A parent of a 7-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) since he was 5 years old is talking to the school nurse about her concerns about the son's physical condition....

A parent of a 7-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) since he was 5 years old is talking to the school nurse about her concerns about the son's physical condition. The parent states that his medication, Concerta (methylphenidate extended release), controls his symptoms well but is causing him to lose weight. It is difficult to get him up and ready for school in the morning unless he is given the medication as soon as he awakens. Then he does not eat breakfast or very much of his lunch at school. He eats dinner, but only an average amount of food. He has lost 3 lb (1.4 kg) in the last 2 weeks. Which of the following should the nurse suggest the parent do first?

1. Have the child eat a breakfast bar, banana, and a glass of milk at his bedside at the same time he takes his Concerta every morning.

2. Monitor the child's weight closely for a month since he is likely to stop losing weight when the school year ends in 2 weeks.

3. Suggest a change of medication to a nonstimulant drug that will treat his ADHD without causing the appetite decrease.

4. Suggest that the parent supplement the child's dinner with a high-protein drink or other food that will increase his caloric intake.