Pharmacotherapy for pediatric sleep disturbances: Current patterns of use and target populations for controlled clinical trials

The systematic study of pharmacologic treatment of sleep disturbances in children requires both careful selection of patients and a thorough and consistent diagnostic approach. This article examines information pertinent to advancing these efforts by considering the prevalence and significance of pediatric sleep disturbances; reviewing current patterns of use of medication for childhood sleep disturbances; and identifying patient populations in whom pharmacotherapy is likely to be appropriate and controlled clinical studies should be conducted. This review reinforces the need to identify safe and effective pharmacologic agents for treating pediatric sleep disturbances and to clearly define the indications and prescribing parameters for such medications. Several medications for pediatric sleep disturbances are commonly prescribed despite a paucity of data to support their efficacy and tolerability. Furthermore, virtually no information is available to guide decisions about appropriate medication doses or duration of therapy in pediatric patients. Finally, despite the fact that pharmacologic therapies for pediatric sleep disturbances have not been well studied to date, it is clear that they fill an important void in the management of sleep disorders in children and deserve continued consideration and evaluation. Recent increases in awareness of the importance of evaluating pediatric responses to medications and advances in techniques for studying the effects of psychotropics offer optimism that the efficacy and tolerability of sleep medicines will be significantly enhanced.