Ashwin Lewis
Sleep problems are common among infants, children, and adolescents, with evidence suggesting that at least 25% of children experience sleep problems at some point during their development. While medication can be a useful adjunct, it should be used with caution and only after consultation with a doctor. This is because medications can have side effects, and there is a risk of overdose or dependence. Furthermore, very few drugs have been tested and approved for use in children. As such, doctors often prescribe medications off-label, meaning the drug is approved but not specifically for the use in question. This article will explore the various medications that can be used to treat sleep problems in young children, as well as alternative approaches that do not involve medication.
| Characteristics | Values |
|---|---|
| When to use medication | Only after trying sleep and lifestyle changes |
| Who to consult | GP, sleep specialist, pediatrician, psychiatrist |
| Medication decision factors | Child's developmental stage, family circumstances, insomnia type, sleep-wake pattern, co-occurring medical problems, side effects |
| Prescription medication | Melatonin, sedatives (Vallergan, Phenergan), antidepressants, antihistamines, hypnotics (diphenhydramine, hydroxyzine), nasal steroids (budesonide, fluticasone proprionate) |
| Over-the-counter medication | Herbal remedies (chamomile, hops, passion flower, St John's wort), supplements (valerian, omega-3, omega-6 fatty acids), dietary supplements |
| Prescription medication considerations | Not FDA-approved for children, potential side effects, potential for misuse, overdose, or exacerbation of health conditions, potential for long-term dependency |
| Over-the-counter medication considerations | Lack of testing, potential side effects, potential danger when mixed with prescription medication |
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What You'll Learn
Side effects of sleeping medication for children
Sleep medicines are rarely used to help children sleep because they can have side effects. Even herbal or 'natural' remedies can have side effects and are not recommended for children. Before considering medication, it is best to try sleep and lifestyle changes to help your child sleep better.
If your child has persistent sleep problems, doctors might prescribe medication like melatonin or a sedative. Melatonin is a hormone produced naturally by the brain when it gets dark at night, helping the body fall asleep and maintain its body clock. However, melatonin should only be given under direct medical advice and supervision. Melatonin is available in a range of branded products, including Circadin (modified-release tablets) and Slenyto (prolonged-release tablets).
Sedative medicines include Vallergan and Phenergan and are not recommended for children under 2 years of age. These sedatives can cause side effects such as irritability, hyperactivity, challenging behaviour, and daytime drowsiness in some children.
Antihistamines are another common medication choice for treating sleep problems in children. Diphenhydramine and hydroxyzine, for example, are histamine receptor blockers that act on the central nervous system to affect sleep onset and arousal. However, studies in children have shown variable results, with one study reporting reduced sleep onset latency and another showing no improvement.
Doctors have also prescribed antidepressants for sleep problems in children, although these medications have not been approved for treating insomnia. Trazodone, an atypical antidepressant prescribed for adults, has no studies supporting its use in children.
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Melatonin for children
Melatonin is a hormone that the body produces to regulate sleep. It is also sold as an over-the-counter sleep aid in the form of a dietary supplement. Synthetic melatonin mimics the effects of the melatonin produced by the brain, helping to induce sleepiness.
While melatonin is a popular sleep aid for children, it is not regulated, and there have been recent warnings about melatonin overdoses in children. In the US, melatonin is available over the counter, but in countries like the UK, Japan, and Australia, it is regulated as a prescription medication.
Doctors may prescribe melatonin to treat persistent sleep problems in children over two years old. Melatonin may also be recommended for children with neurological conditions like autism spectrum disorder or attention-deficit/hyperactivity disorder (ADHD). However, it is important to note that melatonin is not a long-term solution and may not be suitable for children with nightmares, as it may make dreams more vivid.
Before considering melatonin, it is essential to implement healthy sleep practices and routines. This includes maintaining a regular sleep schedule, limiting screen time before bed, and creating a sleep-friendly environment. If your child continues to have difficulty falling asleep despite these interventions, consult a healthcare professional, who can advise on the appropriate use and dosage of melatonin.
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Non-prescription sleep medication for children
In Australia, sleep medicines are rarely used to help children sleep because of the risk of side effects. Instead, it is recommended to first try sleep and lifestyle changes, such as adopting regular schedules, consolidating sleep to nighttime, and improving sleep hygiene.
If your child is over 2 years old and has persistent sleep problems, a doctor might prescribe melatonin, a sedative, or an antihistamine. Melatonin is available in a range of branded products, including Circadin and Slenyto, and usually works within 30-60 minutes. However, it is important to note that melatonin has not been approved by the Therapeutic Goods Administration for use by typically developing children, and there is a lack of research into whether it is safe for kids. In rare cases, it can cause problems with a child's heart, and it may also cause dizziness, nervousness, stomach pain, rashes, or itching.
Some non-prescription sleep remedies that are available in health food shops include chamomile, hops, passion flower, St John's Wort, valerian, and omega-3 and omega-6 fatty acids (fish oil). However, there is little evidence to show that these herbal remedies help with sleep problems, and they do not go through the same testing as prescription medicines.
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Antihistamines for children
Antihistamines are medications that block histamine receptors in the body. Histamines are chemicals that the body releases during allergic reactions, causing symptoms such as a runny nose, sneezing, and itchy eyes. Antihistamines can be taken orally or nasally and are commonly used to treat allergies or hay fever.
When it comes to children's sleep problems, antihistamines are sometimes prescribed off-label by doctors. Off-label prescription occurs when a drug approved for one purpose is prescribed for a different use. Antihistamines are not specifically approved as sleep medications for children, but they are chosen for this purpose 33% of the time. Diphenhydramine (Benadryl) and hydroxyzine are examples of antihistamines that act on the central nervous system to affect sleep onset and arousal. However, it is important to note that diphenhydramine is no longer recommended as a first-line treatment due to its more severe side effects, including sedation and overdose.
In terms of oral antihistamines for children, Zyrtec, Claritin, and Allegra are commonly recommended for ages 2 and up. Zyrtec (cetirizine) is fast-acting and can take effect within an hour, but it also carries a higher potential for drowsiness. Claritin (loratadine) may take up to three hours to work and may cause minor drowsiness. Allegra (fexofenadine) is another option, but it is important to always consult a doctor or pediatrician before administering any medication to a child, as formulations and dosages vary and safety considerations are crucial.
While antihistamines may be considered for children's sleep problems, it is important to remember that medicine might not be the best solution. Sleep problems in children often require a comprehensive approach that includes behavioural strategies and lifestyle changes. Cognitive behavioural therapy (CBT), stimulus control, sleep restriction, reduced arousal, and chronotherapy are some evidence-based interventions that can help improve sleep habits without the need for medication.
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Sedatives for children
Sleep problems are common among infants, children, and adolescents, with at least 25% experiencing difficulties at some point during this developmental period. While sedatives and other medications can be prescribed to treat sleep problems in children, it is important to exercise caution and closely monitor for potential side effects.
Behavioral Strategies and Lifestyle Changes:
Before considering medication, it is recommended to try behavioral strategies and lifestyle changes to improve sleep habits and the sleep environment. These can include extinction techniques, bedtime fading, the bedtime pass technique, stimulus control, sleep restriction, reduced arousal, and chronotherapy. Cognitive behavioral therapy (CBT) is another effective approach, particularly for psychophysiological insomnia and anxiousness.
Melatonin:
Melatonin is a hormone that plays a crucial role in regulating sleep-wake cycles. While it is sometimes prescribed to children with persistent sleep problems, it has not been approved for use by typically developing children by the Therapeutic Goods Administration. Melatonin should only be given under direct medical advice and supervision. Possible side effects include dizziness, nervousness, stomach pain, rash, and a fast heart rate.
Sedative Medicines:
Sedative medicines, such as Vallergan and Phenergan, are typically recommended for children over the age of two. These medications should only be given under the supervision of a doctor, who will determine the appropriate dose and provide instructions for administration.
Antihistamines:
Antihistamines are commonly chosen to treat sleep problems in children. Diphenhydramine and hydroxyzine, for example, are histamine receptor blockers that affect sleep onset and arousal. However, it is important to note that these medications are often prescribed off-label, as there are currently no FDA-approved medications for insomnia in children.
Other Medications:
In some cases, doctors may prescribe antidepressants or drugs that treat high blood pressure to help with sleep problems in children. Additionally, for conditions like obstructive sleep apnea (OSA), first-line treatment typically involves adenotonsillectomy, followed by continuous positive airway pressure (CPAP) or nasal steroids if surgery is not an option.
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Frequently asked questions
It is recommended that you consult a doctor or pediatrician before administering any medication or supplement to a child. There is no FDA-approved medication for insomnia in children, and medication should only be used in rare circumstances for children under 5 years old. Doctors may prescribe melatonin for children over 2 years old with certain conditions, but this is not recommended except under medical advice and supervision.
Melatonin can sometimes cause problems with your child's heart, including chest pain and a fast heart rate. Other possible side effects include dizziness, nervousness, stomach pain, rashes, and itching. If you notice anything unusual and are concerned, contact your doctor.
Yes, there are several alternatives to medication that can help with children's sleep problems. These include simple sleep and lifestyle changes, such as improving sleep hygiene, adopting regular schedules, and consolidating sleep to nighttime. Cognitive behavioral therapy (CBT) is another effective option for treating insomnia and anxiousness in children.
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