Caregiver attitudes and usage of sleep-promoting medication in children
CPS ePoster Library. Sriskanda H. Jun 25, 2015; 99101
Harshini Sriskanda
Harshini Sriskanda
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Abstract
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Caregiver attitudes and usage of sleep-promoting medication in children

Sriskanda, H., Lepore, N., Miller, M., Seabrook, J., Bock, D.

Background
Pediatric insomnia affects an estimated 30-35% of children, and is a common reason for parental concerns. Despite minimal safety data and limited indications, recent evidence indicates that physicians frequently recommend medications for children with sleep problems. Canadian data on the frequency and type of medication used, and on parental attitudes toward sleep-promoting medications in children are lacking.

Objectives
To characterize parental attitudes and the usage of sleep-promoting over-the-counter (OTC) and prescription (RX) medications for children.

Design/Methods
In this prospective, pilot survey study, caregivers presenting with their children (birth-18 years) to a Pediatric Emergency Department at a tertiary care centre between March 2012-April 2014 completed a 24-item modified version of the Pediatric Sleep Medication Survey, originally developed by Judith Owens and colleagues to assess physician prescribing habits of sleep medications in children.

Results
Three hundred fifty surveys were distributed, of which 346 surveys were sufficiently complete to be analyzed. Children were on average 8 years old (SD±5), 49.1% were female, 73% Caucasian. The 3 most common sleep problems experienced repeatedly by children in our sample were bedtime resistance/delayed sleep onset (43.5%, with 8.6% having received medication to treat this), frequent night awakenings (32%), and difficulty falling asleep or returning to sleep. 21.4% of children had received an OTC sleep-promoting medication on at least one occasion, and 4.6% at least one RX sleep-promoting medication.

In young children, pain reliever combinations (e.g. Tylenol PM) were the most commonly used OTC medications (7.2%) to facilitate sleep. Melatonin was the most frequently cited OTC medication (19.3%) of children in our sample, used at least once between the ages of 6-18 years. Benzodiazepines (2%) were the most frequently reported prescription medications used for sleep in nearly all ages.

Many parents endorsed that medication for sleep problems should be used only if other treatments have failed (53.4%), or in combination with behavioural techniques (27.4%). Some parents (18.9%) also felt that giving sleep-promoting medication was appropriate in order to provide respite for the family. Concern regarding short- or long-term side effects (65.1%) and development of tolerance or habituation (53.7%) were the most frequently cited reasons against sleep medication usage.

Conclusion
Over-the-counter and prescription medications were commonly used to treat sleep problems for children in our sample. Canadian-wide data on the use of pharmacotherapy to treat, and guidelines for managing pediatric sleep disorders are urgently needed, along with pediatric data on sleep medication safety and dosing. Counseling for families should focus on emphasizing behavioural strategies and discouraging pharmacotherapy for managing pediatric insomnia.
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