Last week on this site, Kiersten reported on the growing use of psychotropic medications to treat children with emotional and behavioral difficulties and quite reasonably questioned whether psychiatric and other medical practitioners are going too far. In today’s New York Times, Jane Cross indirectly asks the same question by reporting on the increased use and prominence of medication at children’s summer camps:

Checklist for Camp: Bug Spray. Sunscreen. Pills.

The breakfast buffet at Camp Echo starts at a picnic table covered in gingham-patterned oil cloth. Here, children jostle for their morning medications: Zoloft for depression, Abilify for bipolar disorder, Guanfacine for twitchy eyes and a host of medications for attention deficit disorder.

A quick gulp of water, a greeting from the nurse, and the youngsters move on to the next table for orange juice, Special K and chocolate chip pancakes. The dispensing of pills and pancakes is over in minutes, all part of a typical day at a typical sleep-away camp in the Catskills.

The medication lines like the one at Camp Echo were unheard of a generation ago but have become fixtures at residential camps across the country. Between a quarter and a half of the youngsters at any given summer camp take daily prescription medications, experts say. Allergy and asthma drugs top the list, but behavior management and psychiatric medications are now so common that nurses who dispense them no longer try to avoid stigma by pretending they are vitamins.

“All my best friends take something,� said David Ehrenreich, 12, who has Tourette’s syndrome yet feels at home here because boys with hyperactivity, mood disorders, learning disabilities and facial tics line up just as he does for their daily “meds.�

With campers far from home, family and pediatricians, the job of safely and efficiently dispensing medications falls to infirmaries and nurses whose stock in trade used to be calamine lotion and cough syrup. Three times a day, at mealtimes, is the norm, with some campers also requiring a sleep aid at bedtime to counteract the effect of their daytime medications.

“This is the American standard now,� said Rodger Popkin, an owner of Blue Stars Camps in Hendersonville, N.C. “It’s not limited by education level, race, socioeconomics, geography, gender or any of those filters.�

Peg L. Smith, the chief executive officer of the American Camp Association, a trade group with 2,600 member camps and three million campers, says about a quarter of the children at its camps are medicated for attention deficit disorder, psychiatric problems or mood disorders….

The proliferation of children on stimulants for attention deficit disorder, antidepressants or antipsychotic drugs — or on cocktails of all three — is not peculiar to the camp setting. Rather it is the extension of an increasingly common year-round regimen that has also had an impact on schools, although a lesser one, since most medications are taken at home.

Exacting diagnoses and proper treatments enable some children to go to camp who otherwise could not function in that environment, said Dr. David Fassler, a child and adolescent psychiatrist and a professor at the University of Vermont College of Medicine.

Dr. Fassler said that children with one behavioral or mood disorder often “have a second or even a third diagnosis.� A child with A.D.D. may also be depressed and anxious, he said, a combination of symptoms that can make such children pariahs in the close quarters of a summer camp cabin without the proper combination of remedies.

Some camp owners question the trend, however. Mr. Popkin, the camp owner in North Carolina, is among them. “It’s universal, and nobody really knows if it’s appropriate or safe,� he said.

And many experts say family doctors who do not have expertise in psychopharmacology sometimes prescribe drugs for anxiety disorders and depression to children without rigorous evaluation, just as they do for adults.

“There is no doubt that kids are more medicated than they used to be,� said Dr. Edward A. Walton, an assistant professor of pediatrics at the University of Michigan and an expert on camp medicine for the American Academy of Pediatrics. “And we know that the people prescribing these drugs are not that precise about diagnosis. So the percentage of kids on these meds is probably higher than it needs to be.�

A few medicines growing in popularity, like Abilify and Risperdal, are used for a grab bag of mood disorders. But according to the Physicians’ Desk Reference, the encyclopedia of prescription medications, they can have troublesome side effects in children and teenagers, including elevated blood sugar or the tendency toward heat exhaustion, which requires vigilance by counselors in long, hot days on the ball fields.

Some doctors, nurses and camp directors are uneasy about giving children so-called off-label drugs like Lexapro and Luvox. Such medications are used for depression and anxiety, and have been tested only on adults but can legally be prescribed to children. Clonidine is approved as a medication for high blood pressure but is routinely used for behavioral and emotional problems in children.

“That doesn’t mean they are inappropriate or unsafe,� Dr. Fassler said, adding that camp nurses should be able to call the physician when they have questions, but that not all parents welcome that. [full text]