July 27, 2010 -- Insomnia significantly affects 29 percent of children seen by child psychiatrists, according to a national survey.
Roughly one-quarter of these patients with insomnia as a "major problem symptom" receive sleep medications, although none are approved by the U.S. Food and Drug Administration for pediatric use, found Dr. Judith A. Owens of Rhode Island Hospital and Brown University in Providence, R.I., and colleagues.
Daytime functioning concerns drive sleep medication use, whereas concerns about side effects and lack of research suggesting the drugs are effective in kids constitute the biggest barriers to use, they reported.
The survey of 1,273 members of the American Academy of Child and Adolescent Psychiatry appeared in the August issue of Sleep Medicine. The mailed survey, which had a 26.6 percent response rate, indicated increasing difficulty with insomnia as children got older.
The prevalence of insomnia as a major problem symptom during a typical one-month period rose from 8.4 percent in patients up to 2 years old to 28 percent among those age 6-12 and 32 percent among those 13-18.
Use of medication to address those symptoms also rose with age, from 3.5 percent in those age 2 and under to 25 percent among those 6-12 and 29.2 percent among those 13-18.
In most cases, the strategy was a single medication with hypnotic or sedating properties that could manage both the psychiatric disorder and the insomnia symptoms (45 percent), "presumably to minimize drug-drug interactions and side effects."
Another 23 percent of patients got a sleep medication added to existing psychotropic medication. The researchers cautioned that the high variability among the survey respondents in terms of their use of other medications could have affected the conclusions of the research. But 96 percent of the respondents overall said they recommend at least one prescription medication for sleep symptoms in a typical month.
"The broad array of psychotropic medications that child psychiatrists use to treat insomnia indicates that there is a high degree of variability in their psychopharmacologic approach to insomnia -- not surprising given the lack of empirical support for safety and efficacy of most of these drugs in the pediatric population," the researchers wrote in the paper.
These findings appeared to suggest more common prescription by psychiatrists than seen in a prior surveys of community pediatricians in which 40 percent to roughly half endorsed prescribing sleep medication for children with insomnia.
The higher rate among child psychiatrists may not come as much of a surprise, the researchers suggested.
"Virtually all psychiatric and neurodevelopmental disorders in children, including depression, ADHD, and autism spectrum disorders, can be associated with delayed sleep onset and sleep disruption as well as with daytime sleepiness, fatigue, and abnormal circadian sleep patterns," they wrote in the paper.
The researchers cautioned that their study had a low response rate and may not have been entirely representative of national practice since it excluded general psychiatrists, who may also see children and adolescents as part of their practice