Summit Pediatrics

750 Round Valley Drive, #102

435-649-3748 fax

Starting Stimulant Medications for ADD/ADHD

What to Know about Stimulant Medications

How They Work
ADHD is a neurologically based disorder, resulting from a deficiency of neurotransmitter(s) in specific areas of the brain.  Stimulant medications stimulate cells in certain areas of the brain to produce the missing neurotransmitter.   The result is improved organization, planning, impulse regulation, and information integration.  The effect is immediate, and typically lasts about 6-8 hours. 

These medications come in a variety of forms—capsule, tablet, liquid, patch.  The generic names are methylphenidate and dextro-amphetamine, and various brand names are Ritalin LA, Focalin, Adderall, Vyvanse, Daytrana, Concerta, Metadate, and Methylin.  Some are available in generic and some are not.

Stimulant medications have improved dramatically in the last 10-15 years—this isn’t the same “hyper pill” that you may remember from your childhood!

How to Give Stimulant Medications
We recommend giving the stimulant medication with a power-packed, healthy breakfast.  If your child wakes up later than 10 AM, skip the medication that day to avoid insomnia that night.  If your child takes a second dose of stimulant later in the day, be sure you give it with food.  

If your child misses a dose, do not double up on the dose the next day.
Remember that treating ADD/ADHD with stimulant medications can be a trial-and-error process; it may take several tries of various medications and doses to find the right one for your child.  Please be patient.

Potential Side Effects
Appetite suppression is a universal side effect, so we follow the child’s growth very carefully.  We recommend you provide a power-packed, healthy breakfast and bedtime snack.

Some children develop headaches and stomach aches for the first several days.  These typically resolve after the first week, so have your child continue the medication.  Be sure he/she is taking it after breakfast, and drinking plenty of fluids.

Some children have difficulty sleeping when taking stimulant medications.  For this reason we recommend taking it early in the morning.  Some children can have a rebound hyperactivity or irritability as the medication is wearing off in the afternoon/evening.  Please call if you notice this—we have strategies to prevent this.

Stimulants can bring out underlying heart problems.  If your child experiences palpitations, chest pain or inappropriate shortness of breath, stop the medication and call.  Stimulants can also bring out tic disorders.  If this happens, do not stop the medication, but call us.
Some parents note that their child’s personality is a bit “flat” while taking stimulants.  If your child has a “zombie” appearance, the dose is too high; call us.

Taking the medication with food will prevent nausea and jitteriness.

Children can have rare, idiosyncratic reactions to stimulant medications.  In general, if you are concerned, please call us.

Should I give my child the medications on weekends and holidays?
Some children take the medication purely for academic reasons, and don’t require the medication on weekends and holidays.  Some children benefit from taking the medication if they have a summer camp, if doing homework, for sports practices, or any other activity that would require increased focus.  Some children have significant impulse control and mood regulation issues, and would benefit from continuing the medication on weekends and holidays.

Will my child take this medication forever?
Our hope is that your child will engrain good academic/behavioral habits while taking their stimulants so they don’t need to take them long-term.  When your child has matured after a year or two, it may be appropriate to trial a week or two during the school year without the medications.

Are there risk of not taking medications?
Research shows that people with non-treated ADD/ADHD have an increased risk of accidents and substance abuse.

Sometimes we prescribe non-stimulant medications to treat ADD/ADHD.  These may include Strattera, Kapvay, Intuniv, and Tenex.  They typically don’t reduce the target symptoms as effectively as stimulant medications, but are an option for some children, such as those on high doses of stimulants.

Stimulants are controlled substances
Unfortunately, some people abuse stimulant medications.  Please keep your medications in a secure locationFor this reason, all these prescriptions must be printed out on paper; we cannot call or email them in to your pharmacy.  Only a 30-day supply can be filled at a time, and the prescription expires if not filled within 30 days.  This means you need to plan ahead when your supply runs low!

More Information
I highly recommend for a plethora of information regarding all aspects of ADHD, including classroom modifications, homework tips, parent classes and support groups.

Evidence-Based Update on Gluten Sensitivity

Here at Summit Pediatrics we had the privilege of hosting Dr. Steve Guthery, a pediatric GI specialist from Primary Children's Hospital.  He graciously accepted our invitation to present on celiac disease and gluten-free diets at one of our monthly parent eduction nights. His recommendations are all based on solid scientific research.  Dr. Guthery's wife is a local Park City celebrity as she teaches first grade at Jeremy Ranch Elementary School.  The following is a summary of Dr. Guthery's presentation.

Gluten-induced health conditions boil down to three main entities:  celiac disease, wheat allergy and non-celiac gluten sensitivity.

Celiac Disease

Celiac disease, also known as celiac sprue, is caused by an immune reaction to gluten.  Gluten is a protein present in wheat, barley and rye.  It is the substance that makes bread dough stretchy.   Patients with celiac disease have measurable damage to the absorptive lining of their intestines, which causes a range of symptoms including abdominal pain, diarrhea, constipation, poor weight gain, iron-deficiency anemia, irritability (in toddlers especially), osteopenia (low bone mineral density), and skin lumps.  It is diagnosed with an antibody blood test, and confirmed with intestinal biopsy that reveals the characteristic microscopic destruction.

Treatment for celiac disease is a completely gluten-free diet.  This is very challenging, as even tiny amounts of ingested gluten (as contained in 1/60 of a slice of bread) can cause intestinal damage and a surge in symptoms.  In fact, people with celiac should prepare their foods in a different location and with separate utensils from those used for gluten-containing foods.   Often "gluten-free" foods are not truly gluten-free because of cross-contamination during preparation.  The good news is that the FDA recently mandated that prepared foods have precise gluten labeling, which will make strict adherence to a gluten-free diet more straightforward.

Wheat Allergy

Wheat allergy is caused by an antibody against wheat, similar to a peanut allergy.  Symptoms include swollen lips, wheezing, vomiting, and occasionally anaphylaxis.  These folks often have other food allergies, and should carry an epinephrine injector in case of accidental ingestion.


Another recently-identified entity is non-celiac gluten sensitivity.  Affected people have symptoms similar to those with irritable bowel syndrome--abdominal pain, bloating, nausea, diarrhea, and constipation.  Scientifically rigorous studies (randomized, placebo-controlled, double-blinded trials) show that when they adhere to a gluten-free diet, their symptoms improve.  Unfortunately, there is no test to diagnose these patients.  The biochemical cause of symptoms has not yet been discovered.

Gluten-Free Diets

So what is up with this gluten-free bandwagon everybody seems to be jumping on?  Much of it is advertising hype.  Gluten-free diets are not healthier unless you have one of the three above conditions.  The vast majority of people tolerate gluten without any problem whatsoever.  Then why do people who go on gluten-free diets lose weight and feel better?  Because they are paying closer attention to their diet, eating more whole foods and fewer processed foods.  It's not just about the gluten, it's improved overall nutrition.  People who eat better feel better.  (Dr. Guthery didn't state this quite as strongly--I'm editorializing a bit.)

Putting a child on a gluten-free diet can be problematic.  A gluten-free diet is expensive.  The child cannot consent to this special diet, and adherence is difficult when he/she is away from home.  It may cause mealtime power struggles and food battles.  There is the possibility of nutritional deficiency with any restrictive diet.  Many "gluten-free" foods are not truly gluten-free, although this will improve with implementation of new standards for gluten content in labeling.  If a parent believes his/her child is gluten-sensitive, he/she must weigh these cons vs. the potential benefits gained from a gluten-free diet.

The question and answer session revealed:

  • First-degree relatives of those with celiac disease should also be tested.
  • Some people with celiac disease have no symptoms.
  • Treatment for irritable bowel disease includes a special diet called a FODMAP diet, peppermint oil, anti-spasmotic medicines, and cessation of gum-chewing.
  • There is no data that probiotics relieve symptoms in these conditions.
  • Go Gluten-Free Gracefully  is a very useful website authored by a local Parkite with celiac disease.
  • Gluten-free foods in restaurants are often prepared with the same utensils as gluten-containing foods, so they may contain trace amounts of gluten.
  • Symptoms of lactose intolerance can overlap with symptoms of celiac.  Many patients with celiac disease have secondary lactose intolerance due to malabsorption.
Thank you so much to Dr. Steve Guthery for helping elucidate this confusing topic!  The topic of our April parent education night will be sensory issues in children on the autism spectrum.  Stayed tuned to our Summit Pediatrics Facebook page for details.

Antibiotic Rashes

At Summit Pediatrics we get numerous calls about rashes, especially rashes that develop when a child is taking an antibiotic.  Parents wonder:  is it dangerous?  Should I stop the antibiotic?  What if he gets another ear infection--must we avoid this medication in the future?  

If your child develops a rash while she is on antibiotics, she's not necessarily allergic to the medication.  Here at Summit Pediatrics we've been investigating the science behind some of these rashes.

Medication Allergy

If your child breaks out in a red or white itchy, blotchy, welt-y rash within several hours of starting an antibiotic, he is allergic.  The rash may be associated with swelling, wheezing, difficulty breathing, and may rarely progress to a serious anaphylactic reaction.  Taking an antihistamine such as Benadryl will alleviate the symptoms.  These kids should not take the antibiotic again unless they are cleared by an allergist.

Non-Allergic Medication Rash

If he breaks out in a rash after 3-10 days of antibiotic treatment, he is most likely NOT allergic.  This rash consists of scattered, irregular, red, flat or slightly raised spots.  They blanch (turn white with pressure) and are generally not itchy.  They usually start on the chest or back, and spread outward onto the arms, legs and face.  They may also involve the palms of the hands and soles of the feet, as well as the scalp. This rash goes away without treatment after about 3 days.  Up to 7% of patients treated with amoxicillin or penicillin get this type of rash.  These kids can safely take amoxicillin again.

Viral Rash

Complicating all this is the fact that many children who are being treated with an antibiotic have a viral illness as well as the bacterial illness.  For example, most children diagnosed with bacterial ear infections also have a viral respiratory infection.  A variety of viruses can cause a variety of rashes...really, viral rashes can look like anything.


If your child gets a raised, itchy rash after 1-2 doses of antibiotic, stop the antibiotic, give a dose of diphenhydramine (Benadryl), and call us.  We may need to switch his antibiotics.  If he also has facial or oral swelling, difficulty breathing, vomiting or collapse, he needs emergent evaluation.

If your child gets a flat, diffuse, non-itchy rash a few days into the antibiotic course, call us.  Benadryl will not get rid of the rash.  We may need to see her again to determine whether the bacterial infection is gone, and prescribe another antibiotic if it isn't.  In this case your child can safely take the same antibiotic again with future infections.

Rashes are mysterious and anxiety-provoking.  Rashes can be difficult to diagnose, especially over the phone.  If you have concerns about your child's rash, it is best to have her seen by her pediatrician.  Hopefully this provides some clarity for this otherwise frustrating symptom.


I hope you enjoy this guest blog by our clinical coordinator extraordinaire, Dusty Housel.  She was asked to participate on the panel that accompanied the community viewing of the bullying film, Finding Kind.

"On April 17th, 18th, and 19th the intermediate school and high school aged children had the opportunity to view a documentary, findingkind (  The film addresses girl to girl bullying.  The film was started by two college friends, Lauren Parsekian and Molly Thompson, both of whom had been bullied by other girls.  They felt passionate about making a documentary exploring how common girl to girl bullying is by driving around the country and presenting their anti-bullying message at schools.

The film’s intent is to get girls thinking about how we treat others and to make a commitment to treat others better.  Lauren and Molly gave the girls they presented to the opportunity to privately convey their experiences.  All of the girls featured resolved to take responsibility for their actions toward others.  At the end of the screening, the students were given the assignment of filling out an anonymous “apology” card and a “kind” card.  Lauren and Molly give this assignment to all of the girls in the film. In the film they read a couple of the apology cards that show remorse for bullying another person.

The bullying girls do to each other is particularly difficult because often times it starts with girls they consider friends and then it ends up being that group bullying a former friend.  The girls are left feeling humiliated, emotionally stripped and socially isolated with no where to turn.  It is also pointed out, girls have a tendency to be particularly cruel and keep the bullying going.

One of the subjects that came up during the film, and later the panel discussion, was the fact that adult women continue the girl to girl bullying and, in turn, teach it to their girls.  How are girls suppose to develop healthy relationships when they are being taught such unhealthy ways of dealing with conflict and peer pressure??  As mothers and women, we need to be respectful when dealing with conflict.  We need to teach our girls that we don’t have to be friends with everyone, however; we also don’t have demean another’s character or isolate someone when we have a conflict with another woman.

So, how can we combat bullying? 

Start by being an example to your children.  If each of us raise our children to be socially responsible and respectful, bullying will be less acceptable.  Air your grievances by starting your sentences in a way that does not teardown the character of the person you are upset with; such as, “I am angry with Jane because she wasn’t truthful with me”, rather than “Jane lies all the time.  She is such a (insert explicative)!”  This teaches kids it is okay to be angry, hurt, upset, etc. with a person or situation without starting rumors or demeaning another’s character. 

Another good example is for you, as the parent, to not repeat gossip that you have heard.  Talk to your kids about why it is hurtful and potentially damaging for gossip to be repeated.  Your actions influence your kids more than you could ever know. 

While there is no easy solution to bullying, if you find your child is being bullied, it is important to talk to your child about what is going on.  First, see if they feel like they can find a solution to get it to stop.  Remember to support and empower your child.  Often they feel ashamed and embarrassed that they are being bullied.  If they say they need help or you see the bullying is not stopping, go with your child to talk to their teacher or the school counselors for help.  If your child is the victim of a bully, remember to reinforce positive qualities often. 

Where can I find more information?

Here, in Summit County, we have the United Against Bullying Coalition.  A new group comprised of community leaders who are interested in combating bullying along the Wasatch Back. 

Other useful resources are:,, and Kind Campaign