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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From Psych Central's website:
PsychCentral (September 18, 2009)

    Last reviewed: 18 Sep 2009