There have been reports that children taking Ritalin and other stimulants for attention deficit hyperactivity disorder can develop dangerous heart complications. Should a child have a heart evaluation before starting a stimulant?

This is a very actively debated controversy. The American Heart Association suggested that at a minimum, children should see their pediatrician. And you know, anytime people—whether adults or children—start a medication, they should be seen by a doctor and carefully evaluated with a physical examination, listening to the heart, and so on, for any murmurs or any other evidence of abnormality. The American Heart Association also recommended that an electrocardiogram, an EKG, be performed. The American Academy of Pediatrics issued a separate guideline saying that that was not necessary. In the final analysis, speak to your pediatrician, who best knows your own child.

I served on a Food and Drug Administration advisory panel that reviewed these drugs, and, in fact, I suggested that they needed a black-box warning, a strong warning, because of the heart risks. And I do support careful evaluation of the potential for heart-related adverse events in children, like sudden death, from heart arrhythmias. These are very rare, and no parent should be excessively concerned, but anything we can do to reduce the risk makes sense to me, and I feel an EKG is a very reasonable thing to do before taking these medications. What you're looking for is to see if there are any abnormalities that might make them higher risk to developing complications. And of course, if they have heart-related symptoms when they're already on the medication, they need to be evaluated.