A study published in the journal Sleep Medicine has found that Canadian pediatricians and family physicians have been prescribing sleep-promoting medications to children without proper guidelines or training in pediatric sleep disorders.
Researchers from Western University, the Lawson Health Research Institute and the Children’s Health Research Institute surveyed pediatricians and family physicians in Southwestern Ontario and found that over a typical 6 month period, 89 per cent of respondents recommended over-the-counter medications to children with sleep problems and 66 per cent recommended prescription medications, yet only 20 per cent of pediatricians and family physicians had received formal training in pediatric sleep disorders.
“Our data underlines the need for evidence-based data and guidelines on the management of pediatric insomnia, and indicate a gap in the training of Canadian physicians with regard to pediatric sleep disorders,” say the study’s authors.
Research indicates that physicians may frequently use pharmacotherapy to treat pediatric insomnia despite minimal safety data and very limited indications.
The authors further argue that currently there is not enough research to verify the safety and efficacy of these drugs for children. Doctors who take the pharmaceutical route in responding to concerns about a child’s insomnia or sleep disorder are, according to the survey, either recommending over-the-counter medications like melatonin or antihistamines or prescribing antidepressants or benzodiazepines. But none of these drugs have been approved for treatment of pediatric insomnia by the U.S. Food and Drug Administration, and the one position paper on the topic from the Canadian Paediatric Society says for the drug melatonin more research is needed on its use to manage sleep disorders in children and adolescents.
“Research indicates that physicians may frequently use pharmacotherapy to treat pediatric insomnia despite minimal safety data and very limited indications,” say the study’s authors.
Insomnia is a common concern raised by caregivers about their children. According to a report by Shelly K. Weiss and Penny Corkum of the Canadian Sleep Society, up to 25 per cent of children are affected by pediatric behavioural insomnia, which can be a significant source of stress for both caregivers and children. Children with neurodevelopmental disorders such as autism spectrum disorder or attention deficit hyperactivity disorder (ADHD) are at greater risk for developing sleep disorders but for others, a lack of proper sleep hygiene can often be part of the problem. Developing good bedtime habits is important. Caregivers need to ensure that there’s a consistent routine around bedtime, that age-appropriate sleep and wake times are followed and that nightly activities help create an environment conducive to healthy sleeping.
“Good sleep is important for optimal growth and development. Most children respond with resolution of the sleep difficulties with a behavioural approach to treatment,” say Drs. Weiss and Corkum.
The London, Ontario, study was based on survey responses from 28 pediatricians and 33 family physicians within Southwestern Ontario. Results match with data from other countries, such as in the United Kingdom where 68 per cent of pediatricians had prescribed sleep-promoting drugs to children and in the United States where 77 per cent of surveyed pediatricians had recommended over-the-counter medications and 58 per cent had prescribed drugs to treat insomnia in children.
The authors of the study urge that a larger national study of sleep-promoting medications and their current uses in Canada be undertaken.