Thyroid Disorders: ADHD/Bipolar Copycat

In my first several posts I explored the new treatment regimes for ADD/ADHD and Bipolar diagnoses in children. If you haven't read those posts, please take a moment to read posts named
"Medicating Children for Behaviors" of June, 2009. In those posts, I discussed the new multi-medication treatments for ADD/ADHD and how this diagnosis is frequently evolving into a new diagnosis of Bipolar Disorder. Today, powerful antidepressant medications and antipsychotic medications seem to be regularly added to the prescribed stimulant medications in effort to combat symptoms of ADD/ADHD and Bipolar. All these medications I have seen prescribed regularly in children under the age of 6!

Something that you as parents should be aware of before any medications are prescribed is that the thyroid hormone plays a powerful role in emotions, thought and behavior. The thyroid gland is located in the front of the neck at the "adams apple". Every cell in the body depends upon thyroid hormones for regulation of their metabolism. Too much thyroid hormone is called hyperthyroidism; too little thyroid hormone is called hypothyroidism.

According to the Thyroid Foundation of Canada, hyperthyroidism and hypothyroidism have symptoms that appear to look like mental illness. People with too much thyroid hormone may be anxious, impatient and irritable, and emotionally explosive. They may also be easily distracted, over active, sensitive to noise, have problems with sleep and appetite. In extreme cases,
they may appear schizophrenic, losing touch with reality and becoming delirious or hallucinating.

The Thyroid Foundation of Canada states that people with too little thyroid show slowing of mental processes, poor memory, loss of interest in activity, depression and paranoia, and eventually, if not treated, dementia and permanent harmful effects on the brain.

For each condition, people have been wrongly diagnosed and treated unsuccessfully for mental illness. Please review these symptoms again; note that symptoms of hyperthyroidism are very close if not exactly the symptoms of ADD/ADHD. Note also that the symptoms of hypothyroidism could easily be the symptoms of depression, and depending upon the activity level or effects on the brain, the symptoms of Bipolar Disorder.

Imagine the young child treated with a multitude of stimulants, antipsychotics and antidepressants when the undiagnosed problem is actually Thyroid disorder. Please keep this in mind if you are seeking medical help for a child with behavior difficulties.

Source: http://www.cchr.org/media/pdfs/The_Thyroid_and_the_Mind_and_Emotions_by_Awad_Professor_of_psychiatry.pdf

Chicken Pox: What's going on?

During the 2007-2008 school year, something very interesting happened with our elementary school aged students. We had a chickenpox epidemic, affecting approximately 33% of the student population in our 500-student elementary school.

It started in October 2007 with one kindergarten student was sent to me showing 7 raised blisters on his head and face. I thought it resembled chickenpox; admittedly I was rusty on this childhood illness as it had become more rare since the introduction of the chickenpox vaccine. The student had all of the symptoms of chickenpox:

He had a sore throat, had a slight fever, his parents reported that he had been sick over the previous weekend with an upset stomach and a cough. Now, the raised blisters on his face were itching to the point that he could not stop scratching.

Reviewing the vaccination history, this child had received the chickenpox vaccine when he was about 12 months old, as recommended by the CDC. In fact, in 2005, the chickenpox vaccine was required for every child in Michigan before entering school.

It was first thing in the morning, so to be more comfortable with assuming a chickenpox possibility, I counted the blisters and logged them on a diagram. My next step was to recheck in one hour while contacting the local Public Health Department. One hour later, the blister count had increased to 16, with new blisters in the scalp and abdomen. The child was sent home with the presumption of chickenpox. He was taken to his pediatrician, and unfortunately, the chickenpox diagnosis was denied. The reason--he had had the vaccine as an infant.

Within 2 weeks, similar symptoms were showing up in our elementary school students across the board; attempts to contain the illness to grade-level, or geographic location in the school building was impossible. I was reporting to the Public Health Department 5-15 students weekly with chickenpox. By Christmas, pediatricians in the city were confirming the diagnosis. By Easter, the chickenpox had affected approximately 180 students, all of whom had had the vaccine as an infant.

But here is another interesting question that remains unanswered: This epidemic was limited to elementary school students only. No older siblings in the Middle School or High School were affected. While this question continued to be raised by myself and the local Public Health Department, by the end of the school year letters were sent by the Health Department to all school age children in our district encouraging a chickenpox booster shot as recommended by the CDC.

In 2007, the new CDC guidelines for chickenpox vaccination:

1. All healthy children 12 months through 12 years of age should have two doses of chickenpox vaccine, administered at least 3 months apart. Children who have evidence of immunity to varicella do not need the vaccine.
2. People 13 years of age and older who do not have evidence of immunity should get two doses of the vaccine 4 to 8 weeks apart.
3. Chickenpox vaccination is especially important for certain groups of susceptible adults.

**An interesting side note for further discussion; my own child erupted in chickenpox on the last day of school in 2005 at the age of 7. He had had the vaccine at age 18 months along with his older brother and sister, who were vaccinated at age 4 1/2 and 6 years old. Neither of the older children showed any signs of chickenpox during or after his illness.

While the CDC denies any change in effectiveness of the vaccine based on the age of the person receiving the dose (see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm "Risk factors for Vaccine Failure"), why is it that in these two incidents, children who received the vaccine at an older age did not develop the chickenpox when exposed to their siblings with active chickenpox who had received the vaccine as infants?

Atopic Dermatitis: Uncontrollable Scratching

Over the years, I have had elementary school children sent to me with a red, raised itchy rash on the inside creases of their elbows and behind their knees. Sometimes, the rash is also noted on the back of the neck, in the armpits, and along the jawline. Frequently, the student is also known to have asthma, with an inhaler or nebulizer used at school. Often, the teacher is concerned about something contagious, such as chickenpox or scabies.

These signs and symptoms usually result in a diagnosis of atopic dermatitis. This is a noncontagious skin condition that starts in infancy and is most notable by about the age of 3 months. It is a form of excema. The child will show bright red, raised and bumpy skin on the cheeks and chin. Soon, the red patches appear in the creases of the elbows and behind the knees. The child will rub the itchy areas until the skin is raw and weepy. Some respiratory problems might be noticed at this time, such as coughing or runny nose.

As the child develops into a toddler and preschooler, it is obvious that something occurs with the skin in a course that has flare-ups and total remission. I have dealt with this condition affecting my own child for 14 years. With my child, the flare-ups would occur on the first warm day of spring. Instantly, her cheeks would become swollen with reddened hives, she would begin scratching her arms in the elbow creases, her legs behind the knees, and the skin folds under her eyes would become visible. She would scratch until the skin was scraped raw, and the areas would become weepy. Attempts to cover the itching skin was futile; the area was too great and any covering would stick to the weepy skin. Asthma symptoms would then start, with coughing and wheezing evolving into need for a nebulizer. Interestingly, by the fall and winter, the skin condition that had once defined our summers was a distant memory.

By the time the child is school-aged, the itch-scratch cycle is evident if not predictable. The rash location is very predictable: behind the knees, in the creases of the elbows, the armpits, behind the ears, at the neck and the jawbone. Scratching is uncontrollable, especially while the child is sleeping. The skin in the creases becomes thick and leather-like. Asthma or other breathing problems usually accompany the rash.

Criteria used to diagnose atopic dermatitis include: itching skin in a cycle that is preceded by some type of irritation (for my child, we believe it is warm weather and sweating); remissions; early onset, such as in infancy; changes in the skin as time passes (such as leathery or discolored skin).

Treatment is designed to combat three problems:
1. Avoiding the irritant if it can be identified
2. Preventing the itch-scratch cycle
3. Treating the rash if it develops

Avoiding the irritant is easier once you are able to identify the problem. For my child, we believe it is triggered by heat. Therefore, we attempt to keep her indoors on hot days and have air conditioning to keep her cool at night. Air conditioning helps in two ways: it improves the asthma symptoms and keeps night time scratching to a minimum.

Preventing the itch-scratch cycle starts with keeping other irritants to a minimum by using mild soap only, such as unscented Dove; unscented laundry detergent; and mild shampoo. Use an unscented moisturizer such as Cetaphil to keep the skin from becoming dry and leathery. Have the child wear cotton gloves to bed to prevent nighttime scratching ( a pair of cotton socks on the hands at night works well also). The doctor may prescribe an antihistamine at night to keep the itching under control.

Treating the rash will depend on the prescribing physician. A steroid cream is often effective, and the physician will recommend using it only during flare-ups to avoid side effects from long term use.

Research shows that this condition may be hereditary, and usually lessens in intensity by puberty and early adulthood. In the meantime, vigilance in watching for triggers, preventing the itch-scratch cycle, treatment during flare-ups; and remaining aware of respiratory complications should help the child remain more comfortable until the condition lessens with age.

Over-the-Counter Multi Symptom Medications: Overdose Risk!

This week the FDA released a report that it is considering warnings on over-the-counter multi symptom cold and flu products. The problem is one that I have had concerns about for years: many of these products contain acetaminophen, the pain reliever found in brands such as Tylenol and Exedrine. That alone is not a problem; however, when acetaminophen is an ingredient in many products that might be used together to treat such illnesses as a cold or flu, the potential for overdose is great. According to the FDA report, from 1998 to 2003, acetaminophen was the leading cause of liver failure in the United States. 48% of those cases were from accidental overdose.

Consider the average parent going to the drugstore hoping to find medication to help their child's cold symptoms. The child is coughing; has a stuffy, runny nose; is running a slight fever; and has a headache. He picks up some cough medicine, a decongestant, and some children's pain reliever for the headache and fever. Unless the parent is knowledgeable about the generic names for medications, what he did not see when he stared at the shelves and shelves of cold and flu products is that many of the medications he picked up were combination medications. These may have been labeled to address one of his child's symptoms, but had other ingredients in the formula.

Examples of generic names for symptom-relieving medications include: acetaminophen, a pain reliever; phenylephrine HCL, a nasal decongestant; guaifenesin, a medication to liquify thick mucus; diphenhydramine, an allergy medication; and dextromethorphan, a cough suppressant.

In my own medicine cabinet, I have found a children's cough medicine that has an additional label in small print "and nasal congestion". I also have a cough medicine that has in an additional label in small print "chest congestion, sore throat". So, liquid medication was purchased intending to control a cough, and in addition, expectorant, nasal decongestant, and acetaminophen were also included in these medications.

If I had not known the purpose of these additional medications, (or didn't have my reading glasses on), I probably would have treated my child with a pain reliever for the sore throat and maybe even a dose of nasal decongestant as well if the child was too stuffy to breathe! My child would have been double-dosed on both acetaminophen and decongestant.

The examples of these multi symptom medications are too numerous to list all here. Watch for labeling such as "cough and cold" (which could have all of the medications I listed above), "nighttime" (which might have an antihistamine product as well as a pain reliever), "daytime" (which may have a number of ingredients), "cold and flu" (which may have all the medications I listed above).

My recommendation would be to study the generic names of all the over-the-counter medications you purchase; know what they are and their intended purpose. Know the side- effects of each medication, and the dosage recommended for your child (or yourself for that matter). Consider purchasing only single-symptom medications, and give only those medications that address the symptoms that your child is experiencing.