Magnesium is Not Recommended for Treating Anxiety in Pediatric Patients
Magnesium has no established role in the treatment of pediatric anxiety, and the available pediatric guidelines do not support its use for this indication. The American Academy of Pediatrics guidelines on pediatric emergency medications specify magnesium dosing only for acute medical emergencies—not psychiatric or anxiety disorders 1.
Established Pediatric Indications for Magnesium
The American Academy of Pediatrics recognizes magnesium for the following acute conditions only 1:
- Hypomagnesemia/Torsades de pointes: 25-50 mg/kg IV/IO (maximum 2 g) 1
- Refractory status asthmaticus: 25-50 mg/kg IV/IO (maximum 2 g) over 15-30 minutes 1
These are emergency interventions for life-threatening conditions, not chronic psychiatric management.
Why Magnesium Should Not Be Used for Pediatric Anxiety
Lack of Guideline Support
No major pediatric psychiatric guidelines recommend magnesium for anxiety treatment 1. The American Academy of Pediatrics guidelines on managing acute mental health and behavioral emergencies in children specify benzodiazepines (lorazepam 0.05-0.1 mg/kg) and antipsychotics as appropriate pharmacologic interventions—magnesium is conspicuously absent 1.
Evidence Limitations
While research studies suggest potential benefits of magnesium in adult depression and ADHD-related hyperactivity 2, 3, 4, these findings have critical limitations:
- Wrong population: Studies examined ADHD hyperactivity and adult depression, not pediatric anxiety disorders 2, 3, 4
- Wrong outcome: The ADHD studies measured hyperactivity reduction, not anxiety symptoms 3, 4
- Methodological concerns: Small sample sizes and lack of rigorous placebo controls limit generalizability 2, 3
- No anxiety-specific data: One study examining trace elements in generalized anxiety disorder found no significant difference in magnesium levels between patients and controls 5
Safety Concerns in Pediatric Use
Magnesium administration requires careful monitoring, particularly in children 1:
- Rapid infusion causes hypotension and bradycardia 1
- Requires calcium chloride availability to reverse potential toxicity 1
- Renal function monitoring essential to prevent hypermagnesemia 6
Appropriate Treatment for Pediatric Anxiety
For acute agitation or anxiety in pediatric patients, the American Academy of Pediatrics recommends 1:
First-Line Pharmacologic Options
- Lorazepam: 0.05-0.1 mg/kg PO/IM/IV (most commonly used for anxiety/agitation) 1
- Midazolam: 0.05-0.10 mg/kg IV for sedation/anxiolysis (maximum 5 mg single dose) 1
Important Monitoring
- Respiratory depression risk, especially when combined with other sedatives 1
- Paradoxical agitation may occur, particularly in younger children 1
- Oxygen saturation monitoring is essential 1
Common Pitfall to Avoid
Do not extrapolate adult depression data or ADHD hyperactivity data to pediatric anxiety treatment. The pathophysiology, symptom profiles, and treatment responses differ substantially across these conditions. Magnesium's role in ADHD-related hyperactivity (where deficiency was documented in 95% of studied children) 4 does not translate to anxiety disorders, where magnesium levels show no significant difference from controls 5.