Checklist for Camp: Bug Spray. Sunscreen. Pills
By JANE GROSS
Published: July 16, 2006
BURLINGHAM, N.Y., July 15 — The breakfast buffet at Camp Echo starts at a
picnic table covered in gingham-patterned oil cloth. Here, children jostle
for their morning medications: Zoloft for depression, Abilify for bipolar
disorder, Guanfacine for twitchy eyes and a host of medications for
attention deficit disorder.
A quick gulp of water, a greeting from the nurse, and the youngsters move on
to the next table for orange juice, Special K and chocolate chip pancakes.
The dispensing of pills and pancakes is over in minutes, all part of a
typical day at a typical sleep-away camp in the Catskills.
The medication lines like the one at Camp Echo were unheard of a generation
ago but have become fixtures at residential camps across the country.
Between a quarter and half of the youngsters at any given summer camp take
daily prescription medications, experts say. Allergy and asthma drugs top
the list, but behavior management and psychiatric medications are now so
common that nurses who dispense them no longer try to avoid stigma by
pretending they are vitamins.
“All my best friends take something,” said David Ehrenreich, 12, who has
Tourette’s syndrome yet feels at home here because boys with hyperactivity,
mood disorders and facial tics line up just as he does for their daily
With campers far from home, family and pediatricians, the job of safely and
efficiently dispensing medications falls to infirmaries and nurses whose
stock in trade used to be calamine lotion and cough syrup. Three times a
day, at mealtimes, is the norm, with some campers also requiring a sleep aid
at bedtime to counteract the effect of their daytime medications.
“This is the American standard now,” said Rodger Popkin, an owner of Blue
Stars Camps in Hendersonville, N.C. “It’s not limited by education level,
race, socioeconomics, geography, gender or any of those filters.”
Peg L. Smith, the chief executive officer of the American Camp Association,
a trade group with 2,600 member camps and three million campers, says about
a quarter of the children at its camps are medicated for attention deficit
disorder, psychiatric problems or mood disorders.
Many parents welcome the anonymity that comes when a lot of children take
this, that or the other drug, so none stand out from the crowd.
“It’s nobody’s business who’s taking what,” said one parent of an Echo
camper whose child is medicated for A.D.D. and who asked not to be named for
privacy reasons. “It could be an allergy pill. The way they do it now, he
feels comfortable. He just goes up with everybody else, gets it and then
carries on with his day.”
Increasingly popular is a service offered by a private company called
CampMeds, which provides a summer’s worth of prepackaged pills to 6,000
children at 100 camps. Its founder, Dana Godel, said 40 percent of the
children regularly took one or more prescription medications, compared with
30 percent four years ago. Eight percent used attention deficit medications
last year; 5 percent took psychiatric drugs.
Borrowing technology developed for nursing homes, CampMeds distributes pills
in shrink-wrapped packets marked with a name, date and time. Camp nurses
simply tear each packet along the dotted line, sparing them the
labor-intensive task of counting pills and reducing the risk of error and
The proliferation of children on stimulants for attention deficit disorder,
antidepressants or antipsychotic drugs — or on cocktails of all three — is
not peculiar to the camp setting. Rather it is the extension of an
increasingly common year-round regimen that has also had an impact on
schools, although a lesser one, as most medicine is taken at home.
Exacting diagnoses and proper treatments enable some children to go to camp
who otherwise could not function in that environment, said Dr. David Fassler,
a child and adolescent psychiatrist and a professor at the University of
Vermont College of Medicine. Dr. Fassler said that children with one
behavioral or mood disorder often “have a second or even a third diagnosis.”
A child with A.D.D. may also be depressed and anxious, he said, a
combination of symptoms that can make such children pariahs in the close
quarters of a summer camp cabin without the proper combination of remedies.
Some camp owners question the trend, however. Mr. Popkin, the camp owner in
North Carolina, is among them. “It’s universal, and nobody really knows if
it’s appropriate or safe,” he said.
And many experts say family doctors who do not have expertise in
psychopharmacology sometimes prescribe drugs for anxiety disorders and
depression to children without rigorous evaluation, just as they do for
“There is no doubt that kids are more medicated than they used to be,” said
Dr. Edward A. Walton, an assistant professor of pediatrics at the University
of Michigan and an expert on camp medicine for the American Academy of
Pediatrics. “And we know that the people prescribing these drugs are not
that precise about diagnosis. So the percentage of kids on these meds is
probably higher than it needs to be.”
A few medicines growing in popularity, like Abilify and Risperdal, are used
for a grab bag of mood disorders. But according to the Physicians’ Desk
Reference, the encyclopedia of prescription medications, they can have
troublesome side effects in children and teenagers, including elevated blood
sugar or the tendency toward heat exhaustion, which requires vigilance by
counselors in long, hot days on the ball fields.
Some doctors, nurses and camp directors are uneasy about giving children
so-called off-label drugs like Lexapro and Luvox. Such medications are used
for depression and anxiety, and have been tested only on adults but can
legally be prescribed to children. Clonidine is approved as a medication for
high blood pressure but is routinely used for behavioral and emotional
problems in children.
“That doesn’t mean they are inappropriate or unsafe,” Dr. Fassler said,
adding that camp nurses should be able to call the physician when they have
questions, but that not all parents welcome that.