Abstract
AbstractThroughout their childhood, pediatric insomnia impacts approximately 25% of all children in the general population. Although it can occur as an isolated condition, it commonly associates with other comorbidities, such as autism, developmental delay, and psychiatric disorders. Careful and detailed history is essential, and sleep logs and actigraphy are useful tools in the assessment and diagnosis of pediatric insomnia. However, polysomnography is usually not warranted in the assessment of pediatric insomnia unless underlying medically-based sleep symptoms are concurrently identified and justify such test. In the majority of cases, behavioral interventions are the recommended approach for treatment. Despite the fact that many pharmacological approaches are used for child insomnia off-label, there are currently no FDA (Food and Drug Administration) approved medications for the management of pediatric insomnia. The high prevalence of pediatric insomnia, coupled with the low number of providers, who are formally trained in behavioral treatment for this prevalent condition, highlights the urgent need for improving primary care practitioner awareness, while expanding alternative routes to access to care, such as interactive virtual technology-based treatments, parent education and manuals, along with ongoing efforts to increase professional training opportunities.
Highlights
There is little if any doubt that adequate sleep is an essential ingredient of wellness and the enhanced sleep needs manifested by developing children further attest to the importance of this physiological state in optimal growth and intellectual and emotional development
When suboptimal sleep develops a chronic longer lasting pattern, the diagnostic concept of insomnia needs to be invoked and pursued to identify the factors and trigger underlying such issue and proceed with the necessary interventional steps that will lead to a return to the optimal equilibrium of sleep and waking for each of the family members
The purpose of this review is to summarize the current literature pertaining to pediatric insomnia.[1]
Summary
There is little if any doubt that adequate sleep is an essential ingredient of wellness and the enhanced sleep needs manifested by developing children further attest to the importance of this physiological state in optimal growth and intellectual and emotional development. The American College of Physicians released a paper in 2016 stating that Cognitive Behavioral Treatment for Insomnia (CBT-I) is the first line recommendation for chronic insomnia.[54] Use of sleep hygiene, sleep restriction, stimulus control, relaxation strategies, and cognitive sessions (e.g., worry-time and cognitive restructuring) are utilized in CBT-I (►Table 1) Pediatric versions of these strategies have been developed to address age-related needs (►Table 2). This is an alarming given that the FDA (Food and Drug Administration) has not yet approved any medication for treatment of insomnia in children, even if many drugs are currently prescribed off-label for insomnia in children.[59,60,61] While prescription medication has not been approved, evidence form published studies in the past 15 years supports the overall efficacy and tolerability of melatonin for insomnia in children.[62,63,64,65,66] Melatonin is considered beneficial for insomnia in children with autism[67,68] or special needs.[69,70]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
