Many Doctors Prescribe Sleep Medications to Kids
by Alison McCook
Originally published by Reuters Health, May 6, 2003
NEW YORK — A survey of U.S. pediatricians shows that the majority has recommended over-the-counter or prescription sleep aids to some of their young patients.
Specifically, more than three-quarters of the surveyed physicians said they have recommended that caretakers buy an over-the-counter medication to help children sleep, and more than 50 percent had prescribed a sleep aid to children.
Antihistamines were the most common type of non-prescription medication recommended. Among prescription medicines, doctors turned most often to alpha-agonists such as clonidine, which is used to treat behavioral problems.
Around 15 percent of doctors also said they had recommended melatonin supplements or herbal remedies for their young patients.
Although very little is known about how safe these medications are for treating sleep problems in children, many have been in use for a number of years and are "most likely safe," study author Dr. Judith A. Owens, of Rhode Island Hospital in Providence, told Reuters Health.
Just how well they work is another story, she said.
"We don't really know a lot about their effectiveness, particularly in the setting of treating sleep problems in childhood," Owens said.
She added that insomnia is a symptom of other problems, most of which are not treatable with sleep medications. The fact that so many doctors turn to these medications raises concerns that some may be missing an underlying problem, Owens noted.
In their report, she and her colleagues point out that sleep disturbances are more common among children with psychological problems such as attention-deficit/hyperactivity disorder and depression, and medical conditions such as asthma and juvenile rheumatoid arthritis.
"There are many possible reasons why a child can have problems falling or staying asleep," Owens said. "And those really deserve to be carefully investigated before anyone goes to the next step of looking at medications."
Many parents will say that getting their child into bed, and keeping him there, is difficult. In fact, according to the report, a significant number of children have sleep disturbances—significant trouble falling and staying asleep—with previous research reporting the problem in up to 50 percent of preschoolers.
Most of the time, though, such problems are managed without medication.
Over the years, researchers have developed behavioral strategies to help parents deal with children who don't sleep well, Owens said. Doctors can sit down with parents and talk to them about how to manage the problem, or discuss good "sleep hygiene." This involves encouraging children to fall asleep and wake up at regular times, avoiding caffeine and staying active during the day, she noted.
"in many cases, (sitting down with parents and discussing the problem) is what's most effective and most called for," Owens said.
To determine how frequently pediatricians resort to medications, Owens and her colleagues mailed surveys to 671 U.S. pediatricians. They report their findings in the May issue of the journal Pediatrics.
Despite the widespread use of sleep medications by doctors, most reported recommending sleep aids for certain circumstances, such as for children with acute pain or who are traveling.
Many sleep medications are sold without a prescription, and Owens noted that parents might not realize that different sleep aids share the same active ingredient.
"That sort of brings up the risk of potential overdose if a parent were inadvertently to give both of those medications," Owens said.
"Certainly, there's a big caution there about parents taking the initiative and trying these medications without any guidance from a health care practitioner," she added.
The current study was funded in part by Sanofi-Synthelabo, makers of the sleep medication zolpidem (Ambien).
