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Anxiety Medication for Children

Should you medicate your child? This is one of the biggest questions you might face if you are a parent of an anxious child. 

This page will help you understand at what point it might be necessary to decide to put your anxious child on medication. 

The research is inconclusive about whether medicine or therapy is more effective for children with anxiety. 

Some studies have shown that cognitive behavioral therapy (CBT) and medication combined are more effective than one modality alone for some kinds of anxiety disorders. 

However, most professionals generally advise parents to try a good therapist who uses a combination of Cognitive Behavioral Therapy (CBT) strategies first. With medication always comes the risk of side effects, and most parents don't want to medicate their children if avoidable.

If a child's functioning is seriously impaired and must be quickly gotten under control.medication may be recommended first.

Watch a video summary of this page.

It's also important to be able to ascertain that you have received good therapy before you make that decision to try medicine. Here is a checklist of some of what should be happening in therapy with children who have anxiety. This list does not apply for teens and adolescents. Therapy with teens is often conducted with less parent involvement. 

Anxiety Medication for Children: Get good quality therapy

 Has your child's therapist:

  • Provided both you and your child with education about anxiety and what cognitive behavioral therapy (CBT) can do to help?
  • Helped normalize anxiety symptoms?
  • Explained  the role of avoidance in maintaining anxiety?
  • Helped you understand the process of exposure treatment?
  • Worked with you to create a detailed list of situations you are avoiding and behaviors you or your child are harmfully engaging in to reduce anxiety?
  • Helped you to help your child with self-monitoring of their anxiety reactions? 
  • Helped you both to recognize how you respond to anxiety-provoking triggers with avoidance or negative thoughts feelings or beliefs? 
  • Encouraged you and your child to learn and participate in Cognitive restructuring or cognitive diffusion exercises to help anxious thoughts have less power?
  • Provided you and your child with education and strategies to challenge ideas and worries?
  • Encouraged you to help your child face the things they are afraid of and tried to work with your child to conquer that fear?
  • Offered to work  with the school to assist your child if necessary?
  • Provided you with education and strategies to manage the  physical symptoms of the anxiety? These may include skills such as:
  1. Diaphragmatic breathing- Breathing deeply and slowly in a way that induces a relaxation response.Progressive muscle relaxation- Systematically tensing and relaxing muscles throughout the body to relieve muscle tension that anxiety brings. 
  2. Mindfulness/ Meditation to increase tolerance of physical discomfort
  3. Self compassion practices to increase the tolerance of physical discomfort

Generally this is what good therapy for anxiety should look like. Different diagnoses such as obsessive compulsive disorder, panic disorder, or selective mutism will require more specific  approaches, but good treatment has all of these components in common.  

If you ask your therapist why they haven't tried something above, they should have a good explanation that makes sense to you. You should not be minimally involved in your child's anxiety treatment. You are central to their healing. 

If you feel that you have given good therapy a try, and your child's child’s symptoms have not improved significantly, it may be time to consider child anxiety medication.

If your child’s symptoms have improved but continue to interfere with success at home, school, or with friends, you may also want to consider medication. This is a deeply personal decision, and no one can make it but you. 

 Is CBT the only therapy that works?

Keep in mind that although we know CBT works it may be somewhat difficult to use with young children. A three year old will not be capable of participating in traditional cognitive behavioral therapy. In cases of young children, most of the work should occur with you. Research is showing us more and more that in these cases the work should be with the parent( Lebowitz 2019). It is also important to remember that other techniques may work also.

CBT is not the only therapy, it is just the best researched therapy. We know children who receive it generally make improvements. The important thing to remember is that you feel your child has received the benefit of good therapy prior to trying medication. A good child anxiety therapist  will make use of a combination of techniques such as art and play therapy during the different phases of CBT,  and may use these strategies  to highlight the concepts and issues above for the child. For example, the therapist may have the child draw out what they are thinking and feeling rather than say it. Remember, they will always  work with you the parent, to help you work with your child. 

Anxiety Medication for Children: Selective Serotonin Reuptake Inhibiters (SSRI's), Tricyclic Antidepressents(TCA's), and Benzodiazepines

Even though I’m not a psychiatrist, I can read and understand the research, and so can you. It's crucial for parents to be educated and understand the medicine choices your child's doctor makes.  The most up to date research on anxiety medicine for children at this time shows that SSRI's can be successful at helping anxious children. 

SSRI’s have been shown to increase depressive symptoms, including suicidal ideation, in a SMALL percent of these children and adolescents. Also, there are  no research studies  on the long term effects of SSRI'S on anxious children (AACAP OFFICIAL ACTION Clinical Report, February 1, 2007). Seriously, what parent wants to put their kids on medication?

Here are some of the SSRI's

  • fluoxetine or Prozac
  • sertraline or Zoloft
  • paroxetine or Paxil
  • fluvoxamine or Luvox
  • citalopram or Celexa
  • escitalopram or Lexapro

Only a doctor can prescribe and advise you on child anxiety medicine, but you can be informed enough to ask questions about SSRI’S or any other choices of medications.

A doctor may prescribe something other than an SSRI, or in combination with an SSRI as a child anxiety medication. If your child’s doctor makes a different choice, ask why.

There are two other classes of drugs utilized to treat child and adolescent anxiety. Tricyclic Antidepressants ( TCA’s) and benzodiazepines. TCA’s generally have more serious side effects and need to be monitored more closely .  (AACAP OFFICIAL ACTION Clinical Report, February 1, 2007) .

Anxiety Medication for Children: Questions to Ask the Doctor

Educate Yourself and Your Child about the Child Anxiety Medicine They Take

If you and your doctor have decided to try a child anxiety medication, carefully monitor your child for any changes in their behavior. I also recommend children be told about the medication that is being prescribed, and that they know the names and doses of their medications. Parents need to check in regularly with their child when medication is prescribed to get the child’s opinion of how they feel and how it may be helping or hurting.

Here are some questions to ask your doctor about your child's medication. 

  • How does this medication work?
  • What symptoms am I monitoring for improvement? 
  • How long should it be before I see improvement?
  • What will you do if there is no improvement?
  • How long will my child need to be on this medication?
  • How will my child get off this medication?
  • What side effects am I monitoring for?
  • What questions should I ask my child to determine their personal experience with an improvement in the symptoms?
  • What should I do if I miss a dose of this medication?
  • What should I do if my pharmacy substitutes a generic for this one?
  • Are there any side effects or interactions I should know about?

I hope this page was helpful for you when thinking about whether or not to medicate your child for anxiety.

This page does not apply to Obsessive Compulsive Disorder (OCD) or Post Traumatic Stress Disorder ( PTSD).These diagnoses require different consideration when examining questions about medication (AACAP OFFICIAL ACTION Clinical Report, February 1, 2007)

Resources

OFFICIAL ACTION Clinical Report. (February 1, 2007). Practice Parameter for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolesecent Psychiatry , 267-283.(Rep.). (n.d.).

Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2019). Parent-Based Treatment as Efficacious as Cognitive Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child & Adolescent Psychiatry. doi:10.1016/j.jaac.2019.02.014

M., Alvarez et. al. (n.d.). Psychotherapy for anxiety disorders in children and adolescents. Retrieved April 19, 2019, from https://www.uptodate.com/contents/psychotherapy-for-anxiety-disorders-in-children-and-adolescents#H10658364.


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Thanks for visiting! Feel free to email me at kristenlynnmcclure@gmail.com

Thanks for visiting! Feel free to email me at kristenlynnmcclure@gmail.com
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