Most Docs Don't Follow ADHD Treatment Guidelines for Preschoolers: Study

Some specialists turn to medications too soon while others avoid them completely

By Robert Preidt

HealthDay Reporter

SATURDAY, May 4 (HealthDay News) -- About 90 percent of pediatric specialists who diagnose and manage attention-deficit/hyperactivity disorder (ADHD) in preschool children do not follow treatment guidelines published recently by the American Academy of Pediatrics, according to a new study.

Some prescribe medications too soon, while others do not give the young patients drugs even as a second-line treatment, according to study author Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park, N.Y., and colleagues.

The American Academy of Pediatrics (AAP) guidelines recommend that behavior therapy be the first treatment approach for preschoolers with ADHD, and that treatment with medication should be used only when behavior-management counseling is unsuccessful.

The researchers also found that more than one in five specialists who diagnose and manage ADHD in preschoolers recommend medications as a first-line treatment alone or in conjunction with behavior therapy.

The study is scheduled for Saturday presentation at the Pediatric Academic Societies' annual meeting in Washington, D.C. Data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"It is unclear why so many physicians who specialize in the management of ADHD -- child neurologists, psychiatrists and developmental pediatricians -- fail to comply with recently published treatment guidelines," Adesman said in a medical center news release.

Some physicians also deviate from guidelines with their choice of medication. Although methylphenidate (Ritalin) is recommended as the first drug to try when medications are warranted, many doctors prescribed other types of drugs.

"With the AAP now extending its diagnosis and treatment guidelines down to preschoolers, it is likely that more young children will be diagnosed with ADHD even before entering kindergarten," Adesman said. "Primary care physicians and pediatric specialists should recommend behavior therapy as the first-line treatment."

Awareness is lacking across specialties, another study author said.

"Although the AAP's new ADHD guidelines were developed for primary care pediatricians, it is clear that many medical subspecialists who care for young children with ADHD fail to follow recently published guidelines," study principal investigator Dr. Jaeah Chung said in the news release.

"At a time when there are public and professional concerns about overmedication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children," Chung added.

View the original article here

Parenting Preschoolers: 8 Mistakes Raising 3-5 Year Olds

Find out how you can avoid these common parenting missteps.

Sometimes, it may seem like your preschooler has the innate ability to push you to the outer edge of your patience. And that's on a good day.

Fear not, moms and dads. You're not alone. Preschoolers want to own their newfound independence. But they also want the close attention and love of their caregivers.

Michele Borba, EdD, author of The Big Book of Parenting Solutions, says, "These ages (3-5) are among the most active and frustrating in terms of parenting.

Here are eight common mistakes parents of preschoolers make and some smart fixes to help avoid or resolve problems.

Consistency is key for preschoolers, says pediatrician Tanya Remer Altmann, author of Mommy Calls: Dr. Tanya Answers Parents' Top 101 Questions about Babies and Toddlers.

When you're not being consistent with your routine, preschoolers get confused and may act out more or throw more temper tantrums. Altmann says, "If sometimes you let them do something and sometimes you don't, they don't understand."

Your child probably wants to know why last time Mommy let her play on the playground for 10 minutes when school got out but this time wants her to get in the car right away. Or why did Mommy laid down with her for 10 minutes last night while she fell asleep but now says she can't.

Fix it: Be consistent across the board -- whether it's with discipline, sleep habits, or mealtime routines. 

Altmann says if your routine is consistent 90% of the time and your child is doing well, then so are you, and a minor exception may be OK.

It's easy to hone in on your child's negative actions -- like yelling and screaming -- and ignore the good ones.

Altmann says parents tend to focus on what they don't want their preschoolers to do. "They'll say, 'Don't hit. Don't throw. Don't say 'poopy pants,'" she says.

Fix it: Notice when your child is doing something positive, and reward the good behavior.

The reward for positive actions can be your praise, or it can be giving your child a big hug or kiss. "Those types of things really go a long way with preschoolers," Altmann says.

Tell your child, "I like the way you sat quietly and listened," or "That was good when you were so friendly to the child on the playground."

View the original article here

2 Cups of Milk a Day Optimal for Most Preschoolers

Dec. 17, 2012 -- Milk is an important source of vitamin D and calcium in young children’s diets. But drinking more than two glasses a day may lower how much iron is stored in their bodies, raising the risk for anemia, a new study suggests.

When researchers looked at daily milk intake as it related to iron and vitamin D levels in about 1,300 preschoolers, they found that drinking 2 cups of milk a day seemed optimal for most children, says lead researcher and pediatrician Jonathon L. Maguire, MD, of St. Michael’s Hospital in Toronto.

Vitamin D and iron are important nutrients for growing children. Iron plays a critical role in brain development. Iron deficiency has been linked to problems in movement. Vitamin D is important for many reasons, including bone health.

Milk is one of the best sources of vitamin D and calcium, while iron-fortified cereals and meats are among the best sources of iron.

Drinking 3 cups or more of milk was associated with slightly lower ferritin levels in the blood, but the levels were still within the normal range for most children. Ferritin levels indicate how much iron is stored in the body.

The more milk the children drank, the lower their ferritin levels tended to be.

“Milk is an important source of nutrition for young children, but the message to parents is that too much of a good thing may come with a trade-off,” Maguire says.

Though parents of preschoolers often ask how much milk their young children should be drinking, Maguire says the answer is not that clear.

He points out that the American Academy of Pediatrics recommends limiting cow’s milk to about 2 cups a day for preschoolers, but the group’s committee on nutrition also calls for vitamin D supplements for children who drink less than about 4 cups a day (1,000 mL).

It isn’t clear if drinking milk directly blocks iron absorption or if its impact is less direct.

“Cow's milk doesn’t have much iron, and it may be that kids who drink a lot of it are not eating other foods that are rich sources of iron,” Maguire says. “We really don’t know.”

In the study, published in the journal Pediatrics, each 8-ounce cup of milk a child drank was associated with a 3.5% drop in ferritin levels.

“That may not sound like a lot, but it can add up, especially in children with other risk factors for iron deficiency,” Maguire says.

The researchers noted that vitamin D supplements may be important for darker-skinned children or for children who get little vitamin D from the sun. The body makes vitamin D when exposed to sunlight.

Pediatrician Steven Abrams, MD, a member of the AAP committee on nutrition, says parents shouldn’t stress too much about exactly how much of a certain food their child eats, as long as the child is eating a variety of healthy foods.

“Most of the children in this study who drank a lot of milk were not iron deficient,” he says. “The effect of milk on iron status was pretty small.”

In a statement addressing the study, the National Dairy Council pointed out that it is not clear if drinking milk has a direct impact on iron levels.

“This study supports the role and importance of milk in helping children meet their nutrient needs, specifically vitamin D, when following recommended guidelines for milk consumption,” the statement reads.

View the original article here

2 Cups of Milk a Day Optimal for Most Preschoolers

BySalynn Boyles
WebMD Health News Reviewed byLaura J. Martin, MD

Dec. 17, 2012 -- Milk is an important source of vitamin D and calcium in young children’s diets. But drinking more than two glasses a day may lower how much iron is stored in their bodies, raising the risk for anemia, a new study suggests.

When researchers looked at daily milk intake as it related to iron and vitamin D levels in about 1,300 preschoolers, they found that drinking 2 cups of milk a day seemed optimal for most children, says lead researcher and pediatrician Jonathon L. Maguire, MD, of St. Michael’s Hospital in Toronto.

Vitamin D and iron are important nutrients for growing children. Iron plays a critical role in brain development. Iron deficiency has been linked to problems in movement. Vitamin D is important for many reasons, including bone health.

Milk is one of the best sources of vitamin D and calcium, while iron-fortified cereals and meats are among the best sources of iron.

Drinking 3 cups or more of milk was associated with slightly lower ferritin levels in the blood, but the levels were still within the normal range for most children. Ferritin levels indicate how much iron is stored in the body.

The more milk the children drank, the lower their ferritin levels tended to be.

“Milk is an important source of nutrition for young children, but the message to parents is that too much of a good thing may come with a trade-off,” Maguire says.

The Truth About Vitamin D

Iron and Milk

Though parents of preschoolers often ask how much milk their young children should be drinking, Maguire says the answer is not that clear.

He points out that the American Academy of Pediatrics recommends limiting cow’s milk to about 2 cups a day for preschoolers, but the group’s committee on nutrition also calls for vitamin D supplements for children who drink less than about 4 cups a day (1,000 mL).

It isn’t clear if drinking milk directly blocks iron absorption or if its impact is less direct.

“Cow's milk doesn’t have much iron, and it may be that kids who drink a lot of it are not eating other foods that are rich sources of iron,” Maguire says. “We really don’t know.”

In the study, published in the journal Pediatrics, each 8-ounce cup of milk a child drank was associated with a 3.5% drop in ferritin levels.

“That may not sound like a lot, but it can add up, especially in children with other risk factors for iron deficiency,” Maguire says.

Supplements Needed for Some

The researchers noted that vitamin D supplements may be important for darker-skinned children or for children who get little vitamin D from the sun. The body makes vitamin D when exposed to sunlight.

Pediatrician Steven Abrams, MD, a member of the AAP committee on nutrition, says parents shouldn’t stress too much about exactly how much of a certain food their child eats, as long as the child is eating a variety of healthy foods.

“Most of the children in this study who drank a lot of milk were not iron deficient,” he says. “The effect of milk on iron status was pretty small.”

In a statement addressing the study, the National Dairy Council pointed out that it is not clear if drinking milk has a direct impact on iron levels.

“This study supports the role and importance of milk in helping children meet their nutrient needs, specifically vitamin D, when following recommended guidelines for milk consumption,” the statement reads.

View Article Sources

SOURCES: 

Maguire, J.L. Pediatrics, Dec. 17, 2012.

Jonathon L. Maguire, MD, MSc, pediatrician, St. Michael’s Hospital, Toronto, Ontario, Canada.

Steven Abrams, MD, professor of pediatrics, Baylor College of Medicine; member, American Academy of Pediatrics committee on nutrition.

News release, American Academy of Pediatrics.

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