This chapter provides general information on medication and its use. Please see other sections in this manual for additional information relating to the use of medication in specific mental health conditions.

1. 1 Medication should only be used when it has been possible to make a diagnosis of a mental disorder. The emotional and behaviour problems shown by many children do not usually fit into any diagnostic category. Children with these problems may well need therapeutic interventions, especially listening and talking treatments. However, medication should be used for cases where a diagnosis has been made and there are clear treatment goals.

2. 2 Not all health professionals are allowed to prescribe medication. Each country has its own regulations. Some of the medications mentioned in Appendix 2 have a lot of evidence to say that they are useful (e.g. stimulants for ADHD). Many other medications do not have such evidence. For detailed accounts of the medication, please see suggested reading (p. 197). When in doubt before (or even after) starting the medication, refer to or communicate with an expert with experience in using medication in children.

3. 3 The general dictum to follow while giving medication to children with mental disorders is: start low, go slow. Allow time for adequate trial before deciding to change the medication, especially in chronic disorders (e.g. it may take 4–8 weeks for a child with depression or schizophrenia to respond to the medication). Where possible, change one medication at a time.

4. 4 All types of medication have side-effects. It is important to warn parents about these when you first prescribe them. If possible, get the mother to tell you before the child starts medication whether the child is showing any of these already. Then, if a side-effect is later reported, you will be able to tell whether the child was already showing this problem before he began to take the medication.

5. 5 Many parents are worried about their children being given tablets to alter their mind or behaviour. You will need to discuss their worries, and if they have strong negative feelings, you may not be able to prescribe the medication. It may be helpful to say things like ‘I think you are quite right to worry about X going on to tablets. I would worry too.