Insomnia in children is a nonspecific impairing symptom that may be the result of normal developmental changes, psychosocial duress, a
sleep disorder, a
psychiatric disorder, other medical disorders, substance misuse, or an adverse effect of medication. Careful clinical assessment of
insomnia in children may include the use of symptom rating scales, laboratory testing, or other medical assessment. Short- and long-term treatment of
insomnia in children involves management of etiological factors and associated syndromes. Controlled treatment studies of pediatric
insomnia are limited to <10 published studies of psychosocial and/or psychopharmacological treatment in young children. Directive parent education and behavior modification techniques have been effective in short-term treatment of
insomnia in young children, and may be the preferred treatment of extrinsic
insomnia, as well as an important adjunctive treatment of any
insomnia symptoms. Two
benzodiazepines [
flurazepam and
delorazepam (
chlordesmethyldiazepam)], one
antihistamine (
niaprazine) and one
phenothiazine [
alimemazine (
trimeprazine)] have been shown to be effective in the short-term treatment of
insomnia in young children, although none of these agents have US Food and Drug Administration approval for pediatric
insomnia. Short-acting
benzodiazepines may have a role in the brief treatment of pediatric
insomnia associated with an anxiety or
mood disorder,
psychosis, aggression, medication- induced activation, or anticipatory anxiety associated with a medical procedure. However, tachyphylaxis and risk of misuse preclude the long-term use of
benzodiazepines for the treatment of
insomnia in children. Newer
hypnotics, which appear better tolerated than the
benzodiazepines in studies of adults, may have a role when combined with psychosocial treatments of pediatric
insomnia. Treatment of intrinsic pediatric
insomnia may additionally involve
chronotherapy or medical management.