Toward a practical definition of pediatric insomnia

Compared with adult insomnia, pediatric insomnia is poorly studied and described. The evaluation and treatment of insomnia in children, unlike in adults, is complicated by the occurrence of developmental changes in sleep habits that blur the distinction between abnormal and normal sleep, the fact that caregivers rather than insomnia sufferers typically voice the complaint of insomnia, the interactions between a child's abnormal or normal sleep behaviors and the caregiver-dictated bedtime schedules and sleep practices, and the unique consequences of childhood insomnia on the family. This article describes the prevalence, clinical manifestations, and impact of childhood sleep disturbances and attempts to arrive at a practical definition of pediatric insomnia based on the criteria for insomnia in adults presented in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Revised Fourth Edition. This definition is intended to facilitate the identification, diagnosis, and study of pediatric insomnia and to assist in determining when intervention is warranted. Ideally, the proposed criteria should comprise one component of a larger effort to increase the knowledge about and awareness of pediatric insomnia. The needs for scientific evaluation of diagnostic and treatment strategies; educational programs for pediatric patients, their families, and physicians; public awareness initiatives; and epidemiologic studies to delineate predictive factors and correlates of pediatric insomnia are compelling.