Attention deficit hyperactivity disorder (ADHD) is a condition that affects a young child’s behaviour and learning. Children with ADHD often have difficulty concentrating and may be easily distracted. School reports might describe a child that ‘daydreams’ and tunes out during lessons. They can also be impulsive and overactive or fidgety. It is important to recognise that in one sense, all young children can have difficulties when it comes to trying to sit still and learn. It is part of normal developmental behaviour. ADHD requires specific criteria to be met and a specialist review before a diagnosis is made.
One treatment for ADHD can be ‘stimulant medication’. Stimulants (called dexamphetamine and methylphenidate) are the most used medications in Australia. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/attention-deficit-hyperactivity-disorder-therapies
They act on neurotransmitters that release dopamine, a small package in the brain which, when released, improves concentration, and reduces hyperactivity. Usually, children feel a calming effect within half an hour of taking medications. Using medications in the correct situation, can be the difference between a child struggling or succeeding in school.
In clinical trials, approximately 70% of affected children derive clinically significant benefits from treatment with stimulant medication, especially when combined with behavioural management. https://www.nps.org.au/australian-prescriber/articles/stimulant-treatment-for-attention-deficit-hyperactivity-disorder
What are the side effects of stimulant medication?
- Appetite suppression and weight loss
- Stomach aches
Many children taking stimulants have very low appetite during the day while the medication is most active. They tend to feel slightly hungry in the early evening and get very hungry later in the evening. This effect on appetite can reduce over a couple of months after starting the medication.
As a GP, I regularly check the weight of children on stimulants but avoid making it the focus of our discussions. Children may already be sensitive to their diagnosis and subsequent medication prescribed, so adding weight concerns into the mix would potentially increase their anxiety. Having said that, we do need to be careful that they aren’t falling off the growth charts.
How do we help children who have lower appetite on stimulant medication?
Tip #1 – don’t force your child to eat when they are not hungry!
Putting pressure on children to eat when they are not hungry, only tends to make matters worse. Pick your battles, they will eat when they are ready. Some days, children may eat very little, and you’re left wondering how are they still functioning Even on days like this, ensure they are hydrated with water, and provide smaller snacks to compensate for the lack of appetite.
Tip #2 – eat before medication in the morning
Eating a substantial breakfast before the morning dose will help you accept that lunch will probably come home untouched. Also, as the effects tend to wear off by the evening, it may be helpful to have a larger dinner and second small meal or snack before bedtime. If your child does not like to eat typical breakfast foods, try a complete and balanced oral nutritional supplement which provides a nutrition and energy boost for the morning.
Tip #3 – look for appetite opportunities with your child
Try to find ‘windows of opportunity’. Use foods that are appealing, offer healthy yet desirable snacks. Snacks that are full of nutrition. A small platter of food in the afternoon that they can nibble on with options like deli meat, crackers, cheese, fruit such as grapes or banana, a muesli bar, nuts, a smoothie or milkshake all of which have some level of nutrition and higher energy.
I’m always open and honest with children who are prescribed amphetamine-based medication that they are likely to experience lower appetite and suggest figuring out a system that works for them. Setting up reminders throughout the day, speaking with the school teacher and having medication breaks on weekends or in school holidays (in discussions with a healthcare professional), are other tips that parents may choose to implement.