Kids and Multiple Medications

A checklist of things you should know about adding and mixing medications

Writer: Caroline Miller

Clinical Expert: Ron J. Steingard, MD

en Español

When children have complex psychiatric symptoms, or aren’t responding adequately to a medication they are taking, doctors often recommend adding another medication.

Taking multiple psychoactive medications is called “polypharmacy.” And studies show that the number of children taking more than one medication is soaring. Combining medications can be effective when they’re prescribed and monitored carefully by a doctor expert in using them with children. But it’s important for parents to know the risks inherent in adding medications, and how to tell if you should be concerned about what a doctor is recommending.

What can go wrong with multiple medications?

The risk in combining medications is that they can interact in ways that increase unwanted or harmful side effects. Let’s say your child is prescribed one medication that causes mild sedation, and a second does the same thing. The result can be so much sedation that the child isn’t herself and can’t stay awake, explains Dr. Ron Steingard, a child and adolescent psychiatrist at the Child Mind Institute.

Another medication interaction that can be problematic is if two medications use the same metabolic pathway—the mechanism in the body that breaks them down and delivers them to the target. In some cases these medications, taken together, can overwhelm that pathway and create a buildup of medication, Dr. Steingard says, and that can cause the kind of side effects you’d see with a much higher dose of one of the meds.

Finally, there’s a risk that a child is prescribed multiple medications when he would benefit more from other supports, including behavioral treatments that have been shown to be effective for kids with many issues, including ADHD, anxiety and depression.

Things to consider if your doctor is proposing multiple medications

Your clinician should have specific training and substantial experience prescribing and managing these medications in children, not just adults. That’s because children, whose nervous systems are still maturing, don’t always respond to medication the same way adults do.

Medications for your child should not be prescribed by two different doctors, unless they are coordinating their care and communicating with each other closely. If there are two prescribing doctors on your child’s treatment team, one should take the lead in your child’s care, and the other act as consultant.

Whenever a medication is introduced, your doctor should explain clearly what symptoms it is expected to treat, and how you will evaluate whether the medication is helping your child.

With any new medication, your doctor should explain what side effects to watch for, as well as anything in a child’s mood or behavior that might indicate that she’s having a bad reaction.

Related: Side Effects of ADHD Medication

If one medication isn’t working, or is barely helping, it can also be a sign that the disorder has been wrongly diagnosed. It’s important that your doctor reevaluate the diagnosis, and the treatment, before adding other medications.

Before a child begins taking a second medication, other supports should be explored that might have lower risks and more benefit. The combination of a single medication and behavioral treatment should be carefully considered before more meds are added.

If your child is experiencing side effects from one medication, it’s advisable to explore either cutting back on the dose or switching medications before adding another med to treat side effects.

A child should not begin taking two or more medications at the same time. Meds should be introduced one at a time, enabling you and your doctor to monitor any side effects that occur, and to measure the effects on your child’s mood and behavior.

If your child is taking more than one medication, dosages should be changed one at a time. It’s impossible to evaluate the effect of each change if more than one is altered.

New medications should be added and dosage changes made when your child’s life and routine are as stable as possible. You want to avoid times like the start of a new school year, vacation, a move to a new home, or a medical illness.

When you change or add medications, it’s important to let everyone on your child’s team know—including her teachers and other caregivers—and check in to find out how she is doing.

When you evaluate the effects of a medication, it’s important to not assume that any change, for better or worse, is a result of the medication. Pay attention to other changes in your child’s life at home and at school that might affect her emotions and behavior.