Bipolar Disorder Q&A: Should My Four-Year-Old Child Take Medication for Bipolar Disorder?

By Candida Fink MD
September 18, 2009

Danielle Asks…

My 4 year old son was diagnosed with bipolar disorder about six months ago…he is currently on Seroquel, and the doctor added lithium today. I am scared that my baby has to be on these medications at such a young age and I am wondering if there is anyone out there with children (or yourself) that started these meds so young.

Dr. Fink Answers…

Hi, Danielle,

This is a complex topic with no easy answers. I suspect that your son has had some pretty severe symptoms and difficulties to receive a diagnosis of bipolar so young and to be on those medications. There are certainly children that age on those types of medications, but since these medications are powerful a thorough evaluation is critical. You want to be clear about the potential risks and benefits and have a system in place to ensure close and careful monitoring.

I have many concerns about diagnosing such young children with bipolar disorder. I encourage you to read my post “Bipolar Disorder Overdiagnosed in Children?” It is certainly true that a small number of very young children fit a narrow definition of bipolar disorder, but other diagnoses are to be considered as well that would imply different, perhaps less risky medication. You don’t mention whether your son and your family are working with a therapist who specializes in children with emotional and behavioral difficulties – this component is equally or even more important than the medication.

I encourage you to ask your current doctors about all of your concerns and questions – be sure to schedule a meeting with enough time for her to help you understand fully why she has made this diagnosis and her treatment plan, including non-medication interventions. Even with that information, I think you should consider obtaining a second opinion. This is such a complicated area that it is important to get a clear picture. Before I would prescribe lithium to a four-year-old, I would encourage the family to seek out a second opinion because of the risks involved.

Be very careful about online information and advice about bipolar disorder in children. Stick with well known and scientifically sound resources, such as National Institute of Mental Health or American Academy of Child and Adolescent Psychiatry.

In terms of non-medication interventions – and regardless of diagnosis – I strongly encourage you to read the book The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children by Ross W. Greene, PhD. Dr. Greene and his colleagues take different view of managing children with behavioral difficulties that I find to be well supported by research and most effective in my practice. They have a website you may be interested in – thinkkids.org. Keep in mind this is not specific to bipolar disorder in children, but it helps to understand and work with children with complicated emotional and behavioral difficulties of all types.

I wish you and your son the best.

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6 Comments to
“Bipolar Disorder Q&A: Should My Four-Year-Old Child Take Medication for Bipolar Disorder?”

Amber Schroeder at 9:34 am on September 22nd, 2009

My four year old daughter has recently been seen by a child psychologist and we were told that she is showing early signs of bipolar disorder. I do not have it but it does run in my family. With everything I have read so far most of the symtoms fit her to a T. I do not want to medicate her I would rather find other means of help. Her doctor suggested behavior modification therapy. I am not sure of the right way to handle her at her most extreme points and feel more terrible about displining her now that we have news that she might have this disorder. We usually put her in time out in a chair or the corner but now more than ever nothing seems to be working and I feel that we are constantly losing the battles. I want to help her overcome her feelings of insecurity and anxiety. At this point my husband and I are exhausted from every angle.

Danielle Buffardi at 12:53 pm on September 23rd, 2009

I am a mother of a 3 year old boy. I have to say that I wouldn’t believe that a child so young could have such a serious disorder. And be put on such detailed meds that are normally given to adults.

I hope that you would seek a second, and even a third opinion.

Squaw1957 at 11:27 am on September 24th, 2009

I AM VERY CONCERNED ABOUT ANYONE TAKING SEROQUEL. I CURRENTLY HAVE A DAUGHTER-IN-LAW TERMINALLY-ILL FROM THE EFFECTS OF SEROQUEL! SHE ALSO TAKES LITHIUM THAT IS DESTROYING HER LIVER. THEY SHOULD TAKE THE DRUG SEROQUEL OFF THE MARKET!!! YOU ARE FACING LONG-TERM POSSIBLE FATAL COMPLICATIONS IF YOUR CHILD IS ALLOWED TO CONTINUE TAKING THIS DRUG. MY DAUGHTER-IN-LAW HAS MEDICAL SETTLEMENTS PAYING HER LARGE SUMS OF MONEY THAT WILL NOT COMPENSATE THE DAMAGE DONE. PLEASE PRAY ABOUT THIS… A VERY CONCERNED MOM

Dana at 7:38 pm on September 25th, 2009

My son just turned 4 and he also is thought to be Early Onset Bipolar. We are medicating him with Clonidine (sedative) and just added a mood stabalizer called lamictal. He NEEDS these medications - he is completely out of control without meds. He is completely in his own world and EXTREMELY violent. I am afraid of him, and what’s worse is we have twin boys a year younger than him that are also afraid of them. One of the twins recently suffered a broken bone in his foot because he raged out and chased him down and threw something on him. Clonidine saved us from the constant deluge of aggression, but he needed something more - something to make him normal. Just remember this if you are doubting the medication: If he truely is Bipolar, and you continue to let him rage away in his manic states - he will get accustom to this behavior and it will become ingrained. Not to mention the fact that MOST people with bipolar LIKE their manic states because they feel invincible, like they can do anything - they have tons of energy to get everything that pops in their head done. Once they start thinking that their manic state isn’t so bad, they don’t want to consistantly take their meds. Start early, and they won’t realize these manic states, and will only know that they just take a pill every day. My husband is also Bipolar, and his treatment wasn’t started until late puberty - and he will NEVER be the person he might could have been.

Colby Kaye at 6:20 pm on October 14th, 2009

Bipolar disorder is a severe and complicated mental illness. Many doctors are unable or unwilling to diagnose bipolar disorder in children and young teens. It is important to get help and recognize the different treatment options available. The Silver Hill Hospital website has some helpful information and resources.

Nick at 12:41 pm on October 27th, 2009

I have a nearly 5 year old step son who is completely out of control. He is always throwing stuff and tries to punch at his mom and I. He is constantly hitting his 19 month old brother, and I fear he may actually hurt him badly. He chokes him and pushes him down all the time. He constantly says he is a “freak” and a “loser”. He cries hysterically when he doesn’t get his way. He never does what he is told; he just says no. He doesn’t eat at dinner time and only wants candy or junk. He initiates fights with him mom and I to make us run after him, then he cries when we catch him. He laughs when he is in trouble for doing something bad. He never listens to me or his mom when we tell him to do something. A task as easy as throwing away his trash becomes World War III. Does anyone think this might be signs of Bipolar, or something else?

Thanks,

Concerned Daddy.