fast

  • Have a terrified, confused, or glassy-eyed look

  • Thrash around, scream, kick, or stare

  • Not recognize you or not realize you are there

  • Try to push you away, especially if you try to hold them

Although night terrors can last as long as 45 minutes, most are much shorter. Most children fall right back to sleep after a night terror because they have not actually been awake. Unlike with a nightmare, children will not remember a night terror.

What You Can Do

  • Stay calm. Children are unaware of ever having a night terror because they are asleep, so there is no effect on children, only parents.

  • Make sure children cannot hurt themselves. If they try to get out of bed, gently restrain them.

  • Remember, after a short time children will probably relax and sleep quietly again. If children have night terrors, be sure to tell the babysitters what night terrors are and what to do. If night terrors persist, talk with your child’s doctor.

Sleepwalking and Sleep Talking

Like night terrors, sleepwalking and sleep talking happen when children are in a deep sleep. While sleepwalking, children may have a blank stare. They may not respond to others, and it may be very difficult to wake them up. Most sleepwalkers return to bed on their own and do not remember getting out of bed. Sleepwalking tends to run in families. It can even occur several times in one night among older children and teens.

What You Can Do

  • Make sure children don’t hurt themselves while sleepwalking. Clear the bedroom of things children could trip or fall on.

  • Lock outside doors so children cannot leave the house.

  • Block stairways so children cannot go up or down.

  • Do not try to wake children when they are sleepwalking or sleep talking. Gently lead them back to bed, and they will probably settle down on their own.

Bedwetting

Bedwetting at night (also called nocturnal enuresis) affects 5 million children in the United States. Although most children are toilet trained between 2 and 4 years of age, some children may not be able to stay dry at night until they are older. Children develop at their own rate. For example, studies have showed that 15% of 5- and 7-year-olds wet the bed. But by age 15, fewer than 1% wet the bed.

What You Can Do

  • Do not blame your children. Remember that it is not their fault.

  • Offer support, not punishment, for wet nights. Let your children know bedwetting is not their fault and that most children outgrow bedwetting.

  • Set a no-teasing rule in your family.

  • Let your children help. Encourage them to help change the wet sheets and covers. This teaches responsibility. It can also keep them from feeling embarrassed if the rest of the family knows. However, if they see this as punishment, it is not recommended.

  • Parents may try waking children to use the toilet 1 to 2 hours after they go to sleep or encouraging children to drink less in the evening. However, keep in mind that bedwetting could still occur because even if your children urinate before going to bed and drink very little in the evening, their kidneys continue to produce urine.

  • If you are concerned about your child’s bedwetting, talk with your child’s doctor. There are treatments available.

For More Information

American Academy of Pediatrics www.aap.org and www.HealthyChildren.org

Disclaimer

Adapted from the American Academy of Pediatrics (AAP) brochure Sleep Problems in Children .

The AAP is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Copyright © American Academy of Pediatrics Date Updated: Nov 17 2024 20:38 Version 0.1

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