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By Alan Mozes
WEDNESDAY, Aug. 1 (HealthDay News) -- More than 80 percent of American children who visit a doctor for help combating sleep problems are given some form of prescription medication, new research has found, despite the fact that no sleeping pills are currently approved for use in kids.
"The concern with sleep medications is that we don't know how much to use and how long to use these drugs for children," explained study co-author Milap C. Nahata. "This is because many drugs used for pediatric care in general -- including sleep medications -- have been well-studied and approved by the FDA but have not been studied for effectiveness and safety among children."
Nahata is a professor of pediatrics and internal medicine and a division chair at the Ohio State University College of Pharmacy in Columbus. His team's study is being published in the Aug. 1 issue of Sleep.
The new findings complement a 2004 National Sleep Foundation poll that revealed that sleep difficulties are extremely widespread among the young.
That survey found that 60 percent of American boys and girls under the age of 11 experience some kind of trouble getting shut-eye at least a few nights a week, while nearly three-quarters of parents indicated that they would like to alter something about their child's sleep behavior.
Nahata and his colleagues noted that, in the United States, about 75 percent of all prescription drugs are not labeled for pediatric use, and not a single insomnia drug is indicated for use among young patients.
In their study, the authors analyzed data collected between 1993 and 2004 by the National Ambulatory Medical Care Survey.
The researchers focused on information concerning survey patients 17 or younger with sleep difficulties who sought care as outpatients.
During that 12-year period, approximately 18.6 million visits were registered by children seeking help with a sleep disturbance. The largest slice -- 36 percent -- involved kids six to 12 years of age. Adolescents (aged 13-17) accounted for another third of the patient pool.
Just over a third of the patients were seen by pediatricians, while under a quarter sought care from psychiatrists. Another 13 percent visited family practice doctors.
In terms of therapies prescribed, the researchers found that 7 percent of the patients were recommended diet and nutritional counseling, while 22 percent were offered behavioral therapy. Mental health and stress management treatment was offered to 17 percent of patients.
By contrast, 81 percent of the children and teens were prescribed some sort of medication for their sleep issues.
Specifically, about a third were prescribed antihistamines, about a quarter were offered alpha-2 agonists, 15 percent were offered benzodiazepines, and 6 percent received prescriptions for antidepressants. A combined regimen of medication plus behavioral therapy was prescribed in just under a fifth of cases.
Patients who sought care from a psychiatrist were more than three times as likely to be prescribed a drug for their sleep trouble than those who visited a general practice physician.
The study did not explore how often the young patients actually filled their prescriptions, or why doctors so readily turned to pharmaceutical solutions to pediatric sleep woes.
Nahata emphasized, however, that his study simply tracked the types of sleep medicines being prescribed for children and the frequency of their usage -- it was not an attempt to gauge the appropriateness of any particular therapy. He believes further research is needed to explore such issues.
"And I'll say that, legally, I'm glad physicians can prescribe these drugs off-label for children when they need to," he added. "Because sometimes they can help. But the point is that, when these drugs are utilized for pediatric care, we need to exercise caution."
But Dr. Gregg Jacobs, an insomnia specialist with the Sleep Disorders Center at the University of Massachusetts Medical School in Worcester, Mass., said prescribing drugs often sidesteps the underlying causes of sleep trouble.
"Children are in the golden years of sleep," he observed. "It's not normal for them to have sleep problems. So, if they do, then you know something's wrong. And medicating the child doesn't get to the heart of the problem. It's more important to figure out what's going on. Is it stress, caffeine, a problem in the home environment?"
Jacobs added that, despite heavy marketing by drug companies designed to convince patients and physicians that prescription sleep aids are an easy and cheap solution, he believes that such therapies are only "marginally effective," regardless of the patient's age.
"And there are many side effects among adults that may be even more serious among children," he cautioned. "Patients may develop tolerance or dependence on these medications, and they often cause daytime sedation and sometimes amnesia. And probably the biggest shocking thing is that regular nightly use of sleeping pills is associated with an increased mortality rate among adults. This is shown in a dozen studies."
"Besides which, behavioral methods of treatment are extremely effective," added Jacobs. "So, why would you want to risk giving this medication to children, when they're probably not very effective and would be masking the real problem in any case? Sleeping pills should be a last resort."
For additional information on sleep and children, visit the Nemours Foundation.
SOURCES: Milap C. Nahata, Pharm.D., professor, pediatrics and internal medicine, and division chair, Ohio State University College of Pharmacy, Columbus, Ohio; Gregg Jacobs, M.D., insomnia specialist, Sleep Disorders Center, University of Massachusetts Medical School, Worcester, Mass; Aug. 1, 2007, Sleep
Last Updated: Aug. 01, 2007
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