Po1373 Insomnia In Children: A Pharmacological Approach

Pedro Sousa1, Inês Amorim2, Alexandra Duarte3, Ana Rodrigues4 e Miguel Magalhães
1USF Ramalde; 2USF de Ermesinde; 3USF São João de Sobrado; 4USF Covelo
Introduction:Sleep disturbances commonly occur in young children. Up to 40% of children experience difficulty in initiating and maintaining sleep. Sleep disturbances in children can be caused by organic (e.g. obstructive sleep apnoea) or behavioural factors (e.g. limit setting disorder, sleep onset association, insomnia). Prevalence of chronic sleep onset insomnia in the non-disabled school-aged population is approximately 10%. In general sense, the operational definition of insomnia in children may be construed as similar to that in adults. A chronically reduced sleep due to insomnia may induce various cognitive and behavioural problems in children as well as more widespread difficulties within their families. The most frequent clinical manifestations of childhood insomnia are bedtime refusal, delayed sleep onset, and/or prolonged night awakenings requiring parental intervention.
Objective: Review the existing literature of children insomnia´s pharmacological treatment.
Methods: Articles published in scientific databases, in English and Portuguese, in the last 10 years using the MeSH terms: Child, Sleep Initiation and Maintenance Disorders and Drug Therapy.
Results and Discussion: A variety of medications like antihistamines, antidepressants, benzodiazepines, etc have been prescribed to treat this problem. However little empirical data regarding the efficacy, safety and tolerability of pharmacological interventions exist in the paediatric population and no medications are approved for use as hypnotics by FDA in children. Certain interventions as graduated extinction, positive routines or parental education, are the mainstay and first choice for treatment of paediatric insomnia. Medication should be used in combination with non-pharmacological strategies because of the faster and more powerful effects. Because of the currently available empirical evidence, pharmacological insomnia treatment in children is inadequate to rank recommendations for the use of these previous medications. The focus is on a description of the drug properties and any specific cautions regarding its use in the paediatric population. Thus, the treatment selection should be based on the clinician’s judgement, regarding the clinical circumstances and the properties of the available drugs. Therefore, clinicians should know the pharmacological profile of the sedative/hypnotics drugs currently used in the paediatric population which, in general, should be used for the shortest period of time.
Child; Sleep Initiation; Maintenance Disorders ; Drug Therapy