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Selasa, 22 April 2008

Anticoagulants

Summary


Anticoagulants are nonhabit-forming medications that keep existing blood clots from growing larger and prevent the formation of new blood clots.

Blood clots are an essential part of the body’s defense against injury. Without blood clots, a person would bleed to death from a relatively minor wound. However, when blood clots form in inappropriate locations, such as inside arteries, the result can be catastrophic. The danger is that a blood clot will prevent the flow of oxygen-rich blood through the vessel, thus resulting in the death of tissue beyond the clot. If this occurs in the heart or brain, a heart attack or stroke may result. If it occurs in peripheral arteries, it may result in the death of muscle and tissue beyond the clot. In internal organs, such as the kidneys, serious organ damage can result. Blood clots can also occur in the veins. In some situations, there is a risk that blood clots that occur in large veins can break off and travel through the circulatory system until they reach the heart or lungs, resulting in a heart attack or pulmonary embolism. To prevent these medical problems, anticoagulants may be prescribed for heart patients or other high-risk patients to prevent new blood clots from forming and to keep existing blood clots from growing larger

The process of blood clotting is complex, but can be roughly understood to include three phases: coagulation, platelet aggregation and formation of the fibrin clot. Anticoagulants deal only with the first phase of blood clotting, or the cascade of chemical reactions that begins the blood clotting process. Other medications, called antiplatelets or clot-busting drugs, interfere with the platelet aggregation and clot-formation phase, respectively. Each of the three classes of drugs has a different clinical use

Alzheimer's Disease FAQs

Does Alzheimer's disease affect only the elderly?

While most Alzheimer's victims are more than 65 years old, it can strike men and women in their 40s and 50s.

How many people are afflicted with Alzheimer's disease?

It affects an estimated 4 million American adults. It is the most common form of dementing illness.

Can an Alzheimer's patient die of the disease?

More than 100,000 die of complications from Alzheimer's disease annually, making it the fourth-leading cause of death in adults, after heart disease, cancer and stroke.

Does the disease strike one gender more than the other?

The disease knows no social or economic boundaries and affects men and women almost equally.

What are the symptoms of Alzheimer's disease?

Symptoms of Alzheimer's disease include a gradual memory loss, decline in ability to perform routine tasks, impairment of judgment, disorientation, personality change, difficulty in learning and loss of language skills.

Senin, 21 April 2008

Elderly use issues with ADHD medications

Dosage levels of some ADHD medications may need to be reduced for elderly patients. In addition, elderly patients may experience additional side effects when taking some ADHD medications. For example, elderly patients who take the alpha-2 adrenergic agonist guanfacine may experience dizziness, drowsiness, hypotension (low blood pressure) and/or faintness

Child use issues with ADHD medications

The safety of many ADHD medications has not been established in children. In many cases, these drugs are not recommended for use in children under the age of 6. Some stimulant medications have been associated with growth suppression in children.

In addition, the U.S. Food and Drug Administration (FDA) has warned that some children and adolescents who use antidepressants and norepinephrine reuptake inhibitors may experience thoughts of suicide. Although this is rare, it has led experts to urge that children who take antidepressants for ADHD be closely observed for signs of agitation, irritability and unusual changes in behavior

Pregnancy use issues with ADHD medications

Women who are pregnant, thinking of becoming pregnant or who are breastfeeding should not use ADHD medications before discussing the potential advantages and disadvantages of such use with a physician. It is unknown whether some ADHD medications are potentially harmful to fetuses or nursing infants, but many experts advise against using these drugs during pregnancy or breastfeeding

Symptoms of ADHD medication overdose

Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Patients exhibiting any of these symptoms while taking stimulants should contact their physician immediately:

  • Agitation
  • Confusion
  • Delirium
  • Dry mouth
  • Euphoria
  • Fever
  • Flushing
  • Headache
  • Hallucinations
  • Heart palpitations
  • Nausea and vomiting
  • Seizures

Symptoms of overdose with antidepressants used to treat ADHD include:

  • Ataxia (disorder that affects many tissues and body systems)
  • Seizures

Symptoms of overdose associated with alpha-2 adrenergic agonists used to treat ADHD include:

  • Hypotension (low blood pressure)
  • Breathing difficultes
  • Hypothermia (low body temperature)
  • Apnea (cessation of breathing)
  • Seizures
  • Lethargy
  • Agitation
  • Irritability
  • Diarrhea
  • Slow heartbeat
  • Unusual tiredness or weakness

Potential side effects of ADHD medications

In the past, some healthcare providers have been reluctant to use medications such as stimulants to treat attention deficit hyperactivity disorder (ADHD) for fear that the patient would become dependent on the drug. However, these fears are largely unfounded. When taken at proper dosage levels, stimulants rise too slowly in the brain to cause the patient to feel “high.” Nonetheless, the number of people who abuse these drugs and use them illicitly appears to be growing.

Some children who take stimulant medications report feeling slightly “funny” or different when taking the drugs. However, this effect is usually minor.

Recent research also indicates that use of stimulants can suppress a child’s growth, although the average growth suppression found in children taking stimulants for the disorder is minimal.

Other Side effects associated with stimulant use include insomnia, loss of appetite, stomachache, dysphoria (condition marked by anxiety, depression and restlessness), lethargy, sedation and/or impaired concentration. In rare cases, stimulant drugs may cause a child to develop a tic. This is typically resolved by changing the child’s dosage level.

Adults who take stimulant drugs may experience mild increases in blood pressure. This can be a significant development for adults who have high blood pressure (hypertension) or liver disease including hepatitis. The risk of abuse is also higher in adults than in children, as adults need to take larger amounts of the drug in order for it to be effective.

Side effects associated with antidepressants taken to treat ADHD may include dry mouth, urinary retention, weight gain, drowsiness and sexual dysfunction, depending upon which antidepressant is used.

In addition, the U.S. Food and Drug Administration (FDA) recently advised that antidepressants, including those used to treat ADHD, may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

Side effects associated with the alpha-2 adrenergic agonists include sedation, depression, and dry mouth. An increase in blood pressure (hypertension) may occur after use of these medications is discontinued

Drug or other interactions

Patients who take drugs to treat attention deficit hyperactivity disorder (ADHD) should consult their physicians before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications.

Stimulant drugs and alpha-2 adrenergic agonists are often combined to treat ADHD. There have been a handful of reported deaths in children who have taken this combination. However, an investigation by the U.S. Food and Drug Administration (FDA) found no significant danger in taking these drugs together.

Caffeine use can decrease the effectiveness of stimulants in treating ADHD. In addition, use of the antidepressant MAO inhibitors (MAOIs) with stimulants can cause severe high blood pressure (hypertension). Vitamin C supplements (ascorbic acid) may shorten the duration of the dosage.

Other drugs that may interact poorly with stimulants include:

  • Antacids
  • Anticonvulsants
  • Anticoagulants (drugs that help prevent blood clots)
  • Antidepressants (in addition to MAO inhibitors)
  • Antipsychotics
  • Bretylium (heart drug)
  • Sedatives such as barbiturates

Drugs that may interact poorly with antidepressants used to treat ADHD include:

  • Other antidepressants
  • Certain blood pressure medications
  • Sedatives such as benzodiazepines

Drugs that may interact poorly with alpha-2 adrenergic agonists used to treat ADHD include:

  • Antidepressants
  • Antihypertensives
  • Central nervous system (CNS) depressants such as alcohol and sedatives
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

Conditions of concern with ADHD medications

The presence of other medical conditions does not necessarily prohibit the use of ADHD medications. However, individuals should always inform their physician of any existing medical conditions and work closely with their physician to design a treatment plan that meets their unique needs.

Stimulants are usually well-tolerated by patients with ADHD and are rarely abused. However, patients with anxiety disorders should take these medications cautiously, as they aggravate the condition. Usually, a physician will choose to treat and control an anxiety disorder before using stimulants to treat attention deficit hyperactivity disorder (ADHD).

Stimulants should only be used with caution in patients who have a history of seizures, drug and alcohol abuse, kidney disease, high blood pressure (hypertension) or EEG (brain electricity) abnormalities. Patients with diabetes may have to alter insulin intake while using stimulant drugs.

One stimulant in particular, dextroamphetamine (Dexedrine), has been linked to sudden death in children and teenagers with certain heart problems. U.S. officials have asked the drug’s manufacturer to add a label reflecting this risk to the drug’s packaging.

Other conditions of concern that may prohibit the use of stimulants include:

  • Glaucoma (disease that results in increased pressure in the eye)

  • Hypertension (high blood pressure)

  • Hyperthyroidism (excessive production of thyroid gland)

  • Liver disease

  • Motor tics

  • Tourette’s syndrome (or family history of this disease)

Conditions of concern for patients taking antidepressants other than bupropion (Wellbutrin) to treat ADHD include:

  • Cardiovascular disease

  • Certain blood disorders

  • Glaucoma

  • Hypertension

  • Liver or kidney disease

  • Tachycardia (rapid heart rate)

Bupropion poses an increased risk of seizures. Therefore, individuals with seizure disorders may benefit from an alternative medication.

Conditions of concerns for patients taking norepinephrine reuptake inhibitors to treat ADHD include:

  • Cardiovascular disease

  • Hypertension

  • Liver or kidney disease

  • Tachycardia

  • Cardiovascular disease

  • Liver or kidney disease

Conditions of concern for patients taking alpha-2 adrenergic agonists to treat ADHD include:

  • Cardiovascular disease and other heart problems

  • Depression

  • Diabetes mellitus

  • Liver or kidney disorders

It is important to note that these conditions do not prohibit the use of the alpha-2 adrenergic agonists

Types and differences of ADHD medications

The four major categories of drugs used to treat attention deficit hyperactivity disorder (ADHD) are psychostimulants, alpha-2 adrenergic agonists, antidepressants and norepinephrine reuptake inhibitors.

Psychostimulants, often simply referred to as “stimulants,” inhibit the reabsorption of dopamine, a neurotransmitter that helps to keep the central nervous system (CNS) functioning normally. This leaves more dopamine circulating in the body. Stimulants are the mainstay of ADHD medication treatment, and up to 90 percent of patients who take them report at least some improvement in symptoms such as impulsivity and hyperactivity, according to the American Psychiatric Association (APA). Although these drugs have a stimulating effect on most people, they are calming in patients with ADHD.

Stimulants usually work fairly rapidly, with symptom reduction beginning between 30 and 45 minutes after ingestion. They work for between four and 12 hours and are typically taken two to three times daily. Some longer-acting (extended release) formulations may be taken just once a day. Most of the stimulants are only recommended for children over age 6. However, some amphetamines may be prescribed to children over age 3. The stimulant pemoline is no longer used as a treatment for ADHD as it can potentially cause serious side effects that may harm the liver. It was withdrawn from the market in 2005.

Alpha-2 adrenergic agonists are sometimes used to treat core ADHD symptoms, but more often are used to reduce irritability and aggression related to ADHD. They can also be used to promote sleep in patients who report insomnia.

Depression is a disorder commonly associated with ADHD, and antidepressants are often prescribed to treat lasting feelings of sadness. In addition, antidepressants that increase the availability of the neurotransmitters dopamine and norepinephrine in the body appear to be effective in treating core symptoms of ADHD. The tricylcic antidepressants and the dopamine-norepinephrine reuptake inhibitor bupropion appear to be particularly effective in treating ADHD.

Antidepressants are sometimes used to treat ADHD in patients who do not tolerate stimulants well. These drugs only have to be taken once daily. They are prescribed far more often in adults than in children. Selective serotonin reuptake inhibitors (SSRIs), often used to treat depression and anxiety, have not been effective in treating the symptoms of ADHD.

Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

Drug Type Generic Name

Brand Name(s)

Stimulants methylphenidate

Ritalin, Metadate, Methylin, Concerta, (Focalin XR),
Daytrana

dextroamphetamine Dexedrine
amphetamine Adderall, Desoxyn
Alpha-2 adrenergic agonists clonidine Catapres
guanfacine Tenex
Antidepressants bupropion Wellbutrin

atomoxetine*

Strattera

*The drug atomoxetine is not approved for use as an antidepressant by the FDA

About ADHD medications

ADHD medications are prescription drugs used to treat attention deficit hyperactivity disorder (ADHD), a set of chronic conditions marked by an inability to pay attention, hyperactivity and a tendency to engage in impulsive acts. The drugs are often highly effective in helping patients to control behavioral problems that hinder them in day-to-day life.

Although they are not certain, experts theorize that ADHD medications improve symptoms by increasing activity in certain parts of the brain that are underactive. ADHD medications function by boosting and balancing levels of chemicals known as neurotransmitters in the brain. Patients who take these drugs often experience dramatically reduced levels of hyperactivity and impulsivity. This makes it much easier for them to focus on tasks such as working and learning. These drugs also improve coordination in some patients, making it easier for them to write or engage in athletics.

Individuals may respond differently to the various drugs used to treat ADHD. Parents are urged to work closely with physicians in trying to find the appropriate medication and dosage level for their child.

It is important to remember that medications cannot cure ADHD, but can only help control symptoms during the period that they are working in the body. Behavioral therapy, other forms of psychotherapy and family support are also crucial to helping children cope with ADHD.

Children who take these drugs and find them to be effective may be asked by a physician to suspend use of the drugs for a period of time to see whether or not they are still necessary. This may be planned around a time such as summer vacation, when a child is more relaxed and has fewer tasks that need to be completed. In some cases, drugs are only necessary for a year or two before a change in a child’s symptoms renders them unnecessary.

In most cases patients will continue to take medications into adolescence and possibly into adulthood. About 80 percent of patients with ADHD take medication into their teenage years, and 50 percent of all patients will continue to require medication as adults, according to the National Institute of Mental Health (NIMH).

ADHD drugs are available in tablet, capsule and injection form. The U.S. Food and Drug Administration also recently approved the first transdermal (skin) patch to treat the disorder in children ages 6 to 12

ADHD Medications

Summary

ADHD medications are prescription drugs used to treat attention deficit hyperactivity disorder (ADHD). These drugs are often highly effective in helping to control symptoms such as inability to pay attention, hyperactivity and impulsivity.

ADHD medications improve symptoms by boosting and balancing levels of brain chemicals known as neurotransmitters. This can have a dramatic calming effect on ADHD patients, allowing them to more easily focus on tasks such as learning and working. The drugs may also improve coordination in some patients.

Psychostimulants – often simply referred to as “stimulants” – are the chief form of medication therapy for ADHD. Up to 90 percent of patients who take them report at least some improvement in symptoms, according to the American Psychiatric Association (APA). Certain types of antidepressants and alpha-2 adrenergic agonists are also used to treat ADHD, often in patients who do not respond well to stimulants.

ADHD drugs are usually well-tolerated by patients. However, patients with certain medical conditions may not be good candidates for drug therapy. In addition, some medications – particularly the antidepressants known as monoamine oxidase inhibitors (MAOIs) – may have poor and possibly dangerous interactions with ADHD drugs.

ADHD drugs are available in tablet, capsule and injection form. The U.S. Food and Drug Administration (FDA) also recently approved the first transdermal (skin) patch to treat the disorder in children ages 6 to 12.

Women who are pregnant, thinking of becoming pregnant or breastfeeding are usually urged not to use ADHD medications. In addition, these drugs are not generally prescribed for children under the age of 6. Older adults may use many ADHD medications safely, but dosage levels may have to be adjusted to prevent side effects.

In some cases, young patients need to take ADHD drugs only for a year or two before a change in their symptoms renders the drugs unnecessary. However, in most cases patients will continue to take medications into adolescence and possibly into adulthood

Symptoms of cold medication overdose

Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Overdoses may cause hemorrhagic stroke (bleeding in the brain that damages brain tissue), dysrhythmias (abnormal heart or brain rhythms), myocardial infarction (heart attack) or ischemic bowel infarction (death of intestine portion after its blood supply is cut off). Children who overdose on the ingredient phenylpropanolamine may experience hypertensive encephalopathy, a brain disease resulting from high blood pressure. Parents who notice their child exhibiting any of these symptoms should contact a physician immediately:

  • Blurred vision
  • Chest pain
  • Lethargy or stupor
  • Loss of ability to control muscle movements (ataxia)
  • Loss of contact with reality (psychosis)
  • Seizures
  • Significant headache
  • Significant agitation

Potential side effects of cold medications

Children who take over-the-counter cold medications may experience dried-out respiratory passages and thickened nasal secretions. Overuse of nasal decongestants can lead to a “rebound effect” in which the drug becomes less potent and nasal congestion begins to worsen.

Other potential side effects associated with cold medications include:

  • Agitation
  • Anxiousness
  • Dizziness
  • Drowsiness
    • Fast heartbeat (tachycardia) or slow heartbeat (bradycardia)
    • Fatigue
    • High blood pressure (hypertension)
  • High blood sugar levels
  • Hyperactivity
  • Insomnia
  • Irritability
  • Loss of appetite (anorexia)
  • Nervousness
  • Nightmares
  • Racing heart
  • Restlessness
  • Retention of urine
  • Unusual excitement
  • Upset stomach


Drug or other interactions with cold medications

Parents should consult their child’s pediatrician before giving the child any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Substances that may preclude the use of decongestants or antihistamines include:

  • Anticholinergic drugs (used for abdominal or stomach spasms or cramps)

  • Antidepressants

  • Central nervous system (CNS) depressants, including alcohol

  • Digitalis glycosides (heart medication)

Conditions of concern with cold medications

Patients of all ages should tell their physician about any illness or allergies before taking cold medications. In addition, certain medical conditions (many of them more common in adults) may preclude the use of cold medications. These include:

  • Anemia (reduced levels of red blood cells)

  • Diabetes mellitus

  • Enlarged prostate or urinary tract blockage

  • Glaucoma (disease that causes increased pressure in the eye)

  • Gout (uric acid build-up in a joint)

  • Heart or blood vessel disease

  • High blood pressure (hypertension)

  • Kidney disease

  • Liver disease

  • Portal hypertension (rare lung disorder in which blood pressure in the pulmonary artery rises far above normal)

  • Thyroid disease

Types and differences of cold medications

There are many different types of cold medications available. It is important to note that many experts contend there is no proof that these drugs work in children. Parents are urged to consult with a physician about whether cold medications should be given to a child, and whether the potential benefits outweigh the risks of side effects.

The major types of cold medications include:

  • Antihistamines. These drugs are known to relieve a runny nose, itchy eyes and sneezing in patients with allergies. Experts consider antihistamines to be ineffective for treating colds. However, they are often marketed as part of cold medications or sold in combination with decongestants. Antihistamines are known to cause side effects in some children, including nightmares, unusual excitement, nervousness, restlessness and irritability.

  • Decongestants. Drugs that help relieve stuffiness associated with colds or allergies. These drugs temporarily shrink the blood vessels in the lining of the nose, reducing swelling of nasal tissues and improving breathing. In children, oral decongestants may cause hyperactivity, anxiousness, racing heart or insomnia. They may also cause a “rebound” effect in which the medication becomes less effective and symptoms return in a worse form than when they began. They may also cause blood pressure increases in children. Decongestants should not be used in infants, who may absorb too much of the drug through their nasal membranes.

  • Combination medications. Some cold medications combine a decongestant with an antihistamine. This can cause side effects such as hyperactivity, insomnia and irritability. Other medications combine other ingredients, such as the pain relievers. It is crucial for parents to avoid giving their children too much of certain kinds of medications. Thus, children who are taking a certain pain reliever to control a fever should never take a cold medication that also contains the same pain reliever, because this can lead to a dangerous overdose.

  • Cough syrups. There are two kinds of cough medications. Expectorants help loosen mucus, whereas suppressants prevent the patient’s cough reflex from activating. Experts generally advise against giving suppressants to children, because coughing can help clear the lungs. It is especially important not to give children cough syrups that contain codeine.
Colds are caused by viral infections. As a result, they do not respond to antibiotics, which are used to treat bacterial infections. Studies have found no evidence to support the role of the herb echinacea or vitamin C supplements in treating a child’s cold. In addition, aspirin should not be used to treat a child’s cold. Use of aspirin in children has been associated with Reye syndrome, a rare but extremely serious condition that affects all organs of the body and that can be fatal. The danger is most common in children who take aspirin when they have a viral infection, such as the flu or chickenpox. Symptoms of Reye (pronounced “rye”) syndrome include nausea, vomiting, rapid breathing, lethargy and behavioral changes (such as increased belligerence).

About cold medications and children

Cold medications are often taken by patients of all ages – including children – to help relieve symptoms such as a runny or stuffed-up nose, coughing and sneezing. In adults, the medications may provide relief from some symptoms, despite the fact that they cannot stop or shorten a cold. However, the use of these drugs in children is a source of controversy. Though many parents maintain that these drugs help their children to better endure cold symptoms, some experts contend that there is little or no proof that cold medications are effective when used by children.

Colds are a regular part of a child’s life, with the average child experiencing six to 10 colds each year that typically last for 10 days to two weeks. There is no cure for the common cold, but these infections typically are relatively harmless and resolve on their own over time.

A child with a cold may experience symptoms such as runny nose (rhinorrhea) and cough that generate major discomfort. As a result, parents often turn to cold medications to relieve these symptoms. There are scores of these medications available in various combinations that include substances such as decongestants, cough suppressants, antihistamines, antipyretics (which reduce fever) and analgesics (which reduce pain).

According to the American Academy of Pediatrics (AAP), studies have failed to show any proof that cold medications help young children. In particular, these drugs should not be used in children 2 years of age or younger. In this population, these medications can be harmful and sometimes even life-threatening, according to new research. Cold medications may be more effective in treating symptoms related to adolescents and adults.

Although most cold medications are generally considered to be safe, they may present health risks – some of which can be fatal – when they are taken by children at excessively high dosage levels or when taken at correct dosage levels over long periods of time. Parents may not consider over-the-counter cold remedies to be medications when a physician asks if the child has taken any medications. In addition, dosage guidelines for children have traditionally been based on information gathered about adult usage and therefore are not considered to be especially precise. Parents may initially give a child a recommended dosage, but increase the dosage, expecting that a higher dosage may provide additional relief. In some cases, this may worsen symptoms.

In recent years, the Food and Drug Administration (FDA) has asked all drug manufacturers to remove the ingredient phenylpropanolamine (PPA) from over-the-counter decongestants. It is suspected that this ingredient may lead to an increased risk of hemorrhagic stroke (bleeding in the brain that damages brain tissue). Most drug manufacturers have worked to either remove medications that contain PPA or replace PPA with other ingredients.

Many experts urge parents to avoid using cold medications in children if possible. Cold medications cannot prevent or reduce the length of a cold. At best, they can control symptoms, and whether they are effective at all in children remains a topic of debate. Studies have shown that the sedative quality of many of these medications often fools parents into thinking the drugs are working, when in fact they have little or no impact on a child’s symptoms.

Parents are urged to consult with a physician, preferably a pediatrician, about the potential risks and benefits of using cold medications before deciding whether or not these drugs are appropriate for a child

Cold Medications & Children

Summary


Cold medications are often taken by patients to help relieve symptoms such as a runny or stuffed-up nose, coughing and sneezing. Many parents also give these medications to children with cold symptoms.

The common cold has no cure. It is caused by viruses and may involve nasal congestion, coughing and sneezing. Cold medications sometimes provide relief from symptoms, but that relief may only be in the form of drowsiness or greater ability to rest. The use of cold medications in children is a source of controversy. Many experts contend that there is no evidence that cold medications alleviate cold symptoms in children. Parents may believe that anything that helps a child rest better or appears to alleviate symptoms can help their children.

Many medications are available to treat the symptoms of colds. Some of them are more commonly used to treat similar symptoms associated with allergies (e.g., sneezing and a runny nose). They include:

  • Antihistamines. Help to stop a runny nose, itchy eyes and sneezing in patients with allergies. Experts consider these medications to be ineffective for treating colds. However, they are often marketed as part of cold medications or sold in combination with decongestants.

  • Decongestants. Medications that help relieve stuffiness associated with colds or allergies. These drugs temporarily shrink the blood vessels in the lining of the nose, reducing swelling of nasal tissues.

  • Combination medications. Some cold medications combine a decongestant with an antihistamine. Other medications combine other ingredients, such as pain relievers.

  • Cough syrups. There are two kinds of cough medications. Expectorants help loosen mucus, and suppressants prevent the patient’s cough reflex from activating.

Patients of all ages should tell their physician about any illness or allergies before taking cold medications. Though most cold medications are generally considered to be safe, they may present health risks – some of which can be fatal – when they are taken by children at excessively high dosage levels or when taken at correct dosage levels over long periods of time. In addition, children may receive excess dosages if a parent is not aware of duplication of ingredients in separate medications.

Side effects associated with cold medications include agitation or drowsiness, high blood pressure, and insomnia. More serious symptoms such as chest pain, loss of contact with reality (psychosis) or seizures may indicate an overdose, which requires immediate medical attention.

Parents are urged to consult with a physician about the potential risks and benefits of using cold medications before deciding whether these drugs are appropriate for a child. All cold medications should be kept locked away from children and only administered with a parent’s supervision

Consequences and signs of poor nutrition

A combination of good nutrition and exercise helps keep the body healthy and fit. Poor nutrition and lack of exercise can lead to numerous health problems, including obesity, malnutrition and iron deficiency anemia. Poor nutrition and lack of exercise can also increase the risk of heart disease, cancer, stroke and osteoporosis (weak and brittle bones associated with insufficient amounts of calcium) later in life.

Early signs of atherosclerosis (a condition in which fatty material collects along the walls of arteries), a common cause of heart disease, may be noticed during childhood and adolescence. This condition is related to poor dietary habits that lead to high levels of cholesterol in the blood. More and more American children are overweight or obese than in years past. In addition, an increasing number of children are being diagnosed with high cholesterol (also called hypercholesterolemia). High cholesterol was not even screened for or tracked in children until recently. Poor dietary choices can also cause cavities.

The Centers for Disease Control and Prevention (CDC) reports that 67 percent of United States youth aged 6 to 19 years old consume too much total fat, 72 percent consume too much saturated fat and 80 percent of American youth do not eat enough fruits and vegetables. Furthermore, only 39 percent of American youth aged 2 to 17 consume enough fiber.

According to the American Academy of Family Physicians, 70 percent of American adolescents – especially females - do not consume enough calcium. The CDC reports that 85 percent of teenage girls do not consume a sufficient amount of calcium. This may be because many female adolescents mistakenly believe that all dairy foods are high in fat. However, low-fat milk contains as much calcium as whole milk. Mineral supplements may be considered for children and teens who cannot or will not consume adequate amounts of calcium.

Caffeine is present in many foods and beverages, including chocolate, sodas, coffee and tea. It is a stimulant and a diuretic (increases urine production) that can cause many problems when consumed in excess, including nervousness, upset stomach, headaches and difficulty concentrating and sleeping. Excessive urination due to caffeine may lead to dehydration. Young children may be particularly susceptible to these effects. In addition, caffeine interferes with calcium absorption, which can result in less bone formation in children who consume it in excess.

According to the CDC, the average daily consumption of sodas in adolescent girls increased from 6 ounces (177 milliliters) to 11 ounces (325 milliliters) between 1978 and 1998. Over the same period of time, average daily soda consumption increased from 7 ounces (207 milliliters) to 19 ounces (561 milliliters) among adolescent boys. Sodas are full of caffeine, sugar and empty calories. They are not nutritious and may replace healthier foods and beverages in the child’s diet. Health experts recommend that children and teenagers limit their consumption of sodas

Nutrition in older children and adolescents

On average, school-age children grow a little more than 2 inches (5 centimeters) and put on about 6 ½ pounds (3 kilograms) per year. However, individual children may grow much more or less. At this age, children may be introduced to numerous challenges to good nutrition. Commercials and other advertisements can persuade children to become interested in snacks and foods that are often high in fats and sugars. Highly advertised foods are also purposefully placed at a child’s level in supermarkets. Educating children on health and nutrition can help them choose healthy foods instead of highly advertised foods.

At this age, children may also become more aware of what their peers are eating. Children may feel deprived if certain foods (e.g., chocolate, candy) are banned to them, particularly if the foods are not banned to their friends. Instead of banning a particular food entirely, the American Academy of Pediatrics (AAP) recommends that it is offered only occasionally, such as during special occasions (e.g., birthdays, a weekly “treat day”).

Older children often continue to display many behaviors seen in the toddler years, such as refusal to eat or refusal to eat a certain food. Similarly, the same guidelines, such as not forcing the matter or offering bribes, remain. Healthy children will not starve as long as nutritious food is available.

The AAP recommends that parents and other caregivers use MyPyramid as a reference to ensure that children are getting all the nutrients, vitamins and minerals they need. In general, the AAP recommends that half of a child’s daily calories come from carbohydrates. According to the AAP, children typically can and should receive all the nutrients they require through their diet. Vitamin supplements are not generally necessary. As a general guideline, boys between the ages of 4 and 18 and girls aged 4 to 8 need about 25 grams of fiber daily, and girls aged 9 to 18 need between 31 and 38 grams of fiber every day.

The AAP stresses the importance of breakfast. Research suggests that skipping breakfast can affect children’s intellectual performance. If scheduling problems make it difficult to have breakfast at home, many children can eat breakfast at school. It is important to note that not all school meal programs meet standard nutrient requirements. However, school meal programs must serve a balanced diet that includes a selection of fruits, vegetables and grains, if they receive federal assistance funds. The amounts and types of fats in foods are also restricted.

Many schools also offer a much wider selection of non-regulated food choices. Snack and beverages from student stores and vending machines are often very high in sugar and fat and low in other nutrients. The AAP recommends that parents and caregivers advocate for healthier food choices throughout schools, including in student stores and vending machines.

As children near adolescence, they may begin to grow in spurts. These spurts become more frequent in adolescence. During these spurts, the child may grow as much as 4 inches (10.1 centimeters) per year.

Adolescents are much more mobile than children and often have their own sources of money. Because of this, it can be difficult for parents to guide the adolescent’s food choices. However, good habits established during childhood may continue during adolescence.

Eating disorders (e.g., anorexia nervosa, bulimia nervosa, binge eating) are a common concern during adolescence, particularly among girls. Contact a physician if any adolescent displays signs of an eating disorder. Furthermore, the AAP does not recommend weight-loss diets for children or teenagers. Teens who follow weight-loss diets and use unhealthy methods to control their weight are at increased risk of becoming overweight and developing eating disorders, according to new research. Parents and other caring adults who are concerned about a child’s weight are encouraged to speak to a pediatrician.

The number of calories adolescents need every day varies widely between individuals. However, the AAP recommends, as a general rule, that moderately active adolescent boys consume about 2,700 calories per day, and similarly active adolescent girls consume about 2,300 calories each day. It is recommended that between 55 to 60 percent of these calories come from carbohydrates, and 35 percent or fewer come from fats. Protein is also important. The AAP recommends that 10 to 12 percent of daily calories come from protein. The recommended daily amount of iron for adolescent girls is 15 milligrams, and the recommendation for boys is 12 milligrams daily. However, some girls may need more iron to compensate for blood lost during menstruation.

Calcium is also increasingly important. Bone mass peaks at some point during late adolescence or early adulthood. After this point, it only decreases with time. In order to maintain long-term bone health (and reduce the risk of osteoporosis [weak, brittle bones] in later adulthood), the peak bone mass needs to be as high as possible. This goal is reached by consuming plenty of calcium during childhood and adolescence. The AAP recommends that adolescents consume at least 1,300 milligrams of calcium every day. This is generally attainable through four servings of dairy products daily.

Family meals are important for both children and teens. Involving the child in age-appropriate tasks in the kitchen can be a learning experience and motivate them to eat healthy. For example, young children can set the table or pour beverages while older children grate cheese. Adolescents can help with the actual cooking. Children and adolescents may also be involved in planning the meal, such as choosing ingredients at the grocery store. If a child or adolescent resists family meals, it may help to allow them to invite a friend

Nutrition in infants and toddlers

Infants will grow more in their first year of life than at any other time. Although breast milk and/or formula will provide all the nutrition they need to grow, infants will eventually begin eating other types of foods. The age at which a child is ready for “solid” food varies. The American Academy of Pediatrics (AAP) recommends starting to introduce supplemental foods between the ages of 4 months and 6 months. The first foods to be introduced are semi-solid and often include ground rice or oat cereal mixed with a little breast milk or formula. Sometime around 7 months, an infant might begin eating strained or mashed foods.

The speed in which food should be introduced varies greatly; some children take to new textures and tastes readily whereas others (especially premature infants) may not be as receptive. The AAP recommends not forcing or rushing an unwilling infant to try new foods. Foods should be introduced one at a time to help detect allergies and intolerances (which are most likely to occur within the first year of life), and avoid overwhelming an infant with new textures. New foods may need to be introduced many times (e.g., 10 or more times) before they are accepted.

Between the ages of 6 months and 8 months, caregivers may want to introduce fruits, other types of cereals (such as Cheerios) and vegetables. Between the ages of 9 months and 12 months, soft foods such as pasta, yogurt, cheese and beans may be introduced. After one year, whole cow’s milk can be given. After age 2, low-fat milk is recommended.

According to the AAP, the recommended minimum daily intake for a child between 12 months and 18 months should resemble the following:

  • 16 to 24 ounces of whole milk

  • 4 to 8 tablespoons of fruits and vegetables

  • 4 servings of bread and cereals (1 serving equals ¼ slice of bread or 2 tablespoons of rice)

  • 2 servings (½ ounce) of meat, poultry, fish, eggs

After the first year, it is normal to see a sharp drop in a child’s appetite as their rapid rate of growth slows. The calorie intake of a toddler will vary widely, depending on the child’s activity level and body type. In general, each inch requires roughly 40 calories every day for children between ages 1 and 3 years, according to the AAP. This means a 32-inch child would need to eat 1,300 calories a day.

Although this means that different toddlers have different caloric needs, the AAP recommends that a child aged 1 to 3 years consume a diet that is similar to the following:

  • 6 servings of grains (1 serving equals ¼ to ½ slice of bread, 4 tablespoons of cooked rice, cereal or pasta, ¼ cup of dry cereal, or 1 to 2 crackers)

  • 2 to 3 servings of vegetables (1 serving equals 1 tablespoon of cooked vegetables for each year of the child’s age)

  • 2 to 3 servings of fruits (1 serving equals ¼ cup of cooked or canned fruit, ½ piece of fresh fruit, or 2 to 4 ounces of juice)

  • 2 to 3 servings of dairy (1 serving equals ½ cup of milk, 1/3 cup of yogurt, or 1-inch cube of cheese)

  • 2 servings of protein (1 serving equals 1 ounce of meat, ½ egg, 2 tablespoons of soaked and cooked beans, peas or legumes, or 1 tablespoon of smooth peanut butter spread thin on bread, toast or a cracker)

Fruit juice is a good source of many vitamins and minerals. However, it is also an ample source of sugar and calories. All of the same vitamins and minerals as well as additional nutrients can be obtained from eating whole fruits. The Food and Drug Administration (FDA) requires that products labeled as “fruit juice” contain 100 percent juice. Products with less than 100 percent juice may be referred to as fruit drinks, beverages or cocktails. It is generally recommended that children and adolescents consume no more than half of their suggested fruit intake in the form of fruit juice (and not fruit drinks).

Although mealtimes can become a frustrating test of wills, it is normal for a child’s appetite to decrease. The AAP suggests avoiding cajoling, begging, bribing or threatening to get a child to eat more. If a child continually refuses to eat, the AAP recommends offering only the foods that have been put on the table rather than cooking an entirely new meal to a child’s liking. If the child refuses to eat all foods, calmly end the meal. Although parents often worry a child is not eating enough, healthy children will not starve as long as nutritious food is available.

Children benefit from predictable routines. It is best to have each meal and snack at the same time every day. For young children, small, frequent feedings (three meals and two to three snacks) are best. Portions should remain small

The MyPyramid food guide and nutrition

The MyPyramid food guide was developed by the U.S. Department of Agriculture (USDA) as a dietary guideline for children, adolescents and adults. This interactive tool is composed of six different-colored steps, each representing a specific food group. The steps are used to emphasize the importance of exercise, which goes hand in hand with nutrition for good overall health. The suggested amounts of each food group are merely guidelines. On some days, a child may have more or less of a recommended food group. What is important is that the long-term (e.g., weekly) intake averages out.

Suggested Daily Intake By Age & Gender

Age

Grains

Vegetables

Fruit

Dairy

Protein

Children 2 to 3 years

3 ounces (oz.)

1 cup

1 cup

2 cups

2 ounces (oz.)

Children 4 to 8 years

4 to 5 oz.

1 ½ cups

1 ½ cups

2 cups

3 to 4 oz.

Girls
9 to 13 years

5 oz.

2 cups

1 ½
cups

3 cups

5 oz.

Boys
9 to 13 years

6 oz.

2 ½ cups

1 ½ cups

3 cups

5 oz.

Girls
14 to 18 years

6 oz.

2 ½ cups

1 ½ cups

3 cups

5 oz.

Boys
14 to 18 years

7 oz.

3 cups

2 cups

3 cups

6 oz.

The six food groups represented in the pyramid include:

  • Grains. These include breads, cereals, rice, pasta and similar foods. Whole grains are high in complex carbohydrates and other important nutrients. No more than half of the grains consumed each day should come from refined grains (e.g., white bread, white rice). Refined grains have been processed and many nutrients, including the fiber, have been removed. Whole grains (e.g., oatmeal, brown rice, rye bread) are much more nutritious. MyPyramid measures grains by ounce. One slice of bread or half a cup of cooked rice, pasta or oatmeal equals 1 ounce.

  • Vegetables. A variety of vegetables in the diet provide numerous vitamins and minerals. Vegetables are also an excellent source of fiber. They should be scrubbed before cooking or eating to remove dirt, pesticides or other contaminants. Vegetables are best eaten raw, steamed or microwaved.

  • Fruits. These are a superb source of vitamins, especially vitamin A and vitamin C, as well as potassium, carbohydrates and fiber. Fruits are best eaten raw. They should be scrubbed before cooking or eating to remove dirt, pesticides or other contaminants. For fruit juice to replace whole fruits, it must be 100 percent fruit juice. No more than half of the daily amount of fruit consumed should come in the form of fruit juice. Fruit juice does not provide the fiber found in whole fruits.

  • Dairy. Includes milk and milk products (e.g., yogurt, cheese). These foods provide plenty of calcium, protein and vitamins, particularly vitamins A and D.

  • Meats, fish, beans and nuts. These are the primary sources of protein. They also provide iron and vitamins. MyPyramid measures protein sources by the ounce. One egg, 1 tablespoon of peanut butter, ½ ounce of nuts or seeds, or 1.4 cups of cooked dry beans equals about 1 ounce.

  • Fats and oils. These essential nutrients must be consumed in moderation. However, they are very important for infants and young children, and should not be restricted until the age of 2 years. Although sugar is neither a fat nor an oil, it is often included with these two because dietary intake of refined sugar also needs to be limited

About nutrition

New parents and caregivers ask a pediatrician about nutrition in the first few years of a child’s life more than any other care-related question. Getting the right balance of nutrients is challenging because children’s nutritional needs will change as they grow – along with their food preferences, eating habits and activity levels. A child’s nutritional needs will vary based on age, size and metabolism, existing health conditions and other factors. It is important to discuss any questions or concerns about a child’s nutritional needs with a pediatrician.

Newborn infants receive all of their nutritional requirements either through breastfeeding or formula. By eating a healthy diet, a mother who breastfeeds can help to ensure her child receives proper nutrition.

Good nutrition for children older than 2 years old is essentially the same as for adults, with the exception of the amount of calories required. Good nutrition is the right balance of nutrients, which contain different amounts of calories. For instance:

  • A gram of carbohydrate provides 4 calories
  • A gram of protein provides 4 calories
  • A gram of fat provides 9 calories

Fats, proteins and carbohydrates are broken down into smaller molecules that are then carried through the bloodstream to all the cells in the body. For example, carbohydrates are broken down into glucose, which is used by all cells and organs. Protein is broken down into amino acids, which are needed for the continuous process of muscle and tissue growth and repair, as well as for making enzymes, hormones, antibodies and more.

Obesity and poor nutrition in children have been growing concerns among health professionals in the United States for several years. About 13 percent of children between the ages of 6 and 11, and 14 percent of children aged 12 to 19, are overweight, according to the U.S. Department of Health and Human Services. These figures have tripled over the past two decades. Teenagers who are overweight have a much greater likelihood of remaining overweight or obese in adulthood.

Long-term, poor eating habits are hard to break. By encouraging good nutrition and food choices from the beginning, a child has a better chance of avoiding obesity, cardiovascular diseases and type 2 diabetes, all of which are rising among children.

Like adults, children need the right assortment of nutrients, vitamins and minerals to grow, develop and function. Nutrients include the following:

  • Carbohydrates. The primary source of calories for the human body. Nutritional experts generally recommend that between 50 and 60 percent of an individual’s total daily calories come from carbohydrates, primarily complex carbohydrates. There are two different types of carbohydrates:

    • Complex carbohydrates. These starches are found in whole grain cereals and breads, rice, potatoes, pastas, fruit and vegetables. They require more time than simple carbohydrates to process and use, so they do not build up as quickly.

    • Simple carbohydrates. Also called simple sugars, these are found in large amounts in some fruits, as well as in snack foods, candy and soda. An apple is an example of a nutritious food that contains simple carbohydrates. The carbohydrates in soda, however, provide empty calories. High sugar foods that replace whole foods (such as drinking soft drinks in place of milk) can lead to nutritional deficiencies, especially in children who have higher nutritional needs for these nutrients.

  • Protein. Found in meat, poultry, fish, beans, nuts, eggs and dairy products, protein is composed of amino acids. They are crucial to building and repairing most body tissues (e.g., muscles, skin, organs). It is generally recommended that about 10 to 20 percent of an individual’s daily calories come from protein.

  • Fats. Also called lipids, the proper amount of fat is vital to good health. Fat is part of all cell membranes and makes up the sheathing around nerves, which is important to efficient nerve conduction. In addition, fat absorbs and carries vitamins A, D, E and K, and affects cholesterol levels. It is recommended that no more than 35 percent of the daily dietary calories of an older child, adolescent or adult come from fat. Infants and younger children (under the age of 2 years) require additional fat intake for the production and development of brain and other nerve cells. Parents and caregivers should be aware of the types of fats that affect a child’s health:

    • Saturated fats. These fats are solid at room temperature. They come from animal products, such as butter, cheese, whole milk, ice cream and meat. Too much saturated fat can lead to high cholesterol and heart disease.

    • Unsaturated fats. These fats are liquid at room temperature. They come from vegetable oils, nuts and fish. Unsaturated fat does not raise cholesterol levels in the blood and may reduce them. Unsaturated fat can be monounsaturated or polyunsaturated (found in canola, flaxseed, peanut and olive oils). Omega 3 fatty acids are a type of polyunsaturated fat that research has found to be especially important to childhood development. The most common source for omega 3 (fish oil) also carries a risk of mercury toxicity, but it can be found in oils (such as canola and flaxseed oil) as well.

    • Trans fats. These fats are created from unsaturated fats that have been processed (hydrogenated) to make them solid at room temperature, such as in stick margarine. They may also be found naturally in similar products as saturated fats. Excess consumption of trans fats can lead to high cholesterol and heart disease.

  • Fiber. A filling nutrient that helps move food through the digestive tract and prevents constipation. It may also reduce LDL cholesterol (bad cholesterol) levels in the blood and reduce the risk of diabetes and heart disease. Grains, fruits, vegetables and cereals are good sources of fiber.

Vitamins are also essential to good nutrition. Important vitamins include vitamin A, C and D. Vitamin A is important to eyesight and skin health and can be found in orange vegetables (e.g., carrots, squash) and dark green, leafy vegetables. Vitamin C, found in many fruits and some vegetables, is important for healthy teeth and gums as well as helping the body to heal wounds and fight infections. Vitamin D helps the body absorb calcium. Most vitamin D is provided by skin exposure to natural sunlight, but many dairy products are now enriched with it, as well.

Calcium is important for building healthy bones and teeth. Insufficient amounts of calcium can cause rickets (a skeletal disease), low bone density and an increased risk of fractures. Calcium is found in milk and other dairy products (e.g., yogurt, cheese). Lactose-free and low-lactose varieties of many of these products are available for children with lactose intolerance. Many other foods (e.g., orange juice, cereals) are also fortified with calciu

Nutrition & Children

Summary

Getting the right balance of nutrients is challenging because children’s nutritional needs will change as they grow – along with their food preferences, eating habits and activity levels. A child’s nutritional needs will vary based on age, size and metabolism, existing health conditions and other factors.

Newborn infants receive all of their nutritional requirements either through breastfeeding or formula. The age at which a child is ready for “solid” food varies. Good nutrition for children over age 2 is essentially the same as for adults, with the exception of the amount of calories required. Like adults, children need the right assortment of nutrients, vitamins (e.g., vitamin C) and minerals (e.g., calcium, iron) to grow, develop and function. Nutrients include the following:

  • Carbohydrates. The primary source of calories for the human body. Nutritional experts generally recommend that between 50 and 60 percent of an individual’s total daily calories come from carbohydrates, primarily complex carbohydrates.
  • Protein. Found in meat, poultry, fish, beans, nuts, eggs and dairy products. Protein is crucial to building and repairing most body tissues (e.g., muscles, skin, organs) as well as the immune system. It is generally recommended that about 10 to 20 percent of an individual’s daily calories come from protein.
  • Fats. Also called lipids, the proper amount of fat is vital to good health. Fat is part of all cell membranes and makes up the sheathing around nerves, which is important to efficient nerve conduction. It is recommended that no more than 35 percent of the daily calories in the diet of a child over age 2, adolescent or adult come from fat.
Fiber. A filling nutrient that helps move food through the digestive tract and prevents constipation. Whole grains, fruits and vegetables are good sources of fiber

The American Academy of Pediatrics (AAP) recommends that parents and other caregivers use the MyPyramid’s nutritional guidelines as a reference to ensure that children are getting all the nutrients, vitamins and minerals they need. MyPyramid was developed by the U.S. Department of Agriculture (USDA) as a dietary guideline for children, adolescents and adults. It is composed of six different-colored steps, each representing a specific food groups: grains, vegetables, fruits, dairy, protein sources (e.g., meat, fish, beans, nuts), and fats and oils. MyPyramid also encourages regular physical activity as an essential part of any healthy dietary regimen.

A combination of good nutrition and exercise helps keep the body healthy and fit. Poor nutrition and lack of exercise can lead to numerous health problems, including obesity, malnutrition, and iron deficiency anemia.