Overview of current management of sleep disturbances in children: I - Pharmacotherapy

The increasing appreciation of the short- and long-term detrimental impact of childhood sleep disturbances may be partly responsible for the increasing acceptance of pharmacologic management (undertaken by parents acting on the recommendation of a physician or independently without a physician's advice) despite the lack of data from controlled studies. Recent advances in clinical trial design and the increased ability to measure children's responses to pharmacologic interventions have enhanced our ability to conduct the necessary well-controlled studies in pediatric psychopharmacology. With the aim of providing a point of reference for these endeavors, this paper summarizes current knowledge of the clinical pharmacology, efficacy, safety, and tolerability of the drugs most commonly used as soporifics in children. Pharmacotherapies for sleep disturbances have been studied less in children than in adults, and - in part because of the paucity of pediatric data - the clinical benefits of currently prescribed agents are even more equivocal. The failure to identify optimal pharmacotherapy for pediatric sleep disturbances to date should not discourage research in this area. There is a palpable need for effective, well-tolerated pharmacotherapies that can mitigate or eliminate the detrimental effects of poor sleep on children's mood, cognition, and daily function without causing unwanted side effects or otherwise endangering the child. New, well-tolerated, nonbenzodiazepine hypnotics such as zolpidem and medications such as melatonin, in combination with environmental and/or behavioral interventions, are potential therapeutic options that await further study.