A 4-year-old child has been prescribed montelukast 4 mg tablets at night for the prophylaxis of his asthma. He cannot use inhalers. The father reports sleep disturbances and a stutter. What is the MOST appropriate advice to give to the father?

• A. Speak to the GP or Asthma nurse for further advice as soon as possible
• B. Continue and monitor
• C. Stop montelukast immediately and switch to inhaled corticosteroid
• D. Increase the montelukast dose

Answer: (A)

Montelukast can cause neuropsychiatric effects in children, including sleep disturbances and speech changes such as stuttering. When a parent reports these symptoms in a 4-year-old, the safest next step is to have the prescribing clinician review the situation promptly. They can assess whether montelukast is the likely cause, discuss whether a dose change or discontinuation is appropriate, and consider alternative options given the child cannot use an inhaler. Because management decisions for a young child with asthma require medical guidance, the best course is to contact the GP or an asthma nurse as soon as possible for advice.