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HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2025 41 326 Haidt, J. (2024). The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness. Penguin Press. 327 UUU.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans (2nd ed.). https://health.gov/paguidelines/second-edition/. 328 Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M., & Flegal, K. M. (2010). Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA, 303(3), 242–249. 329 Ortega, F. B., Ruiz, J. R., Castillo, M. J., & Sjöström, M. (2008). Physical fitness in childhood and adolescence: a powerful marker of health. International Journal of Obesity, 32(1), 1–11. 330 Donnelly, J. E., et al. (2016). Physical activity, fitness, cognitive function, and academic achievement in children: A systematic review. Medicine & Science in Sports & Exercise, 48(6), 1197-1222. 331 Lang, J. J., Tremblay, M. S., Léger, L., Olds, T., & Tomkinson, G. R. (2016). International variability in 20 m shuttle run performance in children and youth: Who are the fittest from a 50-country comparison? A systematic literature review with pooling of aggregate results. British Journal of Sports Medicine, 52(4), 276–282. https://doi. org/10.1136/bjsports-2016-096224. 332 American Heart Association. (2013, November 19). Children’s cardiovascular fitness declining worldwide. ScienceDaily. https://www.sciencedaily.com/ releases/2013/11/131119112809.htm. 333 Zachariah, J. P., Jone, P. N., Agbaje, A. O., Ryan, H. H., Trasande, L., Perng, W., Farzan, S. F., & American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Lifestyle and Cardiometabolic Health; and Council on Clinical Cardiology (2024). Environmental Exposures and Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation, 149(20), e1165–e1175. https://doi.org/10.1161/CIR.000000000000123A. https://doi.org/10.1161/CIR.0000000000001234. 334 Physical Activity Alliance. (2024). 2024 U.S. Report Card on Physical Activity for Children and Youth. https://paamovewithus.org/wpcontent/uploads/2024/11/2024- US-Report-Card-on-Physical-Activity-for-ChilFINAL-11.2024.pdf. https://paamovewithus.org/wp-content/uploads/2024/11/2024-U.S.-Report-Card-on-Physical-Activity- for-Children-and-Youth_FINAL-11.2024.pdf. https://paamovewithus.org/wp-content/uploads/2024/11/2024-US-Report-Card-on-Physical-Activity-for-ChilFINAL-11.2024. pdf. 335 National Center for Safe Routes to School. (2011). How children get to school: School travel patterns from 1969 to 2009. http://www.saferoutesinfo.org/sites/default/ files/resources/NHTS_school_travel_report_2011_0.pdf. https://www.pedbikeinfo.org/pdf/NHTS_school_travel_report_2011_0.pdf 336 Ibid. 337 Barros, R. M., Silver, E. J., & Stein, R. E. K. (2011). Recess, physical education, and elementary school student outcomes. Economics of Education Review, 30(6), 1358– 1364. (2009). School recess and group classroom behavior. Pediatrics, 123(2), 431–436. https://doi.org/10.1542/peds.2007-2825 338 Dills, A. K., Morgan, H. N., & Rotthoff, K. W. (2011). Recess, physical education, and elementary school student outcomes. Economics of Education Review, 30(5), 889- 900. American Children are on Too Much Medicine—A Recent and Emerging Crisis One in five U.S. children are estimated to have taken at least one prescription medication in the past 30 days, with ongoing use most pronounced among adolescents, among whom 27% take one or more daily prescription drugs. 411 Time trends suggest the current breadth of prescription drug exposure in US children is of relatively recent origin: • Stimulant prescriptions, drugs used to treat ADHD in the US, doubled from 2006-2016;412 by 2022 11% of children had anADHD diag- nosis, with boys having a rate of nearly 1 in 4 by age 17. 413 • Antidepressant prescriptions were written for greater than 2 million adolescents in 2022, 414 a 1400% 14-fold increase from 1987-2014. 415 • Antipsychotic use in US kids rose 800% eight-fold from 1995- 2009 2005 , 66% of which was off-label for issues like ADHD or “aggression.” 416 • Antibiotics for outpatient children reached 49 million in 2022. 417 It has been estimated that about 35% are unnecessary, suggesting every year about 15 million children are prescribed unnecessary antibiotics, offering only risk with no chance of benefit. 418 • Asthma drug controller prescriptions increased 30% from 1999-2008 ; . 419 an estimated 25-40% of mild cases are overprescribed. There is evidence of overprescription of oral corticosteroids for mild cases of asthma. 420 • GLP-1 drug use is increasingly common among US kids, 421 very likely influenced by theAmericanAcademy of Pediatrics (AAP) strong recommendation to use weight loss drugs and surgery “early and at the highest available intensity.” 422 These time trends significantly outpace more moderate increases seen in other developed countries. Psychotropics for ADHD are one example, prescribed 2.5 times more in US than in British children423 , and 19 times more than in Japanese youth. 424425 The crisis of overdiagnosis and overtreatment in children is therefore both empirically evident, and proportionally specific to American youth. While excessive medical intervention in the US healthcare system is broadly recognized, 426 there has been less attention given to direct harms experienced byAmericans due to overtreatment. Despite this there exists a robust evidence base demonstrating significant and costly (both financially and in terms of human suffering) harms experienced by children due to overtreatment at the hands of American healthcare. Of note, as this report lists representative examples of demonstrably harmful practices in children, many will depend on readers’under- standing of a core principle of evidence-based medicine: interventions shown to offer no benefit when compared to placebo are harm- ful. All medical interventions involve some risk of biological adverse effects, as well as cost, resource investment, opportunity cost, and human capital. From an evidence-based standpoint, these harms are the only potential impact when using interventions proven to have no benefit. Therefore, in some of the examples given below, the net harmfulness of a listed example is understood by virtue of the proven absence of a benefit, that is frequently learned when an undertested, but commonly used, intervention is properly evaluated in a random- ized controlled trial, which is the gold standard of evidence in medicine. Examples of proven harms due to overtreatment include: • Psychiatric drugs, commonly used in children are known to cause serious, and often dangerous, short term adverse effects, such as, seizures, manic episodes, QT prolongation, discontinuation withdrawal syndrome as listed on FDA labels. 427 • Adenotonsillectomy for children with sleep apnea, an historically common procedure, conferred no benefit in trials, 428 suggesting the many, and often severe, harms of this surgery are unnecessary. • Tympanostomy tubes for recurrent ear infections, despite being recommended by professional societies, 429 did not reduce infections in trials—showing common surgeries cause harm without offering benefits. 430