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Insomnia in children: when are hypnotics indicated?
Mohammed Younus1, Michael J Labellarte
1Division of Child and Adolescent Psychiatry, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-3325, USA.
Paediatric Drugs
|June 1, 2002
Summary
Pediatric insomnia, a common childhood symptom, requires careful assessment. Behavioral therapies and limited medication options offer short-term relief, but long-term solutions need further research.
Area of Science:
- Pediatrics
- Sleep Medicine
- Child Psychiatry
Background:
- Pediatric insomnia presents as a nonspecific symptom with diverse potential causes, including developmental, psychosocial, and medical factors.
- Accurate diagnosis of childhood insomnia necessitates thorough clinical evaluation, potentially involving symptom scales and laboratory tests.
Observation:
- Controlled studies on pediatric insomnia treatments are scarce, with fewer than ten published on psychosocial and/or psychopharmacological interventions.
- Directive parent education and behavior modification techniques show efficacy in the short-term management of insomnia in young children.
- Certain medications like benzodiazepines, antihistamines, and phenothiazines have demonstrated short-term effectiveness but lack FDA approval for pediatric insomnia.
Findings:
- Behavioral interventions are effective for short-term insomnia relief and as adjunctive treatments.
- Short-acting benzodiazepines may be useful for specific short-term pediatric insomnia cases linked to anxiety or mood disorders.
- Long-term benzodiazepine use is cautioned against due to tolerance and misuse risks.
Implications:
- Further research is needed to develop and validate effective long-term treatments for pediatric insomnia.
- Newer hypnotics, combined with psychosocial approaches, may offer future therapeutic options for childhood insomnia.
- Intrinsic pediatric insomnia might benefit from chronotherapy or specific medical management strategies.