3 Clinical psychopharmacology3.4 Therapeutics

3.4.5.1 Children and adolescents

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Written by Resident Doctor Committee · Published

Drug handling

  • Drug handling changes with body composition, protein binding and organ maturation, so adult doses cannot simply be scaled down.

  • Neonates may clear medicines slowly, while some clearance pathways are faster per kilogram in older children.

Antipsychotic weight gain

  • Children and adolescents gain more weight on antipsychotics than adults do, and they gain it faster.

  • This happens even with antipsychotics regarded as weight-neutral in adults.

Antidepressants

  • Fluoxetine is the antidepressant the National Institute for Health and Care Excellence (NICE) prefers when medication is indicated for depression in young people, usually alongside psychological treatment.

  • Young people starting an antidepressant are commonly reviewed weekly for the first 4 weeks for suicidality and activation.

Monitoring

Drug class

Ongoing monitoring

Antipsychotics

Growth, body mass index, waist, metabolic measures, pulse, blood pressure, movements, prolactin effects

Stimulants and atomoxetine

Height six-monthly; weight three-monthly if aged 10 or under; pulse and blood pressure six-monthly

Lithium and antiepileptic mood stabilisers

Drug levels and laboratory checks; valproate restrictions

Body mass index in a child is plotted against centile curves for age: BMI normally dips around age six and rises through adolescence, so a young person's own centile line matters more than any single BMI figure. U.S. Centers for Disease Control and Prevention. Public domain, via Wikimedia Commons

  • Akathisia may look like worsening agitation.

  • Lisdexamfetamine can still be misused despite its prodrug design.

Consent in England and Wales

Age

Basis of consent

Under 16

Gillick competence; otherwise valid parental authority and the young person's assent

16 and 17

Capacity is presumed under the Mental Capacity Act

  • Confidentiality has safeguarding and public interest limits, so clinicians should not promise absolute secrecy.

Revision material for the MRCPsych examinations. Not clinical guidance, and not for use in patient care.