May 5, 2003 -- Providing children with drugs to help them fall asleep is common, according to a recent report -- and with no product specifically designed to treat insomnia min kids, pediatricians usually rely on antihistamines and other drugs that have sleep-producing side effects.
In fact, a study published in this month's issue of Pediatrics reveals that three in four pediatricians had recommended nonprescription medications for insomnia in kids in the six months prior to being surveyed, while half had written prescriptions for drugs that induce sleep.
And often, the survey shows, it's done for the rest or relief of the parents -- and at their request. Drugs were most often recommended or prescribed by 671 pediatricians surveyed to provide relief for weary parents -- especially in cases with children of special needs. Often the drugs were used in combination with behavioral management strategies. Other reasons in which medications were used included during travel or in children with pain.
"In a sense, we were surprised at how many pediatricians are recommending or prescribing drugs to treat insomnia in children -- especially for reasons like helping the child sleep while traveling," says study author Carol L. Rosen, MD, a pediatric sleep specialist at Case Western Reserve University School of Medicine. "But in another sense, we're not surprised because it's pediatricians who largely treat special-needs children with ADHD and autism, and sleep problems are a well-known problem in young patients with those conditions."
Still, she tells WebMD her study suggests that insomnia in kids is more widespread than believed, and because of that, specific guidelines are needed on how to treat it. Currently, there are no prescription sleep aids specifically designed to be used for insomnia in kids, so doctors must rely on other drugs that induce sleepiness. And medical associations such as the American Academy of Pediatrics have no policies or treatment guidelines.
"The medications we're using for children were never made to help children fall asleep; we're using them because of their side effects ... for their side effects," she tells WebMD. "What came out of our study is there is a real need for something specifically designed for children. There are a lot of drugs to help adults fall asleep that we know are safe and effective. But we have nothing for kids. And if we use an adult sleep aid, we don't know safe dosages."
Her study reveals that the over-the-counter medications most often recommended to parents for insomnia in kids were antihistamines such as Benadryl and "nighttime" pain and cold relievers. Among prescription drugs, doctors typically relied on blood pressure medications such as Catapres, prescription-strength antihistamines, or antidepressants.
Two in three doctors said they might not use drugs to treat insomnia in kids because it gives parent the wrong message about correct treatment, while a slight majority were concerned about long-term side effects.
The study findings concern at least one expert who was not involved in the study. He tells WebMD that while there are good reasons for medicating children to help them to sleep, it should be done only after a thorough examination into possible causes -- and not for the convenience of parents or to treat behavior problems.
"Medication is rarely indicated when children have a hard time falling asleep," says Stephen Sheldon, DO, FAAP, medical director of the Sleep Medicine Center at Children's Memorial Hospital in Chicago and a spokesman for the American Academy of Sleep Medicine. "And when it is, being used to control behavior is probably not the right reason.
"Under certain circumstances, when traveling across many time zones, it may be appropriate to change the sleep-wake cycle to prevent jet lag. But those and other reasons are special circumstances, and as with anything else, caution needs to be used," Sheldon tells WebMD. "If there is a good medical indication for giving medication, then OK. But even over-the-counter medications can have serious side effects. And using drugs to control behavior or to allow parents to get some sleep may not be appropriate. There are special-needs children who have difficulty on a regular basis getting to sleep because of autism or ADHD, and they should be seen by a specialist. But for an otherwise normal child, it's rare they need medication."