Your Child Has a Disability: A Complete Sourcebook of Daily and Medical Care.
Almost all children require medication at one time or another. However, because of their special medical problems, children with disabilities are more likely to receive several types of medication taken simultaneously or for prolonged periods of time. Medications can be life-saving, as in the use of antibiotics to treat spinal meningitis or pneumonia. They can relieve pain and discomfort from a traumatic injury or improve a chronic medical condition like epilepsy. But they may also have unpleasant or dangerous side effects.
Children with cerebral palsy are apt to have problems with food refluxing, or backing up, from the stomach into the esophagus. This can occur when the musclar valve that separates the stomach and food tube doesn't work properly. The acidic stomach contents can then irritate the lower part of the feeding tube. Treatment consists of positioning your child on his side, using medications that increase muscle tone (metoclopramide, Reglan) or decrease stomach acidity (cimetidine [Tagamet] or ranitidine [Zantac]), and occasionally preforming surgery to tighten the junction. Table 19.8 summarizes the medications commonly used to treat reflux problems.
Antispasticity medications are used to decrease muscle tone in children with spastic cerebral palsy Unfortunately, the medications currently available are effective for less than 50 percent of the children who try them and have high incidence of side effects (see Table 19.8). They must be evaluated to determine if the benefits outweigh the risks. Measures of muscle tone and motor abilities should be made by a physical or occupational therapist before and during treatment. She will look to see whether the treatment makes your child easier to diaper, for example, or if your child can roll over, sit or stand better.
The medications used either: (1) affect the brain control of muscle tone - for example, diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), and baclofen (Lioresal) - or (2) decrease the ability of muscle to contract, as in the case of dantrolene (Dantrium).
Diazepam, lorazepam, and clonazepam are central nervous system inhibitors and not only decrease muscle tone but may also cause sleepiness and drooling, and interfere with swallowing. Other than those side effects, these medications are generally well tolerated and can be given over a long period of time. If they are going to work, this should become evident within the first week of therapy. Withdrawal should be gradual, as physical dependency can develop.
Baclofen is also a central nervous system inhibitor. It has been used most extensively to treat adults with multiple sclerosis. In addition to sleepiness, side effects include low blood pressure, stomach upset, and feelings of dizziness. About 10 percent of children treated with baclofen have sufficiently unpleasant side effects to discontinue treatment. Effectiveness is similar to Valium.
Dantrolene works directly on muscle cells to inhibit their contraction. Like baclofen, it has been used primarily to treat multiple sclerosis. It has shown limited success in treating children with cerebral palsy. Side effects include a decrease in muscle tone, muscle weakness, and, rarely, severe liver damage.
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|Publication:||The Exceptional Parent|
|Article Type:||Book Review|
|Date:||Sep 1, 1991|
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