Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1047-1055 (doi:10.1542/peds.2006-2773)
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ARTICLE

Use of Sleep Medications in Hospitalized Pediatric Patients

Lisa J. Meltzer, PhDa,b, Jodi A. Mindell, PhDb,c, Judith A. Owens, MDc and Kelly C. Byars, PsyDd

a Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
b Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania
c Division of Ambulatory Pediatrics, Hasbro Children's Hospital and Brown University, Providence, Rhode Island
d Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio

OBJECTIVE. Little is known about the medications prescribed for sleep in hospitalized children. The aims of this study were to (1) determine the percentage of hospitalized children who receive medication for sleep disturbances, (2) determine what medications are prescribed for sleep difficulties, and (3) examine medical and demographic variables related to medications prescribed during hospitalization.

PATIENTS AND METHODS. A chart review was conducted for all inpatients at 3 pediatric hospitals across 26 randomly selected days in 2004. Demographic, medical, and medication data were collected on 9440 patients. The sample was 54.5% male, had a mean age of 7.0 years, and was 63% white. Almost 19% of the patients had at least 1 psychiatric diagnosis.

RESULTS. Overall, 6.0% of all hospitalized children (3% of all medically hospitalized children, excluding children with a psychiatric diagnosis) were prescribed medications for sleep, with antihistamines the most frequently prescribed medication (36.6%), followed by benzodiazepines (19.4%); hypnotic agents were the least frequently prescribed (2.2%). Significant differences were found in both the frequency of sleep-medication prescriptions and the types of medications used across hospitals, as well as for age, length of hospitalization, and service that the child was discharged from. Children with a psychiatric diagnosis were more likely to receive a sleep medication, with 22% of children on a psychiatric service receiving a sleep-related medication.

CONCLUSIONS. Approximately 3% to 6% of children are treated pharmacologically with a broad array of sleep medications in hospital settings. Prescription practices vary by hospital, medical service, child age, and diagnosis. The results from this study indicate that medications are being prescribed for sleep in hospitalized children, especially in children with psychiatric diagnoses. However, given that there are neither Food and Drug Administration–approved sleep medications for children nor clinical consensus guidelines regarding their use, clinical trials, practice guidelines, and additional research are clearly needed.

Key Words: insomnia • children • adolescents • pharmacotherapy • hospitalization

Abbreviations: FDA—Food and Drug Administration • ADHD—attention-deficit/hyperactivity disorder • CHOP—Children's Hospital of Philadelphia • CCHMC—Cincinnati Children's Hospital Medical Center • HCH—Hasbro Children's Hospital • NS—not significant • OR—odds ratio • CI—confidence interval

Accepted Jan 22, 2007.


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