Pharmacotherapy for insomnia in children and adolescents: A rational approach
- Judith A Owens, MD, MPH
Judith A Owens, MD, MPH
- Director of Sleep Medicine
- Boston Children's Hospital
A variety of behavioral and medical problems can present with childhood insomnia, typically manifested as bedtime resistance, difficulty initiating sleep, night wakings, or combinations of these symptoms. As a result, it is imperative that the choice of therapy be diagnostically driven as well as developmentally appropriate.
The vast majority of sleep disturbances in children and adolescents are appropriately managed with behavioral therapy alone, and behavioral interventions should be considered first-line therapy, as has been recommended for adults . However, in a limited number of clinical situations, pharmacologic intervention may be appropriate for management of the child or adolescent with significant difficulties in initiating or maintaining sleep, as long as a number of important caveats are taken into consideration.
In practice, a variety of nonprescription (over-the-counter) and prescription medications are used to treat pediatric insomnia by pediatric health care practitioners, or are initiated by a child's parents, often without medical guidance. However, little empirical evidence exists regarding the efficacy, safety, and tolerability of these medications in the pediatric population. Furthermore, no hypnotics or other medications are approved by the Food and Drug Administration (FDA) for treatment of insomnia in children under the age of 16 years. Therefore, pharmacotherapy for insomnia in children is always an off-label use and should be approached with careful evaluation of the potential benefits, risks, and treatment options for the individual patient.
A general approach to making decisions about pharmacotherapy for sleep in children is outlined below, followed by a brief summary of the main considerations for individual medications. Related information is included in other UpToDate topics:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GENERAL APPROACH
- Decision to initiate pharmacotherapy
- Choice of medication and dosing
- NONPRESCRIPTION MEDICATIONS
- PRESCRIPTION INSOMNIA DRUGS
- Nonbenzodiazepine receptor agonists
- Drugs with limited pediatric experience
- DRUGS USED OFF-LABEL FOR INSOMNIA
- Alpha-adrenergic agonists
- - Clonidine
- - Guanfacine
- - Tricyclic antidepressants
- - Atypical antidepressants
- - Selective serotonin reuptake inhibitors (SSRIs)
- OTHER MEDICATIONS