Hospitalist nurse practitioner Amber Jewison and psychiatrist Kia Carter, M.D. were featured on the nationally-syndicated show “The Doctors” on Thursday, Nov. 5. The show highlighted a recent trend of TikTok videos that encourage viewers to take excessive amounts of the common allergy medicine diphenhydramine, aka Benadryl.

Cook Children’s first reported on these videos on Checkup Newsroom over the summer after three teens were admitted to the hospital for overdoses.

“We had three patients in a week who specifically told me they saw a video on TikTok that told them they could take Benadryl to get high, and it gave them a specific number (to take),” Amber said in an interview on "The Doctors." “When I viewed that video, I was pretty shocked.”

Patients who overdose on Benadryl can have abnormal electrocardiograms (EKGs) and may not be able to urinate. It’s even possible to suffer seizures. Amber has treated such patients and says parents are usually shocked to find out their child has overdosed.

“I try to tell parents that it’s really good to know what’s out there on social media and to be aware of what your kids may be doing,” she said.

And it’s not just shocking for parents. Medical professionals are also surprised to see healthy adolescents and teens taking part in these dangerous challenges.

“I was alarmed, I was extremely shocked that children are participating in something so lethal,” said Dr. Carter, who is also the medical director of Psychiatry at Cook Children’s. “Being a parent myself, it’s petrifying to think about the idea of my pre-adolescent daughter participating in this.”

So why do teens participate in dangerous viral challenges like the one involving Benadryl?

“I think people have to realize that children’s brains are not fully developed like an adult and judgement and executive function are a huge part in making decisions. When we see kids participating in these high-risk behaviors, we have to remember that their brains are not fully developed,” said Dr. Carter. “There’s some research also to show that social media and participating in these challenges is activating the reward center in the brain, which can cause kids to become further attached to participating in these challenges.”

Dr. Carter says it’s also important to realize the difference between a child participating in an online challenge, and one who is actively trying to harm themselves. She says kids who are taking part in challenges because they want to fit in are usually active and part of a social group. Kids who are taking medicines or over-the-counter substances to harm themselves are often excluded or bullied on social media.

Her advice for parents - be aware.

“Know what your children are doing on social media, participate and ask questions,” Dr. Carter said.

“We've definitely seen a high number of adolescent suicide attempts over the past couple of months, especially during COVID-19,” said Kia Carter, M.D., medical director of psychiatry at Cook Children’s Medical Center. “We've also seen younger kids endorse suicidal ideation.”

At Cook Children’s, the vast majority of patients treated for self-harming are girls, typically between the ages of 13 and 15. But Dr. Carter says she’s had patients in her unit as young as 4 years old talking about wanting to die.

“We've seen a huge increase with younger kids knowing what death is because of video games,” said Dr. Carter. “We have to assess their cognitive level and find out if they know what death means or do they think it’s like the video game where they die, but get a backup player.”

So far in 2020, 192 kids have been admitted to Cook Children’s for attempting suicide. Compare that to the same time period in 2015 when the hospital saw 88 patients - less than half of the current statistics.

Unfortunately, the data from Cook Children’s Behavioral Health Center is in line with a new study from the Centers for Disease Control and Prevention (CDC). The article, released Sept. 11, shows suicide rates among 10 to 24 year olds have increased 57.4% from 2007 to 2018.

"It's a real trend that has been demanding, for a while, a serious public health and research effort to understand what is happening and why," said Anna Mueller, an associate professor of sociology at Indiana University Bloomington. In an interview with USA Today, Mueller said she doesn’t buy that it’s just social media, though we do know many children express anxiety and depression linked to social media.

“Social media plays a big role in the mental health of children and teens,” said Dr. Carter. “They experience bullying online, they may not feel self-worth because they’re comparing themselves to what they see on Instagram. They’re also getting ideas on the internet about how to harm themselves.”

Dr. Carter says social media and sites like YouTube have made self-harm almost acceptable. She says children are looking to those avenues to find out how many pills to take or other ways they can attempt suicide.

“A lot of kids will research how much medication to take to not wake up,” said Dr. Carter. “I would say 99% of the overdoses we see have some over-the-counter component.”

Since January, 31 children have been admitted to Cook Children’s for ingesting too much Benadryl. At least three of the Benadryl overdoses are linked to a TikTok challenge, but the majority of cases were among patients intending to harm themselves. Other drugs commonly found in medicine cabinets such as Tylenol, aspirin and ibuprofen are also frequently used.

So why do children and teens take these drastic measures?

“When people feel like they're not going to get better and there's no way out, they tend to go to these levels,” Dr. Carter explained. “I think the biggest thing is hopelessness. When kids feel like they don't have anyone to talk to, they don’t feel like they can communicate with their parents or they’re getting bullied and they don’t have a social circle. Some kids also are struggling with gender and sexual identity.”

About 30% of the children assessed by Cook Children’s Behavioral Health Center report issues with gender or sexual orientation. Among those are patients diagnosed with gender dysphoria, a feeling of discomfort or distress that can occur when someone feels their gender identity differs from their sex.

“There are some kids who physically don't feel comfortable in the body they're in and they don't feel that they relate to the other girls or the other boys. We see this occur a lot around age 10,” said Dr. Carter. “A lot of times parents feel like it's a phase, and that might be true, but I would encourage parents to not minimize it because kids can begin to feel hopeless.”

She suggests parents keep an open mind, listen to their children and get them in to see a licensed professional counselor. And she says it’s ok to not agree with their feelings, but to share those thoughts with your spouse or a friend instead of the child.

“If you're resistant to it, your child's going to shut down and that can cause a whole realm of depression, hopelessness and not wanting to be alive anymore,” she said.

With COVID-19 and social distancing, spotting signs of depression and hopelessness can be challenging. Things that may have seemed out of the norm in the past, like avoiding social activities, may not be so odd now. But Dr. Carter says watching for changes in behavior is still key.

“Most kids still want to play video games and have their cell phones, so if they don’t want a new video game and all they want to do is sleep, you’re going to want to assess where that change is coming from,” she said.

Other signs of depression to look out for include:

• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness

If you feel your child needs help, please talk to your pediatrician or call 682-885-3917 for a referral to Cook Children's Behavioral Health Center.