Making Polypharmacy Safer for Children with Medical Complexity.

A 14-year-old patient who has severe cerebral palsy and seizures requested that his parents speak to his pediatrician about a medication to help with sleep. He already uses 13 other medications, including anticonvulsants, analgesics, and respiratory medications, and 5 additional as-needed (PRN) medications (Figure 1). He has a vagal nerve stimulator and a gastrostomy tube. His parents had researched several sleep medications, and they were interested in discussing trazodone therapy for his sleep issues. Clinicians who prescribe medications to children with medical complexity (CMC) frequently must consider the question: How does one safely prescribe a patient like ours a new medication, like the sleep medication trazodone, amidst an already complex background of polypharmacy?