Additional advice for children

Children taking an antipsychotic have a 2- to 3-fold increased risk of developing type 2 diabetes compared to the general population.

The monitoring schedule set out in c_ptg8-c73-s1.html#ptg8-c73-s1__tptg8-c73-tbl4 can be used as a guide, but more frequent assessment of some parameters is warranted in children:

  • measure the child’s weight and height weekly for the first 8 weeks of antipsychotic therapy to identify children who gain weight rapidly; for children, body mass index (BMI) and BMI-for-age percentiles give a better indication of significant weight gain than weight alone
  • measure blood lipids and glucose concentrations monthly for the first 3 months of antipsychotic therapy
  • assess all cardiometabolic parameters outlined in c_ptg8-c73-s1.html#ptg8-c73-s1__tptg8-c73-tbl4 at 9 months.

Refer a child to a specialist if they develop:

  • significant weight gain; that is, they
    • have a BMI increase of more than 5% in the first 3 months of antipsychotic therapy
    • become overweight (ie 85th to 95th BMI percentile) and have a weight-related complication (eg hypertension, dyslipidaemia, hyperglycaemia)
    • become obese (greater than 95th BMI percentile)
  • type 2 diabetes
  • dyslipidaemia.

There is inconsistent, limited evidence to support metformin for the management of weight gain in children taking an antipsychotic.