Herbie Murray
Sleep is an essential part of a child's development, and it is common for children to experience sleep problems. While medication can be a useful adjunct, it is rarely the first treatment option for a child's sleep issues. Before turning to medication, it is recommended to try sleep and lifestyle changes, such as adopting better sleep habits and making dietary changes. If these strategies are ineffective, and a child's sleep problems are affecting their well-being, schoolwork, or relationships, a doctor may prescribe medication. Melatonin is one such medication that is sometimes prescribed to children over the age of two who have persistent sleep problems. Other medications used to treat sleep disturbances in children include antihistamines, drugs for high blood pressure, and sedatives like Vallergan and Phenergan. It is important to note that medications for pediatric sleep problems are often used \off-label,\ meaning they are not approved by the FDA for children. As such, it is crucial to consult a doctor before giving any medication to a child for sleep issues.
| Characteristics | Values |
|---|---|
| Medication type | Melatonin, sedatives, hypnotics, antihistamines, antihypertensives, herbal remedies, over-the-counter medications |
| Medication examples | Vallergan, Phenergan, Benadryl, Advil PM, Tylenol PM, NyQuil, ZzzQuil, Unisom, cough syrup |
| Administration guidelines | Only under direct medical advice and supervision, settled and ready for bed before the dose, not recommended for children under 2 years |
| Side effects | Irritability, hyperactivity, challenging behaviour, daytime drowsiness, addiction |
| Alternative treatments | Sleep and lifestyle changes, behavioural therapy, psychotherapy, stress management, diet and nutrition counselling |
| Prevalence of use | 8 out of 10 children who visited a doctor for sleep problems were prescribed medication |
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Melatonin
When given in larger doses (3 or 5 mg) shortly before bedtime, melatonin has a hypnotic (sleepiness-inducing) effect. In much smaller doses (0.5 mg) taken earlier in the evening, it has a chronobiotic effect, shifting the body's circadian rhythms to induce sleep earlier. A bedtime dose is typically recommended for children who have difficulty falling asleep. Melatonin may be beneficial for children with neurological conditions like autism spectrum disorder or attention-deficit/hyperactivity disorder (ADHD).
It is important to note that melatonin does not keep children asleep. It may also make dreams more vivid, which can worsen sleep. Taking a large dose of melatonin can cause gastrointestinal issues or irritability, and it can interfere with the body's natural production of melatonin.
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Sedatives
In general, sleep medicines are rarely used to help children and teenagers sleep because of the potential side effects. Before considering medication, it is recommended to try sleep and lifestyle changes, such as adopting regular schedules, consolidating sleep to nighttime, improving bed-sleep association, and improving sleep hygiene and habits.
If your child has persistent sleep problems, doctors might prescribe melatonin or a sedative. Melatonin is typically recommended for children over the age of 2 who are autistic, have ADHD, or have low vision or blindness. It should be noted that melatonin is not approved for use by typically developing children in some countries. Melatonin usually works within 30-60 minutes, so your child should be settled and ready for bed before taking their nightly dose.
Sedative medicines, such as Vallergan and Phenergan, are generally not recommended for children under 2 years of age due to potential side effects like irritability, hyperactivity, challenging behavior, and daytime drowsiness. These medications should only be administered under the direct supervision of a doctor and are typically used in combination with strategies focused on improving bedtime routines.
Some over-the-counter medications like Benadryl, cough syrup, NyQuil, Tylenol PM, Advil PM, ZzzQuil, and Unisom are commonly used as sleep aids for children. However, it is important to consult a pediatrician before administering any of these medications, as they can have side effects.
Additionally, certain medical conditions, such as restless leg syndrome, periodic limb movement disorder, and low iron stores, can impact your child's sleep. In such cases, your doctor might recommend additional iron intake through foods or supplements to improve your child's sleep quality.
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Hypnotics
Some hypnotics, such as melatonin, are available over the counter and do not require a prescription. Melatonin is a hormone that regulates sleep-wake cycles and can help with insomnia and other sleep disturbances. It is important to note that while melatonin is available without a prescription, it should only be given to children under direct medical advice and supervision.
Other hypnotics, such as benzodiazepines, are prescription medications that may be considered for short-term use in children with insomnia associated with anxiety, mood disorders, psychosis, aggression, or medical procedures. However, benzodiazepines are not approved for long-term use in children due to the risk of misuse and side effects.
Nonbenzodiazepine hypnotics, such as eszopiclone, are also an option for treating insomnia in children. While the precise mechanism of action is unknown, it is believed to involve interaction with specific receptors in the brain. Similar to benzodiazepines, nonbenzodiazepine hypnotics are not FDA-approved for children and should be used with caution.
Overall, while hypnotics can play a role in treating insomnia and sleep disturbances in children, they should be used cautiously and under medical supervision. Behavioural interventions and lifestyle changes are typically the first line of treatment, with hypnotics being considered only when other approaches have been insufficient.
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Over-the-counter medications
Research has shown that parents commonly use over-the-counter medications as sleep aids for their children. The average age of the children in the study was 7.5 years, and the most commonly used over-the-counter drug to promote sleep was Benadryl, with 23.9% of parents reporting any use. This was followed by cough syrup (14.7%), NyQuil (7.95%), Tylenol PM (7.1%), Advil PM (5.7%), ZzzQuil (5%), and Unisom (4.05%). While nearly all parents who gave their child an over-the-counter medication as a sleep aid reported that these methods were effective, they were less aware of the side effects listed on the drug labels. For example, Benadryl can cause side effects such as irritability, hyperactivity, challenging behaviour, and daytime drowsiness in some children.
Diphenhydramine and hydroxyzine, histamine receptor blockers that act in the central nervous system to affect sleep onset and arousal, are also available over the counter. However, studies in children have shown variable results, with one study reporting reduced sleep onset latency and night awakening, while another reported no improvement. Tolerance to these medications can also occur.
It is important to note that medications are not the first treatment option for a child's sleep problems. Before considering medication, it is recommended to try sleep and lifestyle changes, such as improving sleep habits and making dietary and nutritional changes. If these changes do not help, it is best to consult a doctor, especially if the child's sleep problems are affecting their well-being, schoolwork, or relationships. Doctors may prescribe medication if other interventions are unsuccessful, but this should be done under direct medical advice and supervision.
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Prescription medications
It is important to note that medication is rarely the first treatment option for a child's sleep problems. Before considering medication, it is recommended to try sleep and lifestyle changes, such as improving sleep habits and making changes to the child's environment. These changes can include adopting regular schedules, consolidating sleep to nighttime, improving associations with bed and sleep, limiting screen time before bed, and improving sleep hygiene. If these changes do not help, it is advisable to consult a doctor or sleep specialist, especially if the child's sleep problems are affecting their well-being, schoolwork, relationships, or causing anxiety.
If a child's sleep problems persist despite trying different strategies, doctors might prescribe medication. However, it is important to note that there are currently no medications specifically approved by the U.S. Food and Drug Administration (FDA) for treating insomnia in young children. Doctors often have to decide which drug and dose are best by prescribing approved drugs for unapproved uses. Therefore, medication for children's sleep problems should always be used under direct medical advice and supervision.
Some of the prescription medications that might be considered include:
Melatonin
Melatonin is a natural hormone that regulates sleep and can be prescribed to children over the age of two who have persistent sleep problems or trouble falling asleep and waking up. It usually works within 30-60 minutes, so it is important for the child to be settled and ready for bed before taking their nightly dose.
Sedatives
Sedative medicines, such as Vallergan and Phenergan, can be prescribed for children over the age of two. However, these medicines should be used with caution as they can cause side effects such as irritability, hyperactivity, challenging behavior, and daytime drowsiness.
Antihistamines
Antihistamines are commonly prescribed to treat allergies, but they can also have a sedating effect, making them useful for treating sleep problems in children. Diphenhydramine, for example, is an over-the-counter antihistamine that can help with sleep onset and arousal.
Vasopressin-Related Medications
Desmopressin, a synthetic antidiuretic hormone, is used to treat primary nocturnal enuresis (bedwetting) in children older than six years. It works by increasing the reabsorption of water by the kidneys, reducing the likelihood of bedwetting.
Antidepressants
Tricyclic antidepressants are used to treat narcolepsy and enuresis (bedwetting). However, it is important to carefully consider the benefits versus the side effects of administering antidepressants to children.
Non-Benzodiazepine Hypnotics
These medications can be used to treat recalcitrant sleep-wake cycle disturbances related to autism, Smith-Magenis syndrome, and other conditions. While they can be effective, they are not currently FDA-approved for young children.
While these prescription medications can be helpful, it is crucial to closely monitor the child for any side effects and only use the medication as directed by a healthcare professional.
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Frequently asked questions
It is recommended that you consult a doctor before giving your child any medication to help them sleep. Doctors may prescribe medication like melatonin or sedatives, but this is usually combined with other strategies such as sleep and lifestyle changes.
Over-the-counter medications like Benadryl, cough syrup, NyQuil, Tylenol PM, and Advil PM are commonly used by parents to help their children sleep. However, it is important to consult a doctor before administering any of these medications to your child.
Even natural or herbal remedies can have side effects and should be used with caution. It is best to consult a doctor before giving your child any natural remedies to aid sleep.
There are several non-medical strategies that can help improve your child's sleep, such as establishing good sleep habits, stimulus control, sleep restriction, reduced arousal, and cognitive behavioural therapy (CBT).
If your child has a sleep disorder, it is important to consult a doctor or a sleep specialist. They may recommend behavioural strategies, medication, or a combination of both.
