Side Effects Are Pretty Normal

Almost everyone asks me about side effects when I prescribe a medication, which is very smart of everyone. But not everyone asks the very brilliant follow-up:

“I assumed there were side effects, but can you tell me how to minimize them?”

Skinned knees by Jessica Loushe on Flickr.

Skinned knees by Jessica Loushe on Flickr.

The concept of ‘side effect’ is layered with an unreasonable fear and mystery when patients and doctors speak it, but should be straightforward. Everything has side effects. Gardening gives you splinters. Basketball gives you floor burns. Cooking gives you those little oval burn marks where the back of your hand bumps the upper oven rack.

Some of the best things have the most side effects. Great parents take pride in how much outdoor play they provide their children. It’s a good thing the FDA hasn’t studied the side effects of outdoor play.  Imagine the press release:


The FDA has approved Outdoor Play for use by children ages 0-18.

Indications for the use of Outdoor Play include: cabin fever, hyperactivity, anxiety, animosity, boredom, sibling rivalry, inattention, fidgeting, uncontained exuberance and parental frustration overload. Even in the absence of specific indication, Outdoor Play may be used as a supplement to food and shelter, although should not be administered simultaneously with meals or sleep.

Usual dosage: Outdoor Play should be administered daily. Doses as small as 5 minutes have shown statistically significant benefits in clinical studies, while doses ranging to 4 hours show proportionately larger symptom reduction. No dose-related toxicity has been documented. Doses as high as 24 hours, linked sequentially, have been studied in campsites and remote hiking trails with no loss of incremental benefit.

Side effects: The most common side effects include scrapes, falls and stuff that’s NOT FAIR!!

Serious or potentially fatal adverse events: accidental collisions, heatstroke, drowning, lightning strikes, shark bites, traumatic cataracts, West Nile virus. Myocardial infarction, fatal ventricular arrhythmias and unexplained sudden death are fortunately rare, but occur more commonly during active play than sedentary activities.

Side effects occurring in more than 1% of children are listed by body system:

Body-as-a-whole: excessive sweating, exhaustion, frostbite.

Neurologic: concussion, headache

Dermatologic: sunburn, actual dirt in skin folds, skinned knees/elbows/hands, cuts, splinters, bruises, insect and spider bites, dog bites, cat bites, kid bites, poison ivy, campfire burns.

Immunologic: allergic rhinitis, ocular allergies, wheezing, cough, hives.

Eyes: sand or dirt thrown in eyes, conjunctivitis, foreign bodies, sub-conjunctival hematoma.

Head/ears/nose/throat: broken or bloody nose, chipped teeth, accidentally swallowing gum, insects flying into ear canal or up nose

Pulmonary: out-of-breathness

Cardiovascular: heart racing, palpitations, broken hearts, fainting.

Gastro-intestinal: stomach ache from getting punched, stomach ache from eating green apples or wild berries, stomach ache from waiting too long to go inside to the bathroom

Genito-urinary: blood in urine when guys on YouTube crash-land on their crotch

Orthopedic: breaks, sprains, strains, displacements, tears, ruptures, dislocations. Also everything that happens on trampolines.


Skateboard accident

Skateboard accident

The side effects of outdoor play can be divided into two basic categories: a) the things we survived in childhood and now view with a perverse pride, and b) the things we haven’t experienced that make our knees go weak when we imagine them happening to the children we love.

Some people say we should avoid medication because of side effects. I recently heard two licensed professionals advising parents against the use of medication while promoting “the treatment that’s free of any side effects—outdoor play.”

You wonder what kind of weeny fun they call ‘play’. Candy Land on a screened porch?

The majority of my childhood memories are outdoor: free-play, camping, fishing, hunting tadpoles, baseball, football, swimming, bicycling and pretending we didn’t hear the call to come inside for supper. Injuries occurred daily. My friends and I encountered ‘side effects’ every day.

Even now, I can get pretty banged up on weekends from surf kayaking, dinghy sailing, body surfing, running, skiing, gardening and outdoor chores. I’ve got dents in my ski helmet and scrapes on my road bike. I spent 18 months rehabbing a crashed shoulder and 2 years pulling sea urchin spines out of my foot. The last time I fell out of an apple tree was a few months ago. (Sometimes you just need to know you haven’t lost it. The tree and I both recovered quickly.)

Outdoor play has more side effects and less therapeutic effect than ADHD medications, but it’s so important that we can’t give it up. Parents and kids working together can lower the “side effect” rates substantially with supervision, proper techniques and protective gear. Doctors, likewise, have numerous techniques that can prevent or diminish side effects if we remember to ask instead of just giving up.

Side effects aren’t a reason to avoid things, but rather to be prudent in how we do them.

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

Posted in ADD, ADHD, ADHD myths, children, medications, side effects
3 comments on “Side Effects Are Pretty Normal
  1. Karen Greenland says:

    Great post!


  2. great point!
    It is hard to help people understand about side effects – the cost benefit ratio and the risk.
    because side effects are listed, does not mean you will get them. The list is a possible side effects, anything anybody ever got that might possibly have been related to the medication.
    The keys are the percentage – what percent of people on this medicine get the side effect? Is it one out of 10 or one out of 10 million. And, how serious is the side effect – is it uniformly fatal or a minor annoyance.
    And is it permanent? Almost all side effects go away if you stop the medication.
    Then we could talk about water – it definitely has possible side effects and can be fatal inbtoxic doses, but most of us still drink the stuff (although WC Fields didn’t, he said it’s what fish poop in.)
    Keep educating!


  3. This is fabulous in two different ways… the side effects discussion and the prescript for play. Can’t we write the same prescription for adults? We grown-ups have lost the ability to play and we so need it–all kinds of play and movement–those of us with and without ADHD.

    I had a discussion with my daughter, yesterday, who lives in Maine. I am in Doylestown, Pennsylvania. She was remembering when, as younger kids, they were allowed outside to play on the block and to wander down the street to the historic and charmingly arbored cemetery to play for hours without supervision.

    The world has changed. One,we would be afraid to let our kids wander like that, today. And , two,I am sure that if I was raising a younger child today, I would have to work hard to put the outdoors and movement into my kid’s lives.

    Liked by 1 person

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Oren Mason MD
Oren Mason MD

Oren Mason MD

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

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