[Sleep disorders in children and adolescents: Clinical assessment and principles of management]

Sleep disturbances in children and adolescents are a frequent reason for consultation in pediatrics, primary care, and child and adolescent psychiatry. Their clinical presentation is heterogeneous and lies at the intersection of developmental, circadian, behavioral, psychological, and family-related factors. The aim of this review is to provide a structured clinical synthesis of the main sleep disorders in children and adolescents, as well as updated principles of their management.

This narrative review is based on a critical synthesis of the literature and other reference sources (expert consensus) devoted to sleep disorders in children and adolescents, their validated psychotherapeutic management, and pharmacological treatment options. Data were selected for their clinical relevance and organized according to a structured analytical framework focusing on sleep development, assessment tools, differential diagnoses, comorbidities, and therapeutic strategies. This approach was intended to provide an integrative, developmental, and clinically applicable overview.

Management of sleep disorders in pediatric populations first relies on a thorough clinical assessment, including analysis of 24-hour sleep-wake patterns, individual sleep needs, chronotype, external synchronizers, and somatic or psychiatric comorbidities. The most frequent disorders are behavioral insomnia of childhood, insomnia comorbid with anxiety or mood disorders, and circadian rhythm sleep-wake disorders, particularly delayed sleep phase syndrome in adolescence. First-line interventions are based on parental psychoeducation, sleep hygiene among which consistent bedtime routines, and cognitive-behavioral approaches. Pharmacological treatments, among which melatonin, have a limited role (except for neurodevelopmental or neurogenetic disorders) after failure of well-conducted non-pharmacological measures, with particular attention to the benefit-risk ratio, regulatory framework, and comorbidities.

Sleep disorders in children and adolescents require an integrative, developmental, and family-centered approach. Behavioral interventions and circadian rhythm regulation constitute the cornerstones of clinical management. The use of pharmacological treatments should remain individualized, and regularly re-evaluated. Better clinician training and wider dissemination of sleep psychoeducation and cognitive-behavioural therapies targeting insomnia could improve early identification and quality of care.