Aug. 1, 2007 -- Children with sleep problems are likely to be prescribed a sleeping pill or other medication approved only for adults, according to a new study.
When researchers from The Ohio State University and the University of Missouri evaluated 18.6 million children's doctor visits for sleep problems, they found that 81% of visits included a prescription for a medication. The study appears in the Aug. 1 issue of the journal Sleep.
"The findings raise concern because of the large number of patients affected," says researcher Milap C. Nahata, PharmD. Nahata is professor and division chairman at Ohio State's College of Pharmacy and professor of pediatrics and internal medicine at the College of Medicine. "We tend to jump on medication right away."
While he and other sleep experts agree that medication may sometimes help children with sleep problems, they suggest medication is best used in combination with other approaches, such as behavioral therapy. Nahata tells WebMD that studies of the medications in children are needed.
Prescription Patterns for Children With Sleeping Problems
For the study, Nahata and his colleagues evaluated information from a large database, the National Ambulatory Medical Care Survey, from 1993 to 2004, to find out what doctors prescribed or advised when young patients came in for help with sleep problems.
Children were aged 17 and under, all experiencing sleep difficulties such as insomnia. Most visits were by children ages 6 to 12. Pediatricians, psychiatrists, family practice doctors, and others saw the patients.
Among the medications prescribed were sleeping pills such as Ambien and Sonata as well as other medications sometimes prescribed to help sleep problems, such as the antihistamine Atarax, the antidepressant Desyrel, and the high blood pressure medicine Catapres.
Antihistamines were most often prescribed for the children's sleep problems, given in 33% of the visits, followed by blood pressure drugs (26%), benzodiazepines such as the sleeping pill Restoril (15%), antidepressants (6%), and nonbenzodiazepine drugs such as the sleeping pills Ambien and Sonata (1%).
Doctors prescribing the medications that are not approved for use in children did so "off-label," a legal and common practice.
Nahata says his team did the study because there has not been a large study on the topic so far. The results surprised him, he tells WebMD.
"I was thinking one-third [of visits would involve prescription medication]," he says. Beyond the scope of the study, he says, was whether the medications prescribed were appropriate for the condition and how long the children used them.
Alternative Treatments for Children With Sleeping Problems
Nahata's team also looked at how often other approaches for children with sleeping problems were advised. They found that diet and nutritional counseling were advised for 7% of children and that 22% were prescribed behavioral therapy such as psychotherapy and stress management to relieve the sleep problems.
For 19% of children, both behavioral therapy and medication were advised.
While sleep difficulties are often thought of as an adult-only problem, that is not the case. At various times in their lives, Nahata says, up to 25% of infants, children, and teens have some sort of sleep problem.
Besides insomnia, sleep difficulties in children of school age can include sleepwalking, nightmares, sleep talking, restless sleep, and refusal to go to bed. In teens, inadequate sleep is also a frequent problem. Drinking too much caffeine in sodas can cause disturbed sleep.
Another sleep expert says he is not surprised that the medication use is that high among children. But "it is a concern, the 81% finding," says William Kohler, MD, medical director of the Florida Sleep Institute in Spring Hills and director of pediatric sleep services at University Community Hospital in Tampa. Fla. He is familiar with the study results but was not involved in the study.
Like Nahata, Kohler calls for studies of the medications in children.
But treating children with sleep problems is crucial, and the earlier the better, he says. "A child who does not sleep well does not learn well or behave well," he says.
Medication can help, Kohler says, if it is appropriately prescribed. If medication is needed, it's ideally used until improvement is seen, and then the child should be weaned off, Kohler says. Medication shouldn't be used alone; behavior therapy and other strategies are usually advised as well, he says.
What Parents Can Do
Setting up a healthy bedtime routine and making the child's bedroom conducive to sleep can help, Kohler says.
Bedtime and awakening times should be the same from day to day, Kohler says. "Get the TV out of the bedroom, get the Nintendo out."
"Cut out the caffeine after 2 p.m. or 3 p.m., and ideally right after lunch," Nahata says.
Knowing how much sleep a child needs at various ages is important, too. According to Nahata, an infant needs 14 or 15 hours a day, children aged 1 to 5 need 12 to 14, children 6 to 12 need 9 to 11, and teens need 9 to 9.25 hours.