Treating Children with Insomnia

For health care professionals, treating children with insomnia is tricky. Many children go through a period when they have difficulty sleeping; this sleeplessness is sometimes due to sickness or rapid growth, either physical or emotional. There are few studies on the appropriate treatment for children with severe insomnia. As with adults, the physician first looks for treatable causes of the insomnia. Behavioral treatments are the first-line therapies even though kids and their parents may resist them.

Some medications are thought to be safe by some experts and have been used in certain cases, but none have been approved by the FDA for children. Such medications include the long-acting benzodiazepine flurazepam (Dalmane) and certain antihistamines, such as trimeprazine (Temaril). Short-acting benzodiazepines may have some use for brief treatment of children with insomnia related to mood disorders or medication.

A 2006 conference conducted by the National Sleep Foundation brought together experts in the field. The conference participants unanimously agreed there is a need for pharmacologic management of pediatric insomnia and the consensus was that the use of hypnotic and psychotropic medications when little formal study has been done on these drugs in children was troubling. They called for clinical trials to establish the safery and efficacy of medicines for childhood insomnia and a more established consensus among the medical profession.

A retrospective study published in BMC Pediatrics concluded that hypnosis can aid insomnia treatment in children over age 7. However, most primary care doctors are unfamiliar with hypnosis. A Dutch study in 2001 looked at use of melatonin for sleep onset insomnia in kids. The results were not very good.

The University of Michigan Health System on Sleep Problems in Children

Short sleeping and overweight children

Studies have found that children who slept fewer than 12 hours per day are more than twice as likely to be overweight at age 3 years as those who slept longer. Each 1-hour reduction in sleep duration seems associated with a 40% increase in the odds of obesity.

What can parents do to help children get to sleep?

1. Make the bedroom boring. Or at least dark and free of easy distractions. Televisions, computers, bright lights and electronic toys can disrupt the circadian cycle.
2. Create a routine wind-down period before bedtime. Most adults and children find it difficult to sleep after exercise or other heavy physical activity. Resting before bed helps, and establishing a routine imbibes cues to promote sleep habits. Reading a story to small children is one way to do this, and even older children respond to a routine.
3. Make bedtime fun! OK, that sounds a little corny, but good habits start early. Using "being sent to bed" as a punishment to bad behavior is a bad idea.

Then bed becomes associated with losing or being punished. Talk up bedtime as a good thing, not a bad thing.

Star Sleeper website - National Insitute of Health

Children sometimes suffer from sleep-onset association disorder.

Connection between migraine and sleep disorders in children

Sleep Disorders

Dyssomnias

Parsomnias