But researchers who conducted the survey question the practice of looking to pharmaceuticals before doing a thorough examination to determine the cause of the sleep problem. Far more should be known, they say, about the safety and effectiveness of the medications and herbal remedies.

"There is no medication approved by the FDA for use in children with sleep problems," says Dr. Judith Owens, lead author of the study and an associate professor of pediatrics at Brown Medical School in Providence, R.I. "None of these drugs have been properly tested for this particular use and none of them have gone through the rigorous testing process for efficacy and safety."

The study appears in the May issue of Pediatrics.

Owens and her colleagues surveyed 671 primary-care pediatricians in six U.S. cities. Pediatricians were asked when, what and why they prescribed or recommended prescription or over-the-counter sleep aids. They were also asked about their attitudes toward medicating children with sleep problems.

More than half of the pediatricians surveyed had prescribed sleeping pills to children at least once in the last six months. Seventy-five percent had recommended a nonprescription sleep aid, such as the antihistamine Benadryl. Nearly 25 percent recommended melatonin or other herbal remedy, such as chamomile teas and valerian root.

About 55 percent of physicians said they prescribed medicine to treat sleep problems in children to "provide the family with needed respite." About 52 percent said they used the medications in "special needs" children, and 50 percent said they prescribed the medicines "in combination with behavioral treatments."

"We found pediatricians are uneasy about using the medications because there's so little information about them, but they do perceive a need for them," says Owens, who runs the Pediatric Sleep Disorders Clinic at Hasbro Children's Hospital, also in Providence.

Sleep difficulties at all stages of childhood are common, Owens says. About 25 percent of children at some point have a sleep problem their parents think is significant, she says.

Though definitions can vary, a child with pediatric insomnia can't fall asleep for 30 minutes or more, or has difficulty staying asleep through the night, at least three times a week, Owens says.

According to their survey, the use of medication to treat pediatric insomnia fell into two broad categories. The first was short-term use of over-the-counter medications for specific situations, such as travel, acute pain or stress. The second was longer-term, prescribed medicines for children with special needs, including mental retardation, autism and attention-deficit hyperactivity disorder (ADHD).

The most commonly used over-the-counter medicines were antihistamines. The active ingredient is diphenhydramine, which is the same active ingredient in other over-the-counter sleep aids such as Tylenol PM.

"If parents don't know it, they could get into a situation where they are overdosing a kid," she says.

The most commonly prescribed sleeping pills were alpha-agonists. One brand name is Calapres, a hypertension drug for adults that has sedating properties. Another is Tenex, used as a sedative in kids with ADHD, Owen says.

That's not to say drugs are never called for. In her practice, Owens says she sometimes resorts to medications, but not before doing a full assessment of the cause of the wakefulness.

In many cases, it's poor "sleep hygiene" -- bedtime practices that encourage a restful night's sleep. Good sleep hygiene includes avoiding caffeine and heavy foods before bed, and having a regular bedtime and waking time.

"Insomnia is a symptom, not a diagnosis," she says. "There are many different causes for insomnia, and it's certainly inappropriate for a parent or a pediatrician to prescribe medication without conducting a thorough search for underlying causes."

Dr. Stephen Sheldon, medical director of the Sleep Medicine Center at Children's Memorial Hospital in Chicago, agrees with the findings.

"This study brought to the surface significant areas of need in pediatric sleep," Sheldon says. "We don't know a lot about the pharmacology of treating sleep-related problems in children."

Sometimes medication is necessary, he says. But first, doctors need to take the time to determine the cause of the sleeplessness. For example, if a child comes in with a stomachache, a doctor should first try to determine the cause before prescribing medicine to treat it.

"In childhood sleep problems, the key is making the diagnosis, just as in any other medical situation," he says.

More information

Check out the Sleep Foundation or the Riley Hospital for Children for more in sleep hygiene.

SOURCES: Judith Owens, M.D., M.P.H., associate professor, pediatrics, Brown Medical School, Providence, R.I.; Stephen Sheldon, D.O., medical director, Sleep Medicine Center, Children's Memorial Hospital, Chicago; May 2003 Pediatrics

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