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December 2002 - ON SLEEP AND CHILDREN
The problem of not falling asleep at a reasonable hour affects both the child and
family.
Some children don't need much sleep and bounce up at 6 AM despite being awake until 11
PM. But other children who have trouble falling asleep are sleep deprived, and getting up
each morning is a difficult problem creating tension in the home and having a negative
impact on schoolwork.
In dealing with the problem, the first step is to try to identify its cause. One cause
can be ADD. ADD children often have trouble settling down. This can be physical if they
are hyperactive or mental if their mind races and they just can't shut it off. The other
piece to keep in mind is that the stimulants used to treat ADD can also interfere with
sleep.
Another cause is anxiety, which can make falling asleep difficult. The anxiety can be
acute, such as worrying about an exam the next day, or it can be chronic. The chronic type
might be a worrying about a parent's health.
How can sleep be improved? Dealing with the cause is the best way to improve the
difficulty. If medication is the cause, the timing of the last dose needs to be evaluated.
Anxiety can be reduced by reassurance or by therapy if needed. If the cause is less clear,
be sure to have your child evaluated by your doctor to see if there are changes to make
that might improve the difficulty.
There are some medications that can be helpful for children with sleep difficulties.
The anti-histamines such as Benadryl or Vistaril are probably the most commonly used. When
the problem is more significant, Seroquel can be helpful. This is a medication used in
high doses for the treatment of major psychiatric conditions. But at a very low dose of 25
mg. or 50 mg. at bedtime it can be very helpful and without significant side effects in
most cases. These medications can be used in combination with stimulants.
Many families with or without difficult children have common bedtime problems. Young
children are quick to realize that life goes on after bedtime, and they don't want to be
excluded. So, any reason to get out will do. The call for a drink, a blanket, or the
bathroom are all ways of staying in contact. A potentially helpful solution to this
widespread problem is reported in The Archives of Pediatric Adolescent Medicine, 199: 153:
1027-1028 by Friman, PC et al and titled "The Bedtime Pass" in which two
children were studied.
The number of children in the study was two - the author's children. The study
consisted of giving each child a 4 x 6 card which was a pass for one trip out of the room
for any reason. When they came out the card was collected, and they could not come out
again. The results were described as excellent and the method recommended by the authors.
Sleep is complex as are the problems that can be associated with it. Should a problem
exist it is important that it be evaluated to prevent any serious difficulties.
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