Sleep Drugs Often Prescribed for Kids

Children with sleep problems are likely to be prescribed a
sleeping pill or other medication approved only for adults, according to a new
study.

When researchers from The Ohio State University and the University of
Missouri evaluated 18.6 million children's doctor visits for sleep problems,
they found that 81% of visits included a prescription for a medication. The
study appears in the Aug. 1 issue of the journal Sleep.

"The findings raise concern because of the large number of patients
affected," says researcher Milap C. Nahata, PharmD. Nahata is professor and
division chairman at Ohio State's College of Pharmacy and professor of
pediatrics and internal medicine at the College of Medicine. "We tend to
jump on medication right away."

While he and other sleep experts agree that medication may sometimes help
children with sleep problems, they suggest medication is best used in
combination with other approaches, such as behavioral therapy. Nahata tells
WebMD that studies of the medications in children are needed.

Prescription Patterns for Children With Sleeping Problems

For the study, Nahata and his colleagues evaluated information from a large
database, the National Ambulatory Medical Care Survey, from 1993 to 2004, to
find out what doctors prescribed or advised when young patients came in for
help with sleep problems.

Children were aged 17 and under, all experiencing sleep difficulties such as
insomnia. Most visits were by children ages 6 to 12. Pediatricians,
psychiatrists, family practice doctors, and others saw the patients.

Among the medications prescribed were sleeping pills such as Ambien and
Sonata as well as other medications sometimes prescribed to help sleep
problems, such as the antihistamine Atarax, the antidepressant Desyrel, and the
high blood pressure medicine Catapres.

Antihistamines were most often prescribed for the children's sleep problems,
given in 33% of the visits, followed by blood pressure drugs (26%),
benzodiazepines such as the sleeping pill Restoril (15%), antidepressants (6%),
and nonbenzodiazepine drugs such as the sleeping pills Ambien and Sonata
(1%).

Doctors prescribing the medications that are not approved for use in
children did so "off-label," a legal and common practice.

Nahata says his team did the study because there has not been a large study
on the topic so far.B The results surprised him, he tells WebMD.

"I was thinking one-third [of visits would involve prescription
medication]," he says. Beyond the scope of the study, he says, was whether
the medications prescribed were appropriate for the condition and how long the
children used them.

Alternative Treatments for Children With Sleeping Problems

Nahata's team also looked at how often other approaches for children with
sleeping problems were advised. They found that diet and nutritional counseling
were advised for 7% of children and that 22% were prescribed behavioral therapy
such as psychotherapy and stress management to relieve the sleep problems.

For 19% of children, both behavioral therapy and medication were
advised.

While sleep difficulties are often thought of as an adult-only problem, that
is not the case. At various times in their lives, Nahata says, up to 25% of
infants, children, and teens have some sort of sleep problem.

Besides insomnia, sleep difficulties in children of school age can include
sleepwalking, nightmares, sleep talking, restless sleep, and refusal to go to
bed. In teens, inadequate sleep is also a frequent problem. Drinking too much
caffeine in sodas can cause disturbed sleep.

Second Opinion

Another sleep expert says he is not surprised that the medication use is
that high among children. But "it is a concern, the 81% finding," says
William Kohler, MD, medical director of the Florida Sleep Institute in Spring
Hills and diretor of pediatric sleep services at University Community Hospital
inB Tampa. Fla. He is familiar with the study results but was not involved
in the study.

Like Nahata, Kohler calls for studies of the medications in children.

But treating children with sleep problems is crucial, and the earlier the
better, he says. "A child who does not sleep well does not learn well or
behave well," he says.

Medication can help, Kohler says, if it is appropriately prescribed. If
medication is needed, it's ideally used until improvement is seen, and then the
child should be weaned off, Kohler says. Medication shouldn't be used alone;
behavior therapy and other strategies are usually advised as well, he says.

What Parents Can Do

Setting up a healthy bedtime routine and making the child's bedroom
conducive to sleep can help, Kohler says.

Bedtime and awakening times should be the same from day to day, Kohler says.
"Get the TV out of the bedroom, get the Nintendo out."

"Cut out the caffeine after 2 p.m. or 3 p.m., and ideally right after
lunch," Nahata says.

Knowing how much sleep a child needs at various ages is important, too.
According to Nahata, an infant needs 14 or 15 hours a day, children aged 1 to 5
need 12 to 14, children 6 to 12 need 9 to 11, and teens need 9 to 9.25
hours.

By Kathleen Doheny
Reviewed by Louise Chang
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