Medication Use In Children Research Articles

Controller Medication Use and Exacerbations for Children and Adults With Asthma in High-Deductible Health Plans

High-deductible health plans (HDHPs) are increasingly common and associated with decreased medication use in some adult populations. How children are affected is less certain. To examine the association between HDHP enrollment and asthma controller medication use and exacerbations. For this longitudinal cohort study with a difference-in-differences design, data were obtained from a large, national, commercial (and Medicare Advantage) administrative claims database between January 1, 2002, and December 31, 2014. Children aged 4 to 17 years and adults aged 18 to 64 years with persistent asthma who switched from traditional plans to HDHPs or remained in traditional plans (control group) by employer choice during a 24-month period were identified. A coarsened exact matching technique was used to balance the groups on characteristics including employer and enrollee propensity to have HDHPs. In most HDHPs, asthma medications were exempt from the deductible and subject to copayments. Statistical analyses were conducted from August 13, 2019, to January 19, 2021. Employer-mandated HDHP transition. Thirty-day fill rates and adherence (based on proportion of days covered [PDC]) were measured for asthma controller medications (inhaled corticosteroid [ICS], leukotriene inhibitors, and ICS long-acting β-agonists [ICS-LABAs]). Asthma exacerbations were measured by rates of oral corticosteroid bursts and asthma-related emergency department visits among controller medication users. The HDHP group included 7275 children (mean [SD] age, 10.8 [3.3] years; 4402 boys [60.5%]; and 5172 non-Hispanic White children [71.1%]) and 17 614 adults (mean [SD] age, 41.1 [13.4] years; 10 464 women [59.4%]; and 12 548 non-Hispanic White adults [71.2%]). The matched control group included 45 549 children and 114 141 adults. Compared with controls, children switching to HDHPs experienced significant absolute decreases in annual 30-day fills only for ICS-LABA medications (absolute change, -0.04; 95% CI, -0.07 to -0.01). Adults switching to HDHPs did not have significant reductions in 30-day fills for any controllers. There were no statistically significant differences in PDC, oral steroid bursts, or asthma-related emergency department visits for children or adults. For the 9.9% of HDHP enrollees with health savings account-eligible HDHPs that subjected medications to the deductible, there was a significant absolute decrease in PDC for ICS-LABA compared with controls (-4.8%; 95% CI, -7.7% to -1.9%). This cohort study found that in a population where medications were exempt from the deductible for most enrollees, HDHP enrollment was associated with minimal or no reductions in controller medication use for children and adults and no change in asthma exacerbations. These findings suggest a potential benefit from exempting asthma medications from the deductible in HDHPs.

The Impact of Parental Injury on Children's Mental Health Diagnoses and Classes of Psychotropic Medication by Child Age.

Civilian and military research has linked parental illness and injury with increased overall mental health care and psychiatric medication use in children. Care for specific mental health conditions and medications by child age have not been reported. We sought to quantify the effect of parental illness and injury on child mental health care and psychiatric medication use in children overall and stratified by age. A self-controlled case series analyzed the impact of parental illness/injury on mental health and psychiatric medication use of military dependent children. Children were aged 2-16 years (51% male) when their parents were injured and received care in the Military Health System for 2 years before and 2 years after their parent's illness/injury. We used International Classification of Diseases 9th edition codes to identify outpatient mental healthcare visits. Outpatient care for 14 specific mental health diagnoses was classified using the Agency for Healthcare Research and Quality clinical classification system. Outpatient pharmacy records identified psychiatric medication prescriptions by therapeutic class. Parental illness/injury was identified by inclusion in the Military Health System Ill, Injured, and Wounded Warrior database. Adjusted negative binomial regression analysis compared rates of outpatient visits and medication days in the 2 years following parental illness/injury to the 2 years before the parent's illness/injury overall. Secondary analyses were stratified by age groups of 2-5 years (n = 158,620), 6-12 years (n = 239,614), and 13-16 years n = 86,768) and adjusted for parental pre-injury/illness deployment and child sex. Additional secondary analysis compared post-parental injury/illness care of children whose parents had post-traumatic stress disorder or traumatic brain injury to children of parents with physical/mental health injury/illness. There were 485,002 children of 272,211 parents injured during the study period. After adjustment for child sex, years of pre-injury/illness parental deployment, and child age, parental illness/injury was associated with increased mental visits across all categories of care except developmental diagnoses. Post-parental injury visits for suicidal ideation, alcohol abuse, mood, and anxiety disorders were all doubled. For children aged 2-5 years at parental illness/injury, the largest increases in care were in psychotic, anxiety, attention deficit, and mood disorders. In children aged 6-12 years, the largest increases were in psychotic conditions, suicidal ideation, and personality disorders. In adolescents aged 13-16 years, the largest increases were for alcohol and substance abuse disorders, with visits increasing by 4-5 times. For children of all ages, parental injury was associated with increased use of all therapeutic classes of psychiatric medications; use of stimulant medications was increased in younger children and decreased in older children following parental injury (P < .001). Parental illness/injury is associated with increased mental health care and days of psychiatric medication use in dependent children. Practitioners who care for families impacted by parental illness/injury should be cognizant of children's mental health risk. Early identification and treatment of child-related mental health issues can improve family functioning and increase military family readiness.

Factors Affecting Delayed Initiation and Continuation of Medication Use for Attention-Deficit/Hyperactivity Disorder: A Nationwide Study.

Objective: This study evaluated the predictors for delayed initiation and continuation of ADHD medication use in children and adolescents with ADHD in Taiwan. Methods: This longitudinal cohort study enrolled 188,061 children and adolescents with ADHD between 2001 and 2011. Delayed initiation of ADHD medications was defined as the interval >365 days between diagnosis and first prescription, and continuation of ADHD medications was defined as ≥365 defined daily doses of ADHD medications. Results: Of the included patients, 39.2% were never treated with ADHD medications. Delayed initiation and continuation of ADHD medication use were found in 11.9% and 19.9% of the ever-treated patients, respectively. Younger age at ADHD diagnosis, male sex, older mother's age at child's ADHD diagnosis, and higher family income were associated with more delayed initiation but were also associated with more continuation of ADHD medication use. Conclusions: The initiation and continuation of ADHD medication use might be underlined by different mechanisms and warrant different strategies.

Assessing the impact of a family empowerment program on asthma control and medication use in children with asthma: A randomized controlled trial.

In pediatric asthma, family empowerment education has been beneficial for the quality of life, pulmonary function, and family functioning. Few studies addressed the impact of a family empowerment program on asthma symptom control, acute healthcare use (AHCU), and medication use in children with asthma. This study aimed to assess the effect of a family empowerment intervention on asthma symptom control, AHCU, inhaler technique, and controller adherence in children with asthma. A single-center study using a randomized controlled design was conducted in a university hospital in the center of Tunisia from May 2018 to September 2019. Eighty-two families were randomly assigned to the intervention group (n = 41) of 8 weeks of group training sessions, or to the control group (n = 41) of usual care education. Thirty-seven families in the intervention group and 39 families in the control group received allocated intervention at baseline. Thirty-four families in each group completed the study at the 12-month follow-up. At baseline, the intervention and control groups were statistically comparable (p > .05). At follow-up, there were significant differences between the intervention and the control group in asthma symptom control, χ2 (1, N = 34) = 9.950, p = .002, and inhalation technique, χ2 (1, N = 34) = 5.916, p = .01. For AHCU and adherence to asthma controller, there was no significant difference between groups, χ2 (1, N = 34) = 3.219, p = .07, χ2 (1, N = 34) = 0.541, p = .46, respectively. The difference within time in asthma symptom control and inhalation technique was significant (p = 10-3 , p = .001; respectively). This study demonstrated that a family empowerment program significantly improved asthma symptom control and inhaler technique in children with asthma aged 7-17 years. This intervention could be clinically useful and time-saving for pediatric nurses.

Antidiabetic medication use in commercially insured children and adolescents in the United States from 2004 to 2019.

To describe the patterns of non-insulin antidiabetic medication use, initiation and adherence in the paediatric population. We conducted a descriptive study of non-insulin antidiabetic medication use in children and adolescents (aged 10-18 years) using real-world data from a nationwide US commercial claims database (January 2004-September 2019). Trends in the prevalence of non-insulin antidiabetic medication use overall and by class were evaluated. Among new users of non-insulin antidiabetic agents, medication adherence was examined using group-based trajectory models. In a cohort of more than 1 million paediatric patients, the prevalence of any non-insulin antidiabetic medication use was 75.7 per 100 000 patients in 2004 and more than doubled to 162.0 per 100 000 in 2019. Biguanides (metformin) was by far the most widely used medication class. The use of newer classes was low (<10 per 100 000), but there was an uptake in the use of glucagon-like peptide-1 receptor agonists after liraglutide received paediatric approval in 2019. Medication adherence was poor during the 18 months after treatment initiation: 79.6% of initiators experienced an early treatment interruption (median time to interruption: 90 days among metformin monotherapy initiators) and 21% of initiators did not return for a prescription refill after the first month. There was a substantial increase in non-insulin antidiabetic medication use among commercially insured paediatric patients from 2004 to 2019. Nearly all patients were treated with metformin, while the use of newer agents remained low. Despite the increase in medication use, short treatment episodes were observed, even among patients with a diagnosis of type 2 diabetes, raising concern over poor adherence.

Abstract 15811: Prevalent Pharmacotherapy in United States Children and Adolescents After Fontan Completion

Background: Patients who have undergone Fontan palliation are at life-long risk of significant morbidities including thrombosis, heart failure, and arrhythmia. At present there is limited evidence to guide pharmacotherapy and no recent studies have evaluated US pharmaceutical practice in this population. Methods: A retrospective observational study evaluating the prevalent use of prescription medications in children and adolescents with hypoplastic left heart syndrome or tricuspid atresia after Fontan completion (identified using ICD9/10 codes) was performed using data from the Marketscan® Commercial and Medicaid databases. Cardiac pharmaceuticals were divided by class and function. Anticoagualants, other than aspirin, which is not uniformly a prescription medication, were also studied. Associations between increasing age and the likelihood of a filled prescription for each class of drug were evaluated. Results: A cohort of 4056 subjects [median age 12 years (IQR: 8-16), 61% male, 60% commercial insurance] was identified. The most common medication classes were angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), diuretics, cardiac glycosides, and pulmonary vasodilators (Table), although 50% received no prescription medications. Older age was associated with increased likelihood of receiving anticoagulants (p=0.008), antiarrhythmic agents, digoxin, ACEI/ARB, and beta blockers (each p &lt;0.0001 ), but also lower likelihood of receiving pulmonary vasodilators, diuretics (both p &lt;0.0001), and potassium sparing diuretics ( p =0.02). Conclusion: Pharmacotherapy typically used to treat adult heart failure and pulmonary hypertension are the most commonly prescribed medications following Fontan palliation. Determining the optimal regimen for individual patients and the population at large is an important knowledge gap for future research.

Establishing Baseline Metrics of Heart Failure Medication Use in Children: A Collaborative Effort from the ACTION Network.

Heart failure metrics specific to the pediatric population are required to successfully implement quality improvement initiatives in children with heart failure. Medication use at the time of discharge following admission for decompensated heart failure has been identified as a potential quality metric in this population. This study aimed to report medication use at discharge in the current era for children admitted with acute decompensated heart failure. All patients < 21years of age with an index admission (1/1/2011-12/31/2019) for acute heart failure and a coexisting diagnosis of cardiomyopathy were identified from the Pediatric Health Information System. Medication use patterns were described and compared across age groups and centers. A total of 2288 patients were identified for inclusion. An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker (ACEi/ARB) was prescribed in 1479 (64.6%), beta blocker in 1132 (49.5%), and mineralocorticoid receptor antagonist (MRA) in 864 (37.8%) patients at discharge. The use of ACEi/ARB at discharge has decreased over time (64.6% vs. 69.6%, p = 0.001) and the use of beta blockers has increased (49.5% vs. 36.8%, p < 0.001) compared to a historical cohort (2001-2010). There is considerable variability in medication use across centers with an overall increase in beta blocker and decrease in ACEi/ARB use over time. Collaborative efforts are needed to standardize care and define quality metrics to identify best practices in the management of pediatric heart failure.

Pain Control and Medication Use in Children Following Closed Reduction and Percutaneous Pinning of Supracondylar Humerus Fractures: Are We Still Overprescribing Opioids?

The purpose of this 2-part study is to determine opioid prescribing patterns and characterize actual opioid use and postoperative pain control in children following discharge after closed reduction and percutaneous pinning of a supracondylar humerus fracture. A retrospective study was conducted from 2014 to 2016 to determine pain medication prescribing patterns at a single level 1 trauma center. Next, a prospective, observational study was conducted from 2017 to 2018 to determine actual pain medication use and pain scores in the acute postoperative period. Data were collected through telephone surveys performed on postoperative day 1, 3, and 5. Pain scores were collected using a parental proxy numerical rating scale (0 to 10) and opioid use was recorded as the number of doses taken. From 2014 to 2016, there were 126 patients who were prescribed a mean of 47 doses of opioid medication at discharge. From 2017 to 2018, telephone questionnaires were completed in 63 patients. There was no significant difference (P>0.05) in pain ratings or opioid use by fracture type (Gartland), age, or sex. Children required a mean of 4 doses of oxycodone postoperatively. There were 18 (28%) patients who did not require any oxycodone. On average, pain scores were highest on postoperative day 1 (average 5/10) and decreased to clinically unimportant levels (<1) by postoperative day 5. Acetaminophen and ibuprofen were utilized as first-line pain medications in only 25% and 9% of patients, respectively. Two of 3 patients who used >15 oxycodone doses experienced a minor postoperative complication. Pediatric patients have been overprescribed opioids after operative treatment of supracondylar humerus fractures at our institution. Families who report pain scores >5 of 10 and/or persistent opioid use beyond postoperative day 5 warrant further clinical evaluation. Two of 3 pain outliers in this study experienced a minor postoperative complication. With appropriate parental counseling, satisfactory pain control can likely be achieved with acetaminophen and ibuprofen for most patients. If oxycodone is prescribed for breakthrough pain, then the authors recommend limiting to <6 doses. Level IV-observational, cohort study.

Factors associated with physician consultation and medication use in children and adolescents with chronic pain: A scoping review and original data.

Although paediatric chronic pain is common, it is not yet clear which individuals with chronic pain are likely to seek health care for their pain. The aims of this study were to summarize the current evidence of the characteristics of children and adolescents with chronic pain who consult a physician or use medication for their pain. Additionally, we aimed to expand knowledge by further investigating key and promising, factors in a large community sample of adolescents. First, using scoping review methodology, studies on health care utilisation in paediatric chronic pain were identified by the systematic literature search. Out of 1,158 articles, 12 were included for data extraction. Second, in a population-based cross-sectional survey, data of N=2,280 adolescents (10-18years) and their parents (N=1,464), were analysed. Univariable logistic and multivariable LASSO regression models were calculated for adolescents with chronic pain (n=749) to identify predictors of physician visits or analgesics intake due to pain, controlling for acute illness and injury. The scoping review identified higher pain intensity, frequency, severity and pain-related disability as significant individual factors associated with physician consultation. Female sex and higher pain intensity were associated with medication consumption. Multivariable analyses with cross-sectional data revealed only pain-related school absence to be associated with physician consultation; analgesic medication use was associated with school absence and higher pain intensity. Original data from this study support prior findings. School absence and pain intensity, plausible surrogates for pain severity, are the most relevant factors in health care utilisation due to chronic pain. A scoping summary of existing research on predictors for physician consultation and medication use in children and adolescents with chronic pain is provided. Furthermore, the role of potential predictors for health care utilisation-sociodemographic, pain, school, psychological and parent-related characteristics-is analysed in a population-based cross-sectional survey. Controlling for illness and injuries, and using a strict chronic pain definition, the cross-sectional survey allows conclusions on healthcare utilisation specific to chronic pain in adolescents.

Pediatric Drug Policies Supporting Safe And Effective Use Of Therapeutics In Children: A Systematic Analysis.

Several policies have been implemented in the US to promote the evidence-based use of therapeutics in pediatric populations. Under the Best Pharmaceuticals for Children Act of 2002 and the Pediatric Research Equity Act of 2003, the Food and Drug Administration (FDA) can request pediatric studies for new drug and biologic indications. The acts have been credited with generating pediatric information for hundreds of drugs. However, concerns have been raised that delays and noncompliance with study requests contribute to high rates of off-label and potentially unsafe or ineffective medication use in children. We used publicly available FDA documents to analyze all indications for new drugs and biologics approved by the FDA from 2002 through 2018. During this time the FDA issued 389 pediatric study requests (141 under the Best Pharmaceuticals for Children Act and 248 under the Pediatric Research Equity Act) for 274 new drugs and biologics, representing 320 indications. We found that as of December 31, 2018, fewer than a third of these study requests had been completed. Overall, 64percent of new drug and biologic indications deemed relevant to pediatric patients lacked pediatric prescribing information at five years after FDA approval. Enforcement of pediatric drug study policies should be strengthened to reduce non-evidence-based medication use in pediatric patients.

Psychotropic medication use for paediatric mental health patients in an emergency department.

There is paucity of evidence for psychotropic medication use in children and adolescents presenting with mental health (MH) problems to the ED. We set out to describe paediatric psychotropic medication use in the ED. We conducted a retrospective electronic medical record review of ED patients with MH discharge codes at a tertiary paediatric ED in 2018. We assessed the epidemiology and management of patients who received a psychotropic medication. We calculated the odds ratios (ORs with 95% confidence intervals [CIs]) of key demographic factors of medicated versus non-medicated MH patients. During 2018 there were 1695 MH-related presentations to the ED. Of these, 280 presentations resulted in the patient receiving a psychotropic medication (16.5%). Medicated children with MH illness were more likely to be male (OR 1.50, 95% CI 1.16-1.96), have a more acute triage category (OR 3.37, 95% CI 2.28-4.98), have an ED length of stay greater than 12 h (OR 3.96, 95% CI 2.56-6.13) and present after hours (OR 1.51, 95% CI 1.16-1.96). Most had a diagnosis of acute behavioural disturbance or suicidal ideation. A variety of treatment regimens were used but children primarily received a single oral agent (diazepam or olanzapine). Parenteral medications were given in 8.6%. No adverse events were recorded. A minority of children with MH presentations to the ED were medicated. It will require multicentre research to determine the most effective and safe acute psychotropic agents for oral and parenteral use in children in the ED.

Medication Use in Youth With Autism and Attention-Deficit/Hyperactivity Disorder.

Children with autism spectrum disorder (ASD) may benefit from medication to treat a diverse array of behaviors and health conditions common in this population including co-occurring conditions associated with ASD, such as attention-deficit/hyperactivity disorder (ADHD) and anxiety. However, prescribing guidelines are lacking and research providing national estimates of medication use in youth with ASD is scant. We examined a nationally representative sample of children and youth ages 6 to 17 with a current diagnosis of ASD to estimate the prevalence and correlates of psychotropic medication. This study used data from the 2016 and 2017 National Survey of Children's Health. We estimated unadjusted prevalence rates and used multivariable logistic regression to estimate the odds of medication use in children and youth across 3 groups: those with ASD-only, those with ASD and ADHD, and those with ADHD-only. Two thirds of children ages 6 to 11 and three quarters of youth ages 12 to 17 with ASD and ADHD were taking medication, similar to children (73%) and youth with ADHD-only (70%) and more than children (13%) and youth with ASD-only (22%). There were no correlates of medication use that were consistent across group and medication type. Youth with ASD and ADHD were more likely to be taking medication for emotion, concentration, or behavior than youth with ADHD-only, and nearly half took ASD-specific medication. This study adds to the literature on medication use in children and youth with ASD, presenting recent, nationally representative estimates of high prevalence of psychotropic drug use among children with ASD and ADHD.

Efficacy and Safety of Ragweed SLIT-Tablet in Children with Allergic Rhinoconjunctivitis in a Randomized, Placebo-Controlled Trial

Ragweed sublingual immunotherapy (SLIT) tablet reduces symptoms and symptom-relieving medication use in adults with allergic rhinitis with or without conjunctivitis (AR/C) but has not been evaluated in children. This international, multicenter, double-blind, placebo-controlled trial evaluated the efficacy and safety of ragweed SLIT-tablet in children with AR/C. Children (N= 1025; 77.7% polysensitized) aged 5 to 17 years with ragweed pollen-induced AR/C with or without asthma (FEV1 ≥80% predicted) were randomized 1:1 to daily ragweed SLIT-tablet (12 Amb a 1-Unit) or placebo for up to 28 weeks (NCT02478398). The primary end point was the average total combined score (TCS; sum of rhinoconjunctivitis daily symptom score [DSS] and daily medication score [DMS]) during peak ragweed pollen season (RPS). Key secondary end points were TCS during the entire RPS, and DSS and DMS during the peak RPS. Relative TCS (95% CI) improvements with ragweed SLIT-tablet versus placebo were-38.3% (-46.0% to-29.7%; least square [LS] mean difference,-2.73; P < .001) during peak RPS and-32.4% (-40.7% to-23.3%; LS mean difference,-1.86; P < .001) during the entire RPS. DSS and DMS during peak RPS improved with SLIT-tablet versus placebo by-35.4% (-43.2% to-26.1%; LS mean difference,-1.40; P < .001) and-47.7% (-59.8% to-32.5%; LS mean difference,-1.84; P < .001), respectively. Asthma DSS, short-acting β-agonist use, and nocturnal awakenings during peak RPS improved with SLIT-tablet versus placebo by-30.7%,-68.1%, and-75.1%, respectively (all nominal P ≤ .02). No events of anaphylaxis, airway compromise, or severe treatment-related systemic allergic reactions were reported. Ragweed SLIT-tablet significantly improved symptoms and decreased symptom-relieving medication use in children with ragweed pollen-induced AR/C and was well tolerated.

Impact of the Canterbury earthquakes on dispensing of psychiatric medication for children and adolescents: longitudinal quantitative study

Natural disasters are increasing in frequency and impact; they cause widespread disruption and adversity throughout the world. The Canterbury earthquakes of 2010-2011 were devastating for the people of Christchurch, New Zealand. It is important to understand the impact of this disaster on the mental health of children and adolescents. To report psychiatric medication use for children and adolescents following the Canterbury earthquakes. Dispensing data from community pharmacies for the medication classes antidepressants, antipsychotics, anxiolytics, sedatives/hypnotics and methylphenidate are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) and nationally. We compared dispensing data for children and adolescents residing in Canterbury DHB with national dispensing data to assess the impact of the Canterbury earthquakes on psychotropic prescribing for children and adolescents. After longer-term trends and population adjustments are considered, a subtle adverse effect of the Canterbury earthquakes on dispensing of antidepressants was detected. However, the Canterbury earthquakes were not associated with higher dispensing rates for antipsychotics, anxiolytics, sedatives/hypnotics or methylphenidate. Mental disorders or psychological distress of a sufficient severity to result in treatment of children and adolescents with psychiatric medication were not substantially affected by the Canterbury earthquakes.

Gender- and age-stratified analyses of ADHD medication use in children and adolescents in Finland using population-based longitudinal data, 2008-2018.

Aims: This study examined medication use for attention-deficit/hyperactivity disorder (ADHD) among children and adolescents by gender in Finland during 2008–2018. Methods: Aggregated data on medication use for ADHD from 2008 to 2018 were extracted from the nationwide register on reimbursed prescriptions. The annual prevalence of ADHD medication use was calculated as the number of children (6–12 years) and adolescents (13–17 years) per calendar year with at least one ADHD medication purchase divided by the number of children and adolescents in the population. Population prevalence for children was also examined by birth month. Results: In 2008, the prevalence rates for males were 1.26% in children and 0.93% in adolescents, and for females 0.21% and 0.14%, respectively. In 2018, the prevalence rates for males were 4.42% in children and 4.21% in adolescents, and for females 0.99% and 1.28%, respectively. Male-to-female ratios decreased during the study period from 6.0:1 to 4.5:1 (children) and from 6.6:1 to 3.3:1 (adolescents). ADHD medication use was more common among males and females (aged 6–12 years) born in May–August or September–December than among males and females born in January–April. Conclusions: The prevalence of ADHD medication use has continued to increase in Finland. Although use has increased more rapidly among females resulting in lower male-to-female ratios, medication use among females is considerably lower compared with males. Consequently, gender discrepancy in 2018 was relatively large, particularly among children. Future studies should also consider reporting annual prevalence by children’s birth month.

Current Pharmacological Treatments for Childhood-Onset Eating Disorders

Eating disorders are common in childhood and adolescence and have the highest mortality rate of the mental illnesses, largely due to the medical complications of malnutrition. Psychiatric co-morbidities can lead to death by suicide. Despite a dearth of evidence on the topic, psychiatrists are often asked to comment on the potential utility of adding psychotropic medications to the treatment plan. It is challenging to recruit patients with eating disorders to medication studies. There are no psychotropic medications approved for the treatment of eating disorders in children and adolescents, although fluoxetine and lisdexamfetamine are approved for use in adult patients. A number of studies have examined the potential utility of appetite-promoting agents, such as mirtazapine and atypical antipsychotics, with mixed results. Safe, monitored renourishment and regulation of eating patterns are currently the most important intervention in the treatment of eating disorders. Current medication use in children and adolescents with eating disorders is limited to the treatment of co-morbid conditions, such as mood and anxiety disorders. More studies are needed to investigate whether the safety and efficacy of medications approved in eating disorders in the adult population can be generalized to child and adolescent populations. In addition, more work needs to be done to establish the underlying root causes of psychopathology and potential medication receptor targets.

Association between maternal factors and appropriate medication for nursery school children in Japan

Abstract Background Inappropriate medication use for children by caregivers has been reported in Japan. We focused on the factors which could be associated with health literacy (HL) and knowledge of medication (KM). We aimed to examine the association between appropriate use for nursery school children and maternal socioeconomic status (SES) or behavior related to medication adherence among mothers in Japan. Methods The data regarding the conditions of medication for children (aged from six months to six years old) at home and in nursery school by the online survey from April to May 2019 was used. Maternal SES, such as education, occupational status, and economic conditions, were asked via a self-administered questionnaire. Maternal behaviors were measured using a 5-point Likert scale and classified into two groups. HL and KM were scored and divided into two categories. Appropriate medication use was evaluated using a 5-point Likert scale for the statement “I give my child medicine as per instructions,” and the answers were classified into two groups. Poisson regression was employed to investigate the association. Age, maternal SES, chronic disease of children, birth order, HL, and KM were used as covariates. Results A total of 233 (38.8%) of 600 mothers aged 24-48 years, reported appropriate medication use for children. None of the maternal SES was statistically significant. After adjustment, the individuals, who consent to prescribed medications for children, were 2.16 times (95% confidence interval [CI]:1.64-2.86) more likely to use medicine appropriately compared with their counterparts. ’To be able to consult with pharmacists’ were also statistically significant (Prevalence Ratio=2.14, 95% CI:1.63-2.81). Conclusions The mothers, who consent to prescribed medications for children, who consult with pharmacists were more likely to use medicine appropriately. Community pharmacists could support those to improve their skills. Key messages The maternal behaviors related to adherence were associated with appropriate medication for children among Japanese mothers, although none of the maternal SES was statistically significant. Community pharmacists could support mothers and contribute appropriate medical treatment for children.

PNS100 A STUDY OF KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING ADMINISTRATION OF PAEDIATRIC DOSAGE FORMS

Parental attitude is one of the important factors that affect medication use and adherence among pediatrics. Our study aims to assess the Knowledge, Attitude and Practice (KAP) of caregivers regarding medication use in children. A cross sectional study was conducted in the inpatient and outpatient pediatrics department at a tertiary care hospital over 6 months. We surveyed caregivers with children under age 18 to determine the medication administration practices. A validated questionnaire was administered to assess the Knowledge, Attitude and Practices (KAP) of the study population and responses were obtained. Correlations analysis was performed to assess correlation among various domains. A total of 149 caregivers were enrolled in the study. Majority of the primary caregivers surveyed were illiterate (65%), homemaker mothers (64%). 64% and 82.7% were unaware about 1 teaspoon and 1 tablespoon dosing respectively. Caregivers frequently reported stoppage of medicines once the child feels better (50%). Dissolving of solid oral dosage forms and mixing them with milk (61.7%) was the most frequently reported method of administration. 34.9% caregivers reported use of non-standardized liquid dosing instruments. Spearman’s correlation analysis showed significant correlation between education of caregiver and knowledge (p<0.01; 0.34) as well as attitude (p<0.01; 0.44). Medication errors were reported significantly more in the outpatient setting. The caregivers of pediatric population had poor knowledge regarding medicine administration and measurement of dosage forms. Active patient counselling sessions by healthcare professionals can make an impact among caregivers regarding medication utilization practices of pediatric dosage forms.

Trends in Off-Label Drug Use in Ambulatory Settings: 2006-2015.

Off-label drug use in children is common and potentially harmful. In most previous off-label use research, authors studied hospitalized children, specific drug classes, or non-US settings. We characterized frequencies, trends, and reasons for off-label systemic drug orders for children in ambulatory US settings. Using nationally representative surveys of office-based physicians (National Ambulatory Medical Care Surveys, 2006-2015), we studied off-label orders of systemic drugs for children age <18 based on US Food and Drug Administration-approved labeling for age, weight, and indication. We characterized the top classes and diagnoses with off-label orders and analyzed factors and trends of off-label orders using logistic regression. Physicians ordered ≥1 off-label systemic drug at 18.5% (95% confidence interval: 17.7%-19.3%) of visits, usually (74.6%) because of unapproved conditions. Off-label ordering was most common proportionally in neonates (83%) and in absolute terms among adolescents (322 orders out of 1000 visits). Off-label ordering was associated with female sex, subspecialists, polypharmacy, and chronic conditions. Rates and reasons for off-label orders varied considerably by age. Relative and absolute rates of off-label orders rose over time. Among common classes, off-label orders for antihistamines and several psychotropics increased over time, whereas off-label orders for several classes of antibiotics were stable or declined. US office-based physicians have ordered systemic drugs off label for children at increasing rates, most often for unapproved conditions, despite recent efforts to increase evidence and drug approvals for children. These findings can help inform education, research, and policies around effective, safe use of medications in children.

4.6 ANXIETY DISORDER, OCD, AND PHARMACOTHERAPY

The goals of this session are to review ADHD and anxiety disorder assessment and treatment across the age span, to know the range of OCD presentation in clinical practice, and to review psychotropic medication use in children and adolescents from a large prescription database.