Treatment of Pediatric Insomnia with Melatonin

A doctor was once visited by a mother who brought her 12 y/o child. The mother came with a complaint that her child was barely having proper sleep cycles. She was employed and was on melatonin dose to get better sleep. She asked the doctor that if the same melatonin can help his child in having a good sleep! From the story, we can encounter issues that need to be addressed.

❖ Insomnia and its melatonin-related treatment.

❖ Is melatonin-related treatment for Insomnia safe for children.

Case Study:

It is estimated that up to 25% of healthy youths and children, and 75% of kids with neural impairment or psychiatric conditions suffer from irregular sleep cycles (Owens 628) (Mindell at al. 1223). This abnormal sleep syndrome is the leading cause of many negative effects like memory problems, depression, hyperactivity, poor academic performance, etc (Owens 628) (Millman 1774). Melatonin combined with the evaluation of insomnia examination can be an effective treatment for children suffering from delayed sleep phase syndrome.

Pediatric insomnia:

Pediatric insomnia is the persistent difficulty with initiation, duration, quality of sleep that occurs without referring to age and daily functioning diseases among children and their families (Mindell et al.1223). Among all, the most prevalent types of insomnia disease are children behavioral insomnia and delayed sleep phase syndrome (DSPS) (Owens 1001) (Pelayo 79).

Causes of Insomnia:

DSPS is the most prevalent cause of insomnia in teens(Pelayo 79). The administration of melatonin to improve sleep hygiene can be beneficial (Millman 1774). While sleep difficulties in todd lers are frequently linke d to fears (Owens 1001) (Pelayo 79).  In a normally growing infant insomnia is unlikely to occur due to behavioral or feeding issues. A few of them may suffer due to, gastroesophageal reflux or an interrupted sleep (Pelayo 79).

Melatonin related treatment of Insomnia:

Melatonin is a hormone produced spontaneously by the pineal gland, and its release is controlled by the hypothalamus (Millman 1774) (Owens 1001). Melatonin secretion begins at 3 months after birth, with high amounts produced at night and low amounts released during the day(Rivkees 373).

In the current times though, there are several pediatric recommendations to treat insomnia, melatonin is becoming a popular alternative among parents and practitioners (Mindell at al. 1223) (Cummings C 331). 

According to a double-blind placebo experiment the drug was efficient in enhancing the quality and duration of sleep in children receiving it as compared to the placebo ones. This shows that melatonin can be effective when it is given in appropriate dosages to the children (Smits 86).

Some societal recommendations for the melatonin related dosages for insomnia are:

❖ 1 mg of melatonin in infants

❖ 2.5 to 3 mg in older children

❖ 5 mg in adolescents (Cummings C 331).

❖ Children with special needs should be given melatonin with a range of 0.5 to 10 mg (Pelayo79)(Andersen 485).

❖ Melatonin is recommended to be administered 30 to 60 minutes before bedtime (Pelayo 79).

Practitioners should ensure that children are followed up frequently to reassess their sleeplessness and assess whether or not melatonin should be maintained. 

Is melatonin-related treatment for Insomnia safe for children?

Even after proven testing, it is usual for a common man to ask for the safety of melatonin for his child. Through testing conducted in the Netherlands, we are convinced that melatonin is safe to be used for children. 65 percent of 101 Dutch children who were between 6 to 12 years, suffering from attention deficit hyperactivity disorder and DSPS, took melatonin for 4 weeks (3 mg for children weighing less than 40 kg and 6 mg for children weighing more than 40 kg) and continued to use melatonin daily. Even after 3.7 years, their parents reported no concerns or adverse side effects regarding the dosage (Hobert 1).

Conclusions

According to expert panels, melatonin should be administered for circadian rhythm disorders, especially DSPS, with frequent follow-up for insomnia assessment. Melatonin may be an appropriate treatment for children with insomnia who have unremarkable medical histories and physical examination results and who practice excellent sleep hygiene.

References.

Mindell, J A, Emslie, G, Blumer J, Genel et al. "Pharmacologic management of insomnia in children and adolescents: Consensus Statement." Pediatrics, vol. 117, 2006, pp. 1223-1232.

Millman RP. "Excessive sleepiness in adolescents and young adults: Causes, consequences, and treatment strategies." Pediatrics, vol. 117, 2005, pp. 1774-1786.

Owens, J, A, and Moturi, S. "Pharmacologic treatment of pediatric insomnia." Child Adolesc Psychiatr Clin N Am, 2009, pp. 18, pp. 1001- 1006.

Pelayo R, and Dubik, M. "Pediatric sleep pharmacology." Semin Pediatr Neurol, vol. 15, 2008, pp. 79-90.

Cummings C. "Melatonin for the management of sleep disorders in children and adolescents." Paediatr Child Health, vol. 17, 2012, pp. 331- 333.

Rivkees SA. "Developing circadian rhythmicity in infants." Pediatrics, vol. 112, 2003, pp. 373-381.

Pelayo, R, and Yuen, K. "Pediatric sleep pharmacology." Child Adolesc Psychiatr Clin N Am, vol. 21, 2012, pp. 861-883.

Andersen, I, M, Kaczmarska, J, McGrew, S, G, and Malow, B, A. "Melatonin for insomnia in children with autism spectrum disorders." J Child Neurol, vol. 23, 2008, pp. 482-485.