Child Health Alert Feb/2008

[Guest guest]

RX Medications

Some Encouraging News:

Stimulants For Hyperactivity

Don't Seem To Have Major

Heart Side Effects...

Stimulant medications (such as Ritalin and

others) are widely used to treat attention

deficit/hyperactivity disorder (ADHD) in children.

They have long been known to mildly and

temporarily increase heart rate and blood pressure,

but m the last few years a number of cases were

reported of children who had heart attacks or

sudden death while they were on these drugs. Two

years ago, two committees that advise the U.S. Food

and Drug Administration looked into the question

of whether these rare problems could actually be

caused by the drugs, and while one committee

thought a serious warning should be issued about a

possible risk of these side effects, the other

committee thought the evidence that the drugs

caused such problems was quite weak, while the

effectiveness of the drugs was well established.

Now, researchers have examined data from

Florida Medicaid files, where they were able to

identify children between 3 and 20 years of age who

were prescribed stimulants for newly-diagnosed

ADHD. They also looked at whether any of these

children had cardiac problems that resulted in

death, admission to hospital, or an emergency

department visit. Among over 55,000 children in

the database. 5 children died of cardiac causes, but

there were no cardiac deaths among children on

stimulants. Stimulants also werent associated with

an increased risk of hospital admission for cardiac

reasons. Of interest, the researchers found that

children on stimulants were about 20% more likely

to have an emergency department visit for cardiac

problems, which the authors think might reflect the

fact that these drugs can indeed increase heart rate

and blood pressure.

Even though the authors call for more research in

this area, they find it reassuring that they did not

find stimulant drugs to be a signthcant cause of

heart problems that are serious enough to require

hospital admission or lead to death. (Winterstein

AG et al: Pediatrics, January, 2008, pp.el494-

el501)

COMMENT: Its hard to know why children on

stimulants may have slightly higher risks of coming

to an ED for cardiac problems, but over 60% of the

children had either fainting or unusual heart rates—

problems which might be as much related to the

child's ADHD as their medication. We should keep

in mind that these kinds of problems weren't the

ones that made headlines a couple years ago—the

concern focused on much more serious cardiac

problems, such as heart attacks and deaths, and in

this rcgatxl, the current study pro\idcs reassurance

that stimulants lor ADHD are unlikely to be causing

serious heart problems in children.

....And Another Study

Suggests Vaccination Isn't

Causing The Epidemic Of

Autism

Theres little debate that the rates of autism

among children have climbed steadily in recent

years, and researchers, anxious parents, and others

have searched for what might be causing this

problem. One controversial suggestion has been

that autism is caused by children's vaccines, and

many have pointed to one ingredient in a number of

vaccines—a mercury-based preservative (called

thimerosal). A major piece of evidence supporting

that theory was that autism cases increased as use of

mercury-containing vaccines increased. Mercury

hasn't been used in childhood vaccines since 2001.

and if that were the cause of autism, researchers

predicted that we would see the number of new

autism cases drop as the mercury-free vaccines

became more common.

A new study from California found that autism

cases continued to increase after thimerosal was no

longer given to children. Researchers from the

California Department of Public Health found that

among 3 year olds, autism cases increased from 0.3

per 1,000 children born in 1993 to 1.3 per 1,000

children born in 2003. and similar trends were

Child Health .4/.£'/?7'

Ffbruar\- 2008

found in older children. The researchers wrote tbat

these time trends are inconsistent with the view that

thimerosal is a major cause of autism.

Others seem to agree; a spokesperson for the

advocacy group Autism Speaks called the research a

" very important study " and said ati possible causes

of autism, whether genetic or environmental, need

to be aggressively considered. (Associated Press,

January 8, 2008; Schechter R & Grether JK:

Archives of General Psychiatry, January, 2008, pp.