Well, it happened. I finally got my youngest patient yet, a 1y/o! she was adorable but will hit her parents and baby brother. I was basically speechless. What can I say and still be considered professional especially bringing a child to be seen at 3 am in the morning for this?? I deserve a trophy for not rolling my eyes and after a few days, I finally have words to describe my feelings so here we go!
How Young is Too Young?
I had another incident where the parent brought in a 5y/o at 2am for not sleeping so I’m just not shocked anymore. Over the years, I would ask other people and providers where’s the cutoff and how to draw the line. Eventually, I had to come up with my own understanding because people would think I’m being dramatic when this happens more than people like to admit.
My job was like the youngest patient we treated was a 4y/o, but overall there’s no age limit to technically “help” someone. I wish it was clear limits so parents wouldn’t have to pay crazy fees and save people a trip in the middle of the night. I’m assuming there’ll be one soon because it’s a liability. They are certain age limits to be inpatient so I’m not sure why a clinic wouldn’t have one when we have minimal resources.
The youngest I’ve seen being admitted was a 7y/o for aggressiveness, but it wasn’t a good experience because he was in the ER for weeks, and it seems the hold was just to see if the mother would AMA… Another ER d/c’d my suicidal/homicidal patient to be at home with the mother she wanted to kill, pending an admission because there was no availability of beds. It’s truly unacceptable but our system is so broken, it’s a common belief that some treatment is better than none, even if it’s not good. It just makes health care look overall bad so here are some considerations that have helped me with treating younger children:
- 0 to 1y/o: I didn’t think about kids this young until a doctor I worked with used to treat babies for rx withdrawals and failure to thrive. Withdrawals can be from opioids, antidepressants, drugs, alcohol, etc. It also includes education for the parents and families, especially in populations on the reservations. Babies would usually have to be hospitalized until stability and to make sure it’s safe to go home or possibly until a CPS investigation.
- 1-3y/o: I would not admit a patient in these ages or anything that may possibly be unsupervised. Yes, kids should be supervised but most of these psych places are not watching these children, despite cameras. The 0-1y/o kids are primarily monitored in hospitals for issues that may compromise their life, so it’s really a medical reason to be hospitalized and not a “psych” problem. The parent of the 1y/o claimed the regular children’s hospital said the kid has to be potty trained, which I’m not sure if that’s true but whatever…In my heart, any kid that’s super young can’t be hospitalized for behavioral problems or I’m assessing bigger red flags. This is also why I wrote this post, to provide some kind of standard on why we don’t treat kids that young…
Therefore, I wouldn’t medicate around this age. This is the time when it’s critical for the child to reach milestones, and if you medicate the child too early, they may have even more delays… The mother of the 1y/o said the kid was getting tested for ASD, butttt she was too young to be tested or confirmed! I wasn’t even mad because clearly there are just a lot of misconceptions but I was mainly upset that after all these facilities the mother went to, almost no one could just be clear with her about how to handle the situation. Medications may treat the aggression but can also affect cognition, cause sedation, etc., and many times people are not aware of the risks or think about it that way, but I probably wouldn’t think about it either if I wasn’t in healthcare.
According to textbooks and research, the best modality for kids under 5 is THERAPY, to basically really reach those milestones. I did let the mom know about child-proofing the house and since the kid wasn’t intentionally trying to harm herself or others, we can’t admit and to f/u at the hospital for any other issues… Most of the time if it’s truly autism, there are dedicated resources, but it depends on the state. Looking in hindsight, I just somewhat said no in a million ways, when I should’ve just mentioned the importance of not delaying the child any further.
When Would I Consider Meds?
The youngest I did treat was probably around 4y/o because if the child is getting kicked out of daycare, and has certain issues, like uncontrolled screaming and meltdowns, they will miss their milestones. I will also base it off the history, if there are major family dysfunctions, the mother was on substances, s*xu*l abuse, or traumatic events…these kids normally would require medications at a younger age to stabilize their behaviors.
Most medications aren’t FDA-approved for kids but they’re still many options to microdose and proceed with caution to avoid over-medicating or inducing a delay. I overall prefer to treat these issues on an outpatient basis, because it’ll give them the best outcomes. I personally feel like kids less than 10y/o shouldn’t be hospitalized unless they (or at any age) don’t feel safe at home. Otherwise, the parent has to be a parent…so I usually just start giving parenting advice; stop spoiling the kid (enabling bad behaviors), have clear communication, and be CONSISTENT.
Conclusion
My 7/o who got admitted appeared older-looking, and he would make me and his mom laugh because he always acted like this fed-up old man. The mom said he called from the hospital like he was in prison and complaining about the food and still didn’t want to listen to anyone. Overall, some of these kids seriously need a reality check so maybe hospitalizing can help.. but in general, it usually goes back to a lack of parenting and changing learned behaviors. Plus, it takes forever to admit a younger kid in psych, therefore it’s just not the most helpful.
So I normally give everyone my PSA, which is to lock up or secure harmful objects, and then the parents would say I can’t lock up everything, then I would ask, why is everything in your house harmful?? I honestly wish it was more laws to hold people accountable or give parents a yearly allowance if no one gets in trouble. Many kids are simply raising themselves and just given electronic devices, which is creating more monsters so in addition to improving parenting skills, target education and learning skills, which will always make it worth treating the little humans.
