The profound impact on the physical and mental health of a child and the distress for families and carers of children with long-term sleep disorder is not to be underestimated39.
Sleep problems are commonly associated with certain genetic and neuro-developmental problems seen in childhood including ADHD, autism, learning difficulties and epilepsy. However, training and awareness of paediatric sleep disorders is poor, and accurate diagnoses and hence appropriate treatments are often delayed97.
Evidence from a systematic review suggests that most sleep disorders in childhood respond well to behavioural treatments49. Appropriate sleep hygiene measures and more specific techniques of extinction are all more effective than placebo at improving sleep and reducing the number of weekly night wakes in otherwise healthy children who regularly wake up in the night74. These interventions hold for both typically developing children and children with learning difficulties and sleep problems. These interventions may not change sleep parameters in the child, but instead improve outcomes related to impact on parents and other carers.
Unlicensed use of melatonin in children and young people
NICE has developed an evidence summary describing the unlicensed/off-label use of melatonin to treat sleep disorders in children and young people with ADHD65. It considered three small studies in children aged 6 to 14 years with ADHD, stating that “this small amount of evidence indicated that taking unlicensed melatonin just before bedtime reduced the time it took the children to fall asleep (after lights out or when they were put to bed) by approximately 20 minutes. It also improved the total time they were asleep by an average of approximately 15 to 20 minutes.” (None of these studies used off-label prolonged-release melatonin and none of them took place in the UK.)
In the absence of NICE guidance, the BNF for Children10 states: “Little is known about [melatonin’s] long-term effects in children, and there is uncertainty as to the effect on other circadian rhythms including endocrine or reproductive hormone secretion. Treatment with melatonin should be initiated and supervised by a specialist, but may be continued by general practitioners under a shared-care arrangement. The need to continue melatonin therapy should be reviewed every 6 months.”
The Royal College of Paediatrics and Child Health80 and British Association of Psychopharmacologists97 suggest that melatonin may be of value for treating sleep problems in children when appropriate behavioural sleep interventions fail.