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Insomnia and Children

Most parents picture a crying baby when they think about kids and sleep problems. Many older kids and teens have problems sleeping too, including trouble going to sleep and waking up frequently in the middle of the night.

Unfortunately, not getting a good night's sleep can affect your child's mood and behavior during the day, leading to school and discipline problems.

Childhood Insomnia
Like adults, children with insomnia either have trouble going to sleep, staying asleep, or are simply not well rested after what should be a normal amount of time sleeping. In addition to being sleepy during the day, symptoms of childhood insomnia can include: •irritability
•mood swings
•hyperactivity
•depressed mood
•aggressiveness
•a decreased attention span
•memory problems

Causes of Childhood Insomnia
One common reason that many children don't get enough sleep is that they go to bed too late. This is often because parents have unrealistic expectations for how much sleep their kids need or because their kids are over-scheduled and are participating in too many activities or have too much homework. Or your child may simply be up late talking on the phone, playing video games, or watching TV.

Remember that children between the ages of 6 and 12 need about 10 to 11 hours of sleep each night, and teens need about 9 hours of sleep each night.

If you set a realistic bedtime and your child is still not getting a good night's sleep, than common causes of insomnia can include:
•poor sleep habits
•caffeine
•stress
•obstructive sleep apnea (snoring)
•side effects of medications, including stimulants used to treat ADHD, antidepressants, corticosteroids, and anticonvulsants
•asthma (coughing)
•eczema (itching)
•depression
•anxiety
•restless legs syndrome
•neurodevelopmental disorders, such as autism, mental retardation, and Asperger's syndrome

Treatments for Childhood Insomnia
Although parents often want to turn to a prescription to treat their child's insomnia, it is much more important to look for any underlying medical or psychological problems that may need to be treated first.
For example, if your child has obstructive sleep apnea and snores loudly at night and frequently stops breathing, then he might need to have his tonsils and adenoids removed. Or if your child has a frequent nighttime cough because his asthma is poorly controlled, then he may need a stronger preventative asthma medication. If your child has sleep apnea, asthma, or is depressed, then a sleeping pill is not the answer.

Also, the sleeping pills that we all see marketed on TV, such as Ambien CR and Lunesta, have not been approved for use in children. Medications which are sometimes used when necessary and appropriate do include:
•sedating antidepressants, including amitriptyline and remeron
•melatonin
•clonidine, especially if your child also has ADHD or behavior problems
•risperdal, especially if your child also has autism or behavior problems
•antihistamines, although these commonly cause daytime drowsiness and would just be used for a very short period of time

Unless there is another or co-morbid diagnosis as a cause of your child's insomnia, a prescription is usually not the answer.
Non-drug treatments for primary insomnia, or childhood insomnia that is not caused by another medical condition, can include:
•restricting time spent in bed to simply sleeping, which means no reading, doing homework, or watching TV in bed
•having a very consistent schedule of when your child goes to bed and wakes up, including weekends and holidays
•teaching your child about relaxation techniques, including diaphragmatic breathing, progressive muscle relaxation, and visual imagery, which he can use when he is going to sleep
•stopping stimulating activities 30 to 60 minutes before bedtime, such as playing video games, watching TV, or talking on the phone
•getting out of bed and doing something quiet, such as reading, if your child doesn't fall asleep within 10 to 20 minutes
•avoiding caffeine
•exercising regularly

Seeing a counselor or child psychologist, in addition to your pediatrician, can also be helpful for most children with insomnia.

By Vincent Iannelli, M.D.
About.com Pediatrics