Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Medical disorders resulting in problem sleeplessness in children

Stephen H Sheldon, DO, FAAP
Section Editor
Ronald D Chervin, MD, MS
Deputy Editor
Alison G Hoppin, MD


Problems with sleep onset and maintenance are common complaints presenting to the child health care practitioner. A sleepless child affects the entire family, and symptoms of problem sleeplessness are often identified in several members of the same family. Sleeplessness may cause a child to have problems with daytime performance, behavior, or mood, regardless of the underlying cause of the sleeplessness.

Problem sleeplessness in children (pediatric insomnia) is a symptom of a heterogeneous group of disorders that include but are not limited to conditioned, behavioral, social/environmental, circadian rhythm, and medical causes. The causes and clinical presentation of sleeplessness in children are quite different from those in adults, and the approach to diagnosis and management is correspondingly different.

Little substantive literature exists exploring the association between medical conditions and sleeplessness in childhood. This topic review describes medical conditions that may be associated with sleeplessness in children. The general assessment of sleep disorders in children, and the diagnosis and management of behavioral sleep problems are discussed in separate topic reviews. (See "Assessment of sleep disorders in children" and "Behavioral sleep problems in children".)


Otitis media is common in children. Acute otitis media is typically characterized by ear pain, with or without associated fever, and rarely goes unrecognized. However, chronic middle ear disease may go unnoticed; serous or secretory otitis media associated with persistent middle ear effusions can present with disrupted nocturnal sleep, with few other symptoms.

Acute otitis — Children with acute suppurative otitis media typically present with fever, otalgia, changes in appetite, and vomiting, and may appear acutely ill. Prolonged or repeated arousals and wakings often occur, and may be associated with daytime sleepiness and a decrease in daytime activity levels. Physical examination reveals loss of normal tympanic membrane landmarks, erythema, or bulging of the tympanic membrane. (See "Acute otitis media in children: Epidemiology, microbiology, clinical manifestations, and complications", section on 'Clinical manifestations'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jun 23, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Jones MC, Jones CE 2nd. Use of cetirizine in a 23-month-old male causes insomnia. South Med J 2010; 103:485.
  2. Scadding GK. Corticosteroids in the treatment of pediatric allergic rhinitis. J Allergy Clin Immunol 2001; 108:S59.
  3. Kaiser HB, Banov CH, Berkowitz RR, et al. Comparative efficacy and safety of once-daily versus twice-daily loratadine-pseudoephedrine combinations versus placebo in seasonal allergic rhinitis. Am J Ther 1998; 5:245.
  4. Smaldone A, Honig JC, Byrne MW. Sleepless in America: inadequate sleep and relationships to health and well-being of our nation's children. Pediatrics 2007; 119 Suppl 1:S29.
  5. Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. Int J Clin Pract 2006; 60:984.
  6. Grigg-Damberger M, Ralls F. Treatment strategies for complex behavioral insomnia in children with neurodevelopmental disorders. Curr Opin Pulm Med 2013; 19:616.
  7. Newman CJ, O'Regan M, Hensey O. Sleep disorders in children with cerebral palsy. Dev Med Child Neurol 2006; 48:564.
  8. Simard-Tremblay E, Constantin E, Gruber R, et al. Sleep in children with cerebral palsy: a review. J Child Neurol 2011; 26:1303.
  9. Mindell JA, Emslie G, Blumer J, et al. Pharmacologic management of insomnia in children and adolescents: consensus statement. Pediatrics 2006; 117:e1223.
  10. Owens JA, Babcock D, Blumer J, et al. The use of pharmacotherapy in the treatment of pediatric insomnia in primary care: rational approaches. A consensus meeting summary. J Clin Sleep Med 2005; 1:49.
  11. Ferber R. The sleepless child. In: Sleep and its Disorders in Children, Guilliminault C (Ed), Raven Press, New York 1987. p.141.
  12. Simakajornboon N, Gozal D, Vlasic V, et al. Periodic limb movements in sleep and iron status in children. Sleep 2003; 26:735.
  13. Khan S, Heussler H, McGuire T, et al. Melatonin for non-respiratory sleep disorders in visually impaired children. Cochrane Database Syst Rev 2011; :CD008473.
  14. Braam W, Didden R, Smits M, Curfs L. Melatonin treatment in individuals with intellectual disability and chronic insomnia: a randomized placebo-controlled study. J Intellect Disabil Res 2008; 52:256.
  15. Wasdell MB, Jan JE, Bomben MM, et al. A randomized, placebo-controlled trial of controlled release melatonin treatment of delayed sleep phase syndrome and impaired sleep maintenance in children with neurodevelopmental disabilities. J Pineal Res 2008; 44:57.
  16. Gringras P, Gamble C, Jones AP, et al. Melatonin for sleep problems in children with neurodevelopmental disorders: randomised double masked placebo controlled trial. BMJ 2012; 345:e6664.
  17. Uberos J, Augustin-Morales MC, Molina Carballo A, et al. Normalization of the sleep-wake pattern and melatonin and 6-sulphatoxy-melatonin levels after a therapeutic trial with melatonin in children with severe epilepsy. J Pineal Res 2011; 50:192.
  18. Elkhayat HA, Hassanein SM, Tomoum HY, et al. Melatonin and sleep-related problems in children with intractable epilepsy. Pediatr Neurol 2010; 42:249.
  19. Andersen IM, Kaczmarska J, McGrew SG, Malow BA. Melatonin for insomnia in children with autism spectrum disorders. J Child Neurol 2008; 23:482.
  20. Wright B, Sims D, Smart S, et al. Melatonin versus placebo in children with autism spectrum conditions and severe sleep problems not amenable to behaviour management strategies: a randomised controlled crossover trial. J Autism Dev Disord 2011; 41:175.
  21. De Leersnyder H. Inverted rhythm of melatonin secretion in Smith-Magenis syndrome: from symptoms to treatment. Trends Endocrinol Metab 2006; 17:291.
  22. De Leersnyder H, de Blois MC, Vekemans M, et al. beta(1)-adrenergic antagonists improve sleep and behavioural disturbances in a circadian disorder, Smith-Magenis syndrome. J Med Genet 2001; 38:586.
  23. Robinson AA, Malow BA. Gabapentin shows promise in treating refractory insomnia in children. J Child Neurol 2013; 28:1618.
  24. US Food and Drug Adminstration Drug Safety Communication 5/14/2013: FDA approves new label changes and dosing for zolpidem products and a recommendation to avoid driving the day after using Ambien CR. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm352085.htm (Accessed on June 27, 2014).
  25. United States Food and Drug Adminstration Drug Safety Communication 5/15/2014: FDA warns of next-day impairment with sleep aid Lunesta (eszopiclone) and lowers recommended dosedriving the day after using Ambien CR. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm397260.htm (Accessed on June 27, 2014).
  26. Sheldon SH. Disorders of Initiating and Maintaining Sleep. In: Pediatric Sleep Medicine: Principles and Practice, Sheldon SH, Ferber R, Kryger MH (Eds), Elsevier/Saunders, Philadelphia 2005. p.138.
  27. Merenstein D, Diener-West M, Halbower AC, et al. The trial of infant response to diphenhydramine: the TIRED study--a randomized, controlled, patient-oriented trial. Arch Pediatr Adolesc Med 2006; 160:707.
  28. Kaplan BJ, McNicol J, Conte RA, Moghadam HK. Sleep disturbance in preschool-aged hyperactive and nonhyperactive children. Pediatrics 1987; 80:839.
  29. Salzarulo P, Chevalier A. Sleep problems in children and their relationship with early disturbances of the waking-sleeping rhythms. Sleep 1983; 6:47.
  30. Ahmann PA, Waltonen SJ, Olson KA, et al. Placebo-controlled evaluation of Ritalin side effects. Pediatrics 1993; 91:1101.
  31. Bloom BJ, Owens JA, McGuinn M, et al. Sleep and its relationship to pain, dysfunction, and disease activity in juvenile rheumatoid arthritis. J Rheumatol 2002; 29:169.
  32. Ulualp S, Brodsky L. Nasal pain disrupting sleep as a presenting symptom of extraesophageal acid reflux in children. Int J Pediatr Otorhinolaryngol 2005; 69:1555.
  33. Luc ME, Gupta A, Birnberg JM, et al. Characterization of symptoms of sleep disorders in children with headache. Pediatr Neurol 2006; 34:7.
  34. LaPlant MM, Adams BS, Haftel HM, Chervin RD. Insomnia and quality of life in children referred for limb pain. J Rheumatol 2007; 34:2486.
  35. Palermo TM, Fonareva I, Janosy NR. Sleep quality and efficiency in adolescents with chronic pain: relationship with activity limitations and health-related quality of life. Behav Sleep Med 2008; 6:234.