title: Pharmacological and non-pharmacological management of sleep disturbance in children: an Australian Paediatric Research Network survey.
abstract: BACKGROUND
  Australian paediatricians use a wide variety of practices when managing sleep disturbances in children, including use of melatonin and behavioral strategies. However, practice patterns around the use of strategies, dosing, and how the patient populations managed, are unknown. Results could inform guidelines for the management of child sleep disturbances.
  
  
  OBJECTIVE
  We aimed to document management practices by Australian general paediatricians for paediatric sleep disturbances through an online survey sent to members of the Australian Paediatric Research Network (APRN) who are recruited from the Royal Australasian College of Physicians.
  
  
  RESULTS
  181 (49%) of 373 eligible paediatricians responded, with 101 prescribing melatonin. The most commonly prescribed medications for poor sleep initiation were melatonin (89.1%), clonidine (48%) and antihistamines (29%). Melatonin doses ranged from 0.5mg to 12mg and duration of treatment was as long as 200weeks. Less than half of the paediatricians were aware of any potential melatonin side effects. Most paediatricians (82%) reported using behavioral strategies for sleep disturbances, most commonly anxiety relaxation techniques (75%) for poor sleep initiation and graduated extinction (i.e. "controlled crying", 52%) for disrupted overnight sleep.
  
  
  CONCLUSIONS
  Australian paediatricians use both pharmacological and non-pharmacological treatments for paediatric sleep disturbances. Melatonin is the most commonly prescribed medication, but wide variation in its prescribing suggests a lack of knowledge of recommended dosages and effectiveness. Given the prevalence and variation in prescribing, there is an urgent need to develop clear guidance for paediatricians managing children with sleep disturbance.
authors.affiliation: Department of Respiratory and Sleep Medicine, Mater Children's Hospital, South Brisbane, Qld 4101, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Heussler
authors.forename: Patrick
authors.initials: P
authors.lastname: Chan
authors.forename: Anna M H
authors.initials: AM
authors.lastname: Price
authors.forename: Karen
authors.initials: K
authors.lastname: Waters
authors.forename: Margot J
authors.initials: MJ
authors.lastname: Davey
authors.forename: Harriet
authors.initials: H
authors.lastname: Hiscock
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000628:therapy; D001315:Australia; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D003000:Clonidine / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005108:Extinction, Psychological; D005260:Female; D006306:Health Surveys; D006633:Histamine Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008550:Melatonin / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D012064:Relaxation Therapy; D020181:Sleep Apnea, Obstructive / Q000628:therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*
chemical_list: D006633:Histamine Antagonists; D006993:Hypnotics and Sedatives; D008550:Melatonin; D003000:Clonidine