Psychotropic prescribing in children under age 4 in Medicaid

Following 1997 expansion of children’s health coverage, increased demand for services may have increased risk of prescribing psychotropics in young children.  The use of psychotropic drugs in children under age 4 years is highly controversial; few medications have been tested and FDA approved for children in this age range and short- and long-term side effects are virtually unknown.  We followed two cohorts of children (born in 1999 and 2000) up to age 4, to determine prevalence of psychotropic prescribing and indications for prescribing. All children were enrolled within Medicaid programs in 36 states. We modeled odds of receiving any prescription for three indications: attention deficit/hyperactivity disorder, depression/anxiety, and psychotic illness/bipolar disorder. A total of .78% of children received at least one psychotropic drug across both cohorts. Among the three index disorders, greatest prescribing was seen for children with a claims diagnosis of depression/anxiety (.34%). A larger proportion of children aged 3-4 years received drugs compared to those aged 0-1 year (1.81% vs .15%).  Males and those with FFS-only Medicaid had higher odds of receiving a prescription (ORs 1.90, 1.50 respectively), while Black and Hispanic children had lower odds (ORs .50, .35 respectively).  Our finding that children under age 4 are being prescribed psychotropics is concerning; there is not evidence to support the safety or efficacy in this population.  Future research should focus on finding ways to implement medication use practice parameters in infant and toddler clinics, and to expand use of psychosocial interventions for young children with behavioral problems.