The treatment of sleep disorder in children.
A 9-year-old girl is brought to clinic by anxious parents, who say she suffers sleeplessness and night waking. This situation has persisted for the last six months. There are no significant changes coinciding with the onset of her disturbed sleeping pattern.
Her parents have tried the behavioural changes suggested by the health advisor for three months with no success. They now seek a pharmacological intervention. .
A diagnosis of primary insomnia is made. While parents agree to try the behavioural changes suggested by the doctor, they are disappointed that there is no pharmacological intervention offered.
Structured clinical question.
In children with sleeping disorders, is there a role for pharmacological interventions in improving sleeping patterns?.
Search Strategy.
Cochrane: "sleep disorder" , "children".
Pubmed "sleep disorder" , "children" , "treatment".
Clinical evidence: "sleep disorder".
Commentary.
Insomnia is a disturbance of normal sleep patterns characterised by difficulty in initiating sleep and/or difficulty maintaining sleep, with frequent nocturnal or early morning awakenings. .
Although children's sleep disorders are common, there are few available controlled treatment studies of paediatric insomnia in young children . Therefore, clinical impressions rather than systematic research figures prominently in the literature reviewed. Recruiting for trials is challenging because many parents will not allow their young children to receive psychotropic drugs; hence, studies may use unrepresentative populations, particularly children with neurodevelopmental disorders, in whom sleeping disorders are common .Data derived from clinical trials involving adult patients are used to provide guidance in treatment of insomnia in children . This is despite the fact that many hypnotic medications are not licensed for use in children and many behavioural interventions are not applicable to younger children.
