PRINCIPLE 4 Complete and document the assent of the child and consent of the parents before initiating medication treatment and during any changes in treatment. The assent and consent discussion should focus on the risks and benefits of the proposed and alternative treatments. PRINCIPLE 5 Implement medication trials using an adequate dose and for an adequate duration of treatment. Document the side effects, treatment duration and treatment outcome. Document what constitutes a treatment failure (e.g. adequate trial to maximum dose without response; side effects intolerable although mild treatment response). PRINCIPLE 6 The prescriber reassesses if the child does not respond to the initial medication trial as expected. Ensure the treatment is adhered to and the diagnosis is correct if the child is not responding to the treatment PRINCIPLE 7 The prescriber needs a clear rationale for using medication combinations. If multiple medications are indicated, only one medication change should be made at a time unless clinically indicated. Other than cross-tapering,* there is no evidence to support the use of two medications from the same class being used simultaneously and should be avoided. *The use of immediate release stimulants in addition to extended release stimulants is also an exception.
PRINCIPLE 8 Discontinuing medication in children requires a specific plan, which should include ongoing monitoring of return of symptoms. Depending on the diagnosis (e.g. depression, anxiety, ADHD) a discussion of when a medication would potentially be discontinued should be discussed (e.g. after six months to one year symptom free).
Discontinuing Medications If the patient has shown a sustained period of remission or recovery and the prescriber believes the medication may no longer be necessary, a discontinuation trial may be clinically indicated. Before initiating a discontinuation trial, the plan for discontinuation is reviewed with the patient and family focusing on the risks of discontinuation (e.g., the risks for withdrawal symptoms and the risk for
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