Despite a lack of clinical consensus, prescribing medications for sleep disturbances in hospitalized children is "somewhat common"—especially for those with psychiatric diagnoses—researchers report in the June issue of Pediatrics.
"Sleep disturbances are one of the most common behavioral problems experienced by children and adolescents," write Dr. Lisa J. Meltzer, of Children’s Hospital of Philadelphia, Pennsylvania, and colleagues. "They are especially prevalent in special populations, including hospitalized children, and few data exist on the treatment of sleep disturbances in this population."
The researchers examined the use of sleep medications in hospitalized children via a chart review for all patients at three pediatric hospitals across 26 days in 2004. Demographic, medical, and medication data were collected on a total of 9440 patients.
The children had a mean age of 7.0 years. The sample was 54.5% male and 63% white. At least one psychiatric diagnosis was made in 18.6% of the subjects.
Overall, 6% of the hospitalized children, and 3% of those hospitalized for a medical (nonpsychiatric) diagnosis, were prescribed a sleep-related medication.
The most frequently prescribed medications were antihistamines (36.6%), followed by benzodiazepines (19.4%). Other medications that were prescribed for sleep disturbances included antipsychotic agents (16.4%) and alpha agonists (10.4%). The least frequently prescribed medications were nonbenzodiazepine hypnotic agents (2.2%).
The investigators observed significant differences in the frequency of sleep-medication prescriptions and the types of medications prescribed across hospitals. Significant differences were also found for age, length of hospitalization, and service that the child was discharged from.
"A striking finding in this study was that children on a psychiatric service and/or with a psychiatric diagnosis are the ones most likely to receive such a medication," Dr. Meltzer’s team reports. "In this study, 22% of children on a psychiatric service received a sleep-related medication, and more specifically 30% of children with autism and 20% of children with ADHD received a sleep-related medication."
They point out that there are no FDA-approved sleep medications for children or "clinical consensus guidelines about type/specific medicines that should be used." Clinical trials and guidelines are needed, the researchers conclude.