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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

Welcoming a New Sibling: How to Help Your Child Adjust

Welcoming a new baby into your family is exciting! However, along with the excitement comes change.

Keep in mind that children of different ages may react differently to a new baby. Knowing what to expect from each age-group can make it easier to handle the changes in your family. Also, keep in mind that children have different personalities that may affect how they respond.

Here is information from the American Academy of Pediatrics to help parents prepare older siblings (big brothers and big sisters) for a new sibling (little brother or little sister).

Children Aged 1 to 2 Years

Children aged 1 to 2 years may not understand what it means to have a new sibling. However, you can bring up the topic with your child so that she can get used to the idea. Also, it’s important to reassure her that she is loved.

Before Your New Baby Arrives

  • Read children’s books about newborns and siblings with your child. She can become familiar with words such as sister, brother, and new baby.

After Your New Baby Arrives

  • Make sure the focus isn’t all on your new baby. Here are 2 ideas.

    • Give your child a special gift.

    • Plan a one-on-one date with your child. This can be with Mom, Dad, grandparents, or other family members.

  • Explain to your child that sometimes you need to take care of baby first. Although older siblings can help with feeding time or baby’s bath time, your baby needs one-on-one time too.

Children Aged 2 to 4 Years

Children aged 2 to 4 years are learning how to share with others and may feel as if they need to compete for your attention. They may also have a difficult time adjusting to changes in your family’s routine.

Before Your New Baby Arrives

  • Find chances to talk about baby. For example, you can mention that a new baby will be in the family when you start buying nursery furniture or baby clothes or when your child starts asking about Mom’s growing belly. Consider signing up for a siblings class, if your hospital offers one. Continue to read children’s books about newborns and siblings with your child.

  • Remind your child when she was a baby. Show your child her baby pictures. If you are going to use some of her old baby things, let her play with them a bit before you get them ready for the new baby. Buy your child a doll so that she can take care of “her” baby. This helps explain what being around a baby is like.

  • Be honest. Explain that the baby will be cute but will also cry and take a lot of your time and attention. Also, make sure your child knows that it may be a while before she can play with the new baby and, when she plays or helps care for baby, that she needs to be gentle. Reassure your child that you will love her just as much after the baby is born, as you do now.

  • Involve your child in planning for baby. This will make her less jealous. Let her shop with you for baby items.

  • Time major changes in your child’s routine. If you can, finish toilet training or switching from a crib to a bed before the baby arrives. If that is not possible, put it off until after the baby is settled at home. Otherwise, your child may feel overwhelmed by trying to learn new things on top of all the changes caused by the new baby.

  • Tell your child about Mom’s and baby’s hospital stay. You can tell your child that you and the new baby will need to stay in the hospital until the doctor says it’s OK to go home.

After Your New Baby Arrives

  • Expect your child to regress a little. Children may go back to an earlier stage in their development when a new baby arrives. They will act like a baby to get attention. For example, your child might want to drink from a baby bottle. Instead of telling her to act her age, give her the attention she needs. You may tell her that whenever she feels upset to whisper in your ear, “I need attention.” When she does, respond as quickly as possible. Praise her when she acts more grown-up.

  • Set aside special time for your child. Read, play games, listen to music, or simply talk together. Show her that you love her and want to do things with her. Also, make her feel that she is a part of things by having her cuddle next to you when you feed the baby.

  • Find ways to invite your child to help. You want to make sure your child feels included and not excluded. This helps build a bond between siblings, reduce jealousy, and promote curiosity.

  • Ask family and friends to spend time with your older child when they come to see the new baby. This will help her feel special and not left out. Some family and friends may also give her a small gift when they bring gifts for the baby.

  • Have your child spend time with Dad or another family member. A new baby is a great opportunity for fathers and other family members to spend time alone with older children.

School-aged Children

Children older than 5 years are usually not as threatened by a new baby as younger children are. However, they may resent the attention the new baby gets.

Before Your New Baby Arrives

  • Tell your child what is happening in words she can understand. Explain what having a new baby means and what changes may affect her.

  • Have your child help get things ready for the new baby. Your child can help fix up the baby’s room, pick out clothes, or buy diapers.

After Your New Baby Arrives

  • Have someone bring your child to the hospital to meet her new sibling, if your child is not already at the hospital. This will help her feel that she is part of the growing family.

  • When you bring baby home, help your older child feel that she has a role to play in caring for the baby. Tell her she can hold the baby, although she must ask you first. Teach her how to hold the baby. Praise her when she is gentle and loving toward the baby.

  • Do not overlook your older child’s needs and activities. Let her know how much you love her. Make an effort to spend some time alone with her each day; use that as a chance to remind her how special she is.

Important Information for Parents

  • Ask for help if you feel overwhelmed. Accept help from your partner, relatives, and friends. It’s important that you also make time to care for yourself.

  • Remember to make time for your partner. Children of couples who have a strong and loving relationship are more likely to adjust well to the new baby. Taking time to nurture your relationship with your partner can ease the transition to having a new baby for everyone.

Visit HealthyChildren.org for more information.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. 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. Information applies to all sexes and genders; however, for easier reading pronouns such as she are used throughout this publication.

Copyright © American Academy of Pediatrics Date Updated: Apr 03 2025 00:05 Version 0.1

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