HJNO Jul/Aug 2025

MAHA REPORT 42  JUL / AUG 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS   339 Institute of Medicine. (2013). Educating the student body: Taking physical activity and physical education to school. National Academies Press. https://www.ncbi.nlm . nih.gov/books/NBK201501/. 340 Spiegel, S. (2022). How much recess should kids get? U.S. News & World Report. https://www.usnews.com/education/k12/articles/how- much-rece. 341 Centers for Disease Control and Prevention. (2004). Participation in high school physical education-United States, 1991-2003. Morbidity and Mortality Weekly Report, 53(36), 844-847. 342 Kern, B. D., Wilson, W. J., Killian, C. M., van der Mars, H., Simonton, K., Woo, D., & Wallhead, T. (2025). Physical education access in U.S. public schools: A multistate, multiregion study. Journal of Teaching in Physical Education. 343 Mlynek, A. Rix, K. (2022, October 14). How much recess should kids get? U.S. News & World Report. https://www.usnews.com/education/k12/articles/how-much- recess-should-kids-get. 344 McGinn, J. Mader, Jackie, (2022, May 12). Recess guidelines vary greatly from state to state. The Hechinger Report. https://hechingerreport.org/recessguidelines- vary-greatly-from-state-to-state/. “Kids’ access to recess varies greatly” Hechinger Report. https://hechingerreport.org/kids-access-to-recess-varies-greatly/. 345 Faverio, M., & Sidoti, O. (2024, December 12). Teens, social media and technology 2024. Pew Research Center. https://www.pewresearch.org/internet/2024/12/12/ teens-social-media-and-technology-2024/. 346 Minges, K. E., Owen, N., Salmon, J., Chao, A., Dunstan, D. W., & Whittemore, R. (2015). Reducing youth screen time: qualitative metasynthesis of findings on barriers and facilitators. Health psychology: official journal of the Division of Health Psychology, American Psychological Association, 34(4), 381–397. https://doi.org/10.1037/ hea0000172. 347 Basch, C. E., Basch, C. H., Ruggles, K. V., & Rajam, S. (2014). Prevalence of sleep duration on an average school night among 4 nationally representative successive samples of American high school students, 2007–2013. Preventing Chronic Disease, 11, E216. 348 Twenge, J. M., Krizan, Z., & Hisler, G. (2017). Decreases in self-reported sleep duration among U.S. adolescents 2009–2015 and association with new media screen time. Sleep Medicine, 39, 47–53. 349 National Sleep Foundation. (2014). 2014 Sleep in America Poll: Sleep in the Modern Family. https://www.thensf.org/wp- content/uploads/2021/03/2014-Sleep-in- America-poll-summary-of-findings-FINAL- updapdf Updated-3-26-14-.pdf. 350 Hale, L., & Guan, S. (2015). Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Medicine Reviews, 21, 50–58. 351 Yuan, N. Richter, R. (2015, October 8). Among teens, sleep deprivation an epidemic. 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Somnologie, 23(3), 147-156. https://doi.org/10.1007/ s11818-019-00215-x. • Blood tests for inflammation in infants with fever routinely led to a cascade of unnecessary, invasive, and harmful further testing such as spinal taps—but were broadly recommended by professional society guidelines. 431 • ADHD, depression, and “intellectual disability” are diagnosed disproportionately in children relatively young for their school grade, suggesting misdiagnosis leads to unnecessary drugs, treatments, and social stigma. 432 • New generation antidepressants, despite widespread use, in children offer only a “small and unimportant” reduction in depression symptoms according to a meta-analysis of 26 studies. 433 • Antibiotics are over-prescribed to millions of US children annually, causing serious harms like rashes, diarrhea, recurrent infections, allergic reactions, and antibiotic resistance. 434 • Antidepressants, stimulants, antipsychotics, and other psychiatric drugs, when stopped, often lead to disabling and prolonged physi- cal dependence and withdrawal symptoms. 435 • Specific antipsychotics in adolescent boys, when compared to placebo, cause 5 times more gynecomastia (male breast growth), 436 4 times more extrapyramidal effects, and 6-8 times more significant weight gain. 437 • Topiramate, commonly prescribed throughout the 2000s off-label to children for migraine headaches, were presumed effective in children given known efficacy in adults; however, no high-quality trials in children existed. 438 439 In 2017, the first high-quality trial was published, demonstrating the drug did not improve migraines in children 440 but did cause suicidal thoughts and behaviors as acknowledged on the FDA drug label. 441 Following this trial, prescriptions of the Topiramate dropped for children with migraines. The above examples represent harms that have been carefully studied and thus well proven. However, in the setting of childhood growth and development there remains an important likelihood of undetected but potentially major long-term repercussions. Established harms in children may therefore be thought of as the tip of a potentially vast iceberg representing both detectable short term negative effects, and potentially hidden negative effects with long term implications. While long term research on the developmental and adult-stage impact of most commonly used drugs for children is limited, there are contributory human data that raise important questions. Examples include: • SSRIs: Used to treat depression and anxiety, SSRIs carry a black box warning 442 due to established incidents of suicidal thinking and behavior caused by the drugs in adolescents— such incidents are difficult to separate from progression of baseline disease and there- fore may go largely undetected. • Stimulants: According to best trial data available, these widely usedADHD drugs cause long- term height loss averaging an inch; 443 of note, the only long-term trial found exclusively short- term (14-month) behavior benefits, which were not found at 3 years. 444 Indeed, at 3, 5, 8, and 14 years, no benefits were seen in grades, relationships, achievement, behavior, or any other measure. • GLP-1 Agonists: Increasingly common, 445 these popular weight-loss and diabetes drugs with complicated metabolic effects lack neurodevelopmental and other long term safety data, raising the specter of unforeseen problems that interrupt, damage, or impair metabolism and growth development. • Child Chemical and Surgical Mutilation carries major risks related to puberty blockers, cross- sex hormones, and surgeries, including irreversible effects like infertility. 446 TheAMA 447 andAAP 448 recommend these medications and procedures, however, despite an HHS review finding no long-term evidence for safety (or effectiveness) and short-term evidence of “very low quality.” 449 • Antibiotics: Children exposed to antibiotics in the first 2 years of life are more likely to develop asthma, allergic rhinitis, atopic der- matitis, celiac disease, overweight, obesity, andADHD. 450 The antibiotic prescription rate from birth until age 2 is over 2,500 antibiotic prescriptions for every 1,000 children this age. 451