Monday, September 22, 2008

Mood Swings in Infants and Toddlers

Disclaimer: This is not intended to be either a comprehensive review or a diagnostic rubric. The purpose of this paper is to present alternative hypotheses to a consideration of the reasons for mood swings and their treatment. The final decision about treatment and diagnosis depends on professionals having direct contact with the children and their families.

There are many causes of mood swings. The moods of children can change because of physical illnesses and environmental factors. Some children develop a “temperament” that may be perceived as being extreme. Unexplained mood swings in children might be termed idiopathic. It is this author’s experience that idiopathic expressions of an emotional nature are often given psychiatric or psychological labels. Thus, we see increasing numbers of small children being labeled as Bipolar or Manic-Depressive because of unexplained mood swings.

A brief list of physical causes of mood swings (not comprehensive):
Environmental allergens or toxins
Food allergies – manifested by low blood histamines, idiosyncratic food preferences.
Sleep disturbances that may or may not be related to environmental or physical causation
Headache that may or may not be related to environmental or physical causation
Child abuse (physical, sexual, or neglect)
Medications used to treat allergies - added 1-30-2010 - Montelukast (generic for Singulair) has numerous postmarket reports from consumers that children have severe mood changes while taking this medication - consider
Ear infections
Endocrine (hormone) problems including juvenile diabetes/hypoglycemia
Vitamin deficiencies
Scoliosis (undetected spinal torsion – even of a mild nature)
Autoimmune disorders including HIV, PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus).
Coeliac Sprue
Yeast Syndrome – infantile seborrheic dermatitis
Seitelberger Disease (Infantile Neuroaxonal Dystrophy) – rare, autosomal recessive disorder.
Polycystic Kidney Disease – rare
Prader-Willi Sundrome – rare, and marked by obesity and food craving.

The New York Times Sunday magazine recently (September 21, 2008?) had a long article about the "Puzzle of Bipolar Disorder In Children." The article mentioned sections of the book The Bipolar Child by Papalos and Papalos, but left out critical information, some from the book, and some that was absent. Dr. Andrew Stoll, Massachusetts General Hospital, has done research comparing the effectiveness of Omega-3 Fish Oil with that of standard prescription drugs for treating Bipolar Disorder. I have had success with recommending it for my patients. They even discuss the success of parents using flavored, chewable fish oil capsules to treat the bipolar symptoms of children. There is a big question here. If it works, why haven't more psychiatrists recommended it? We might have a fairly good guess about that. Perhaps a side-bar might help.

I worked in a prison as a psychologist for about 17 months, and once attended a mental health conference for the Department of Corrections in my state. Drug companies (they prefer to be called Pharmaceutical Manufacturers) paid folks big bucks to speak, and brought out bunches of little gimmick hand-outs for attendees. One speaker discusses the benefits of a form of "hard drug" to treat Bipolar Disorder. I raised my hand and asked about the success with using fish oil (citing the research of Andrew Stoll, MD). His response was an inappropriately sarcastic, "You don't want a bunch of inmates running around with fish breath, do you?" Money makes people dumber than they really are.

There is research that also strongly suggests that a young child’s mood is often dependent on the mood of their caregiver. This means that mood swings of any kind expressed by a caregiver can result in having a child express similar mood swings as a reaction.

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