Getting Started on Medications

The best way to ensure a child's safety while on medication is to setup a two-way flow of information between the psychiatrist and the family. This exchange typically includes having the doctor explain the types of testing (such as blood work) that may be necessary prior to and during treatment, the medication he is considering, why he is making that choice, and the potential benefits and possible side effects of this treatment. Parents should discuss with their child's doctor any concerns or questions that they have; you're all part of a treatment team, so you need to be able to work together.

What Blood Tests Will My Child Need?

Before giving a child medication for any mood disorder, it's important to get a few baseline blood tests. They may sound intimidating at first blush, but these are standard tests that many physicians will ask for. They include:

• A complete blood count with differential and platelet count: These tests are needed to determine that a child has a normal number of red and white blood cells (the latter to fight infection) and a normal platelet count (which is important for blood clotting).
• A comprehensive metabolic screen: This is a detailed test that measures a variety of important elements of health, such as levels of electrolytes and glucose and liver and kidney functioning.
• Thyroid function tests: These are necessary to ensure that a child does not have a thyroid disorder that could contribute to his psychiatric difficulties. It also serves as a baseline, as some medications can affect thyroid function.
• A fasting lipid panel: This checks the baseline total cholesterol, high-density lipoproteins (HDL) and low-density lipoproteins (LDL), and triglyceride level.
• Prolactin level: Prolactin, which is secreted by the anterior pituitary gland, is a natural hormone present in all our bodies. It is involved with lactation, and it can, on occasion, be affected by certain prescribed medications (Zyprexa, Haldol, Geodon, and Risperdal).

Some parents say, "But my son won't get within ten feet of a needle. How's he going to have blood tests?" They are not alone. Many children, as well as adults, hate needles and are fearful of seeing blood (especially their own). When told that blood tests are needed, kids may cry or appear extremely anxious—or say that they "suddenly" feel better. I tell the kids that I don't like getting poked by needles either. But I explain to them about a "magic" cream that parents can put on their arms before a test, so that it doesn't hurt. There are some wonderful topical anesthetic creams (a combination of prilocaine and lidocaine or lidocaine alone) that can be applied to the area where the blood is drawn. These topical anesthetics are available under several brand names, including EMLA cream (by prescription) or ELA Max. I tell children how I have used these creams for myself and for my own children when we've had to get blood drawn, and they've helped a great deal.

Discovering that there are ways to keep the test from hurting can be very calming to kids (although many have to experience this before they believe it). I also try to make a big deal, in a positive way, about the first set of tests. Since fasting is required prior to the initial blood draw, I suggest that parents take the child out for breakfast afterward at a special place she selects and then stop by the toy store to pick out an inexpensive toy. It may seem like bribery, but this relatively pleasant initial experience often sets the stage for good experiences with future blood work.

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