The first line of treatment of insomnia is behavioural therapy. The second line is pharmacological intervention v/s benzodiazepines, antihistamines and phenothiazines- which has been shown to be effective in the short-term treatment of insomnia in young children . However, clear guidelines for their use are lacking. Also, prescribing of hypnotics for causes other than night terrors or somnambulism is not licensed .
Use of hypnotics considerably by geographic area. Kopferschmitt et al, reported that some 12% of 11 595 kindergarten children in France had been given psychotropic medication for "sleep problems" for 6 months to 5 years. In contrast, medication is rarely given in the US; practitioners prefer behavioural approaches. .
Ramchandani and colleagues demonstrate that drugs have been found to have a short-term effect on improving sleep behaviour. However, there is little evidence to suggest a long-term effect. This is because sleep problems are often a reflection of a parental management style. Also, while night waking is considered normal in infants, it is less tolerated in older children. In older children, concern arises when they "call out" on waking rather than soothing themselves back to sleep. The ability to soothe oneself to sleep and changing parental style are both behavioural modifications that cannot be acquired through the use of medication. .
While physicians are reluctant to prescribe sleep medications to most children, there are special cases in which this is done. Owen et al highlighted use of sleep medication in cases of acute pain, travel and children with special needs. .
Physicians hesitate from using benzodiazepines in children because of the risk of misuse and tachyphylaxis that is associated with these drugs. Newer hypnotics (e.g. Zaleplon), which have a shorter duration of action and fewer side effects, appear promising. .
Clinical message:.
Drugs can have a short-term effect on improving sleep behaviour.
