Pediatric Insomnia

  • Judith A. Owens
    Correspondence. Ambulatory Pediatrics, Potter 200, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.
    Ambulatory Pediatrics, Potter 200, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA

    Brown Medical School, Box GA-1, Providence, RI 02912, USA
    Search for articles by this author
      As in adults, insomnia in children and adolescents should be viewed as a constellation of sleep-related symptoms that result from a wide range of possible causes and not as a diagnosis per se. The causes of childhood insomnia are varied, include both medical issues (ie, drug-related, pain-induced, associated with primary sleep disorders such as obstructive sleep apnea) and behavioral issues (ie, associated with poor sleep hygiene or negative sleep-onset associations), and are often the result of a combination of these factors. In a general sense, the operational definition of insomnia in children may be construed as similar to that in adults: significant difficulty initiating or maintaining sleep or nonrestorative sleep (early morning awakening is an infrequent complaint in children). Practically speaking, the most frequent clinical manifestations of childhood insomnia, particularly in younger children, are bedtime refusal or resistance, delayed sleep onset, or prolonged night wakings requiring parental intervention.
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        • Adams L.A.
        • Rickert V.I.
        Reducing bedtime tantrums: comparison between positive routines and graduated extinction.
        Pediatrics. 1989; 84: 756-761
        • Hiscock H.
        • Wake M.
        Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood.
        BMJ. 2002; 324: 1062
        • Leeson R.
        • Barbour J.
        • Romaniuk D.
        • et al.
        Management of infant sleep problems in a residential unit.
        Child Care Health Dev. 1994; 20: 89-100
        • Blampied N.M.
        • France K.G.
        A behavioral model of infant sleep disturbance.
        J Appl Behav Anal. 1993; 26: 477-492
        • Owens L.J.
        • France K.G.
        • Wiggs L.
        Behavioural and cognitive-behavioural interventions for sleep disorders in infants and children: a review.
        Sleep Med Rev. 1999; 3: 281-302
        • Anders T.F.
        • Halpern L.F.
        • Hua J.
        Sleeping through the night: a developmental perspective.
        Pediatrics. 1992; 90: 554-560
        • Goodlin-Jones B.L.
        • Burnham M.M.
        • Gaylor E.E.
        • et al.
        Night waking, sleep-wake organization, and self-soothing in the first year of life.
        J Dev Behav Pediatr. 2001; 22: 226-233
        • Burnham M.M.
        • Goodlin-Jones B.L.
        • Gaylor E.E.
        • et al.
        Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study.
        J Child Psychol Psychiatry. 2002; 43: 713-725
        • Sadeh A.
        • McGuire J.P.
        • Sachs H.
        • et al.
        Sleep and psychological characteristics of children on a psychiatric inpatient unit.
        J Am Acad Child Adolesc Psychiatry. 1995; 34: 813-819
        • Tirosh E.
        • Sadeh A.
        • Munvez R.
        • et al.
        Effects of methylphenidate on sleep in children with attention-deficient hyperactivity disorder. An activity monitor study.
        Am J Dis Child. 1993; 147: 1313-1315
        • Mirmiran M.
        • Maas Y.G.H.
        • Ariagno R.L.
        Development of fetal and neonatal sleep and circadian rhythms.
        Sleep Med Rev. 2003; 7: 321-334
        • Thoman E.B.
        • Acebo C.
        Monitoring of sleep in neonates and young children.
        in: Ferber R. Kryger M. Principles and practice of sleep medicine in the child. W.B. Saunders, Philadelphia1995: 55-68
        • Carey W.B.
        Night waking and temperament in infancy.
        J Pediatr. 1974; 84: 756-758
        • Keener M.A.
        • Zeanah C.H.
        • Anders T.F.
        Infant temperament, sleep organization, and nighttime parental interventions.
        Pediatrics. 1988; 81: 762-771
        • Sadeh A.
        • Lavie P.
        • Scher A.
        Maternal perceptions of temperament of sleep-disturbed toddlers.
        Early Educ Dev. 1994; 5: 311-322
        • Van Tassel E.B.
        The relative influence of child and environmental characteristics on sleep disturbances in the first and second years of life.
        J Dev Behav Pediatr. 1985; 6: 81-85
        • Frank N.C.
        • Spirito A.
        • Stark L.
        • et al.
        The use of scheduled awakenings to eliminate childhood sleepwalking.
        J Pediatr Psychol. 1997; 22: 345-353
        • Lozoff B.
        • Wolf A.W.
        • Davis N.S.
        Sleep problems seen in pediatric practice.
        Pediatrics. 1985; 75: 477-483
        • Armstrong K.L.
        • Quinn R.A.
        • Dadds M.R.
        The sleep patterns of normal children.
        Med J Aust. 1994; 161: 202-206
        • Mindell J.A.
        Empirically supported treatments in pediatric psychology: bedtime refusal and night wakings in young children.
        J Pediatr Psychol. 1999; 24: 465-481
        • Mindell J.A.
        • Owens J.
        A clinical guide to pediatric sleep: diagnosis and management of sleep problems.
        Lippincott Williams & Wilkins, Philadelphia2003
        • Mindell J.A.
        • Durand V.M.
        Treatment of childhood sleep disorders: generalization across disorders and effects on family members. Special issue: interventions in pediatric psychology.
        J Ped Psychol. 1993; 18: 731-750
        • Richman N.
        Sleep problems in young children.
        Arch Dis Child. 1981; 56: 491-493
        • Kerr S.
        • Jowett S.
        Sleep problems in pre-school children: a review of the literature.
        Child Care Health Dev. 1994; 20: 379-391
        • Blader J.C.
        • Koplewicz H.S.
        • Abikoff H.
        • et al.
        Sleep problems of elementary school children. A community survey.
        Arch Pediatr Adolesc Med. 1997; 151: 473-480
        • Owens J.A.
        • Spirito A.
        • McGuinn M.
        • et al.
        Sleep habits and sleep disturbance in elementary school-aged children.
        J Dev Behav Pediatr. 2000; 21: 27-36
        • Johnson E.O.
        • Roth T.
        • Schultz L.
        • et al.
        Epidemiology of DSM-IV insomnia in adolescence: lifetime prevalence, chronicity, and an emergent gender difference.
        Pediatrics. 2006; 117: e247-e256
        • Fallone G.
        • Owens J.A.
        • Deane J.
        Sleepiness in children and adolescents: clinical implications.
        Sleep Med Rev. 2002; 6: 287-306
        • Smedje H.
        • Broman J.E.
        • Hetta J.
        Associations between disturbed sleep and behavioural difficulties in 635 children aged six to eight years: a study based on parents' perceptions.
        Eur Child Adolesc Psychiatry. 2001; 10: 1-9
        • Dahl R.E.
        The regulation of sleep and arousal: development and psychopathology.
        Dev Psychopathol. 1996; 8: 3-27
        • Randazzo A.C.
        • Muehlbach M.J.
        • Schweitzer P.K.
        • et al.
        Cognitive function following acute sleep restriction in children ages 10–14.
        Sleep. 1998; 21: 861-868
        • Valent F.
        • Brusaferro S.
        • Barbone F.
        A case-crossover study of sleep and childhood injury.
        Pediatrics. 2001; 107: E23
        • Mindell J.A.
        • Carskadon M.A.
        • Owens J.A.
        Developmental features of sleep.
        Child Adolesc Psychiatr Clin N Am. 1999; 8: 695-725
        • Iglowstein I.
        • Jenni O.G.
        • Molinari L.
        • et al.
        Sleep duration from infancy to adolescence: reference values and generational trends.
        Pediatrics. 2003; 111: 302-307
        • Jenni O.G.
        • O'Connor B.B.
        Children's sleep: an interplay between culture and biology.
        Pediatrics. 2005; 115: 204-216
        • Mindell J.
        • Owens J.
        A clinical guide to pediatric sleep: diagnosis and management of sleep problems in children and adolescents.
        Lippincott Williams and Wilkins, Philadelphia2003
        • Hiscock H.
        • Wake M.
        Infant sleep problems and postnatal depression: a community-based study.
        Pediatrics. 2001; 107: 1317-1322
        • Zuckerman B.
        • Stevenson J.
        • Bailey V.
        Sleep problems in early childhood: continuities, predictive factors, and behavioral correlates.
        Pediatrics. 1987; 80: 664-671
        • LeBourgeois M.K.
        • Giannotti F.
        • Cortesi F.
        • et al.
        The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents.
        Pediatrics. 2005; 115: 257-265
        • Carskadon M.A.
        • Wolfson A.R.
        • Acebo C.
        • et al.
        Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days.
        Sleep. 1998; 21: 871-881
        • Carskadon M.A.
        • Vieira C.
        • Acebo C.
        Association between puberty and delayed phase preference.
        Sleep. 1993; 16: 258-262
        • Wolfson A.R.
        • Carskadon M.A.
        Sleep schedules and daytime functioning in adolescents.
        Child Dev. 1998; 69: 875-887
        • Giannotti F.
        • Cortesi F.
        Sleep patterns and daytime functions in adolescents: an epidemiological survey of Italian high-school student population.
        in: Carskadon M.A. Adolescent sleep patterns: biological, social and psychological influences. Cambridge University Press, New York2002
        • American Academy of Sleep Medicine
        International classification of sleep disorders.
        2nd edition. American Academy of Sleep Medicine, Westchester (IL)2005
        • Kuhn B.R.
        • Elliott A.J.
        Treatment efficacy in behavioral pediatric sleep medicine.
        J Psychosom Res. 2003; 54: 587-597
      1. Mindell J, Kuhn B, Lewin D, et al. Behavioral treatment of bedtime problems and night wakings in infants and young children. An American Academy of Sleep Medicine review. Sleep, in press.

        • France K.G.
        • Blampied N.M.
        • Wilkinson P.
        Treatment of infant sleep disturbance by trimeprazine in combination with extinction.
        J Dev Behav Pediatr. 1991; 12: 308-314
        • McMenamy C.
        • Katz R.C.
        Brief parent-assisted treatment for children's nighttime fears.
        J Dev Behav Pediatr. 1989; 10: 145-148
        • Minde K.
        • Faucon A.
        • Falkner S.
        Sleep problems in toddlers: effects of treatment on their daytime behavior.
        J Am Acad Child Adolesc Psychiatry. 1994; 33: 1114-1121
        • Pinilla T.
        • Birch L.L.
        Help me make it through the night: behavioral entrainment of breast-fed infants' sleep patterns.
        Pediatrics. 1993; 91: 436-444
        • Reid M.J.
        • Walter A.L.
        • O'Leary S.G.
        Treatment of young children's bedtime refusal and nighttime wakings: a comparison of “standard” and graduated ignoring procedures.
        J Abnorm Child Psychol. 1999; 27: 5-16
        • Richman N.
        • Douglas J.
        • Hunt H.
        • et al.
        Behavioural methods in the treatment of sleep disorders: a pilot study.
        J Child Psychol Psychiatr. 1985; 26: 581-590
        • Sanders M.R.
        • Bor B.
        • Dadds M.
        Modifying bedtime disruptions in children using stimulus control and contingency management techniques.
        Behavioural Psychotherapy. 1984; 12: 130-141
        • Skuladottir A.
        • Thome M.
        Changes in infant sleep problems after a family-centered intervention.
        Pediatr Nurs. 2003; 29: 375-378
        • Burke R.V.
        • Kuhn B.R.
        • Peterson J.L.
        Brief report: a “storybook” ending to children's bedtime problems–the use of a rewarding social story to reduce bedtime resistance and frequent night waking.
        J Pediatr Psychol. 2004; 29: 389-396
        • Fisher J.
        • Feekery C.
        • Rowe H.
        Treatment of maternal mood disorder and infant behaviour disturbance in an Australian private mothercraft unit: a follow-up study.
        Arch Womens Ment Health. 2004; 7: 89-93
        • Seymour F.W.
        • Bayfield G.
        • Brock P.
        • et al.
        Management of night waking in young children.
        Aust J Fam Ther. 1983; 4: 217-223
        • Seymour F.W.
        Parent management of sleep difficulties in young children.
        Behav Change. 1987; 4: 39-48
        • Durand V.M.
        • Mindell J.A.
        Behavioral treatment of multiple childhood sleep disorders. Effects on child and family.
        Behav Modif. 1990; 14: 37-49
        • Pritchard A.
        • Appleton P.
        Management of sleep problems in pre-school children.
        Early Child Dev Care. 1988; 34: 227-240
        • Scott G.
        • Richards M.P.
        Night waking in infants: effects of providing advice and support for parents.
        J Child Psychol Psychiatry. 1990; 31: 551-567
        • Wolfson A.
        • Lacks P.
        • Futterman A.
        Effects of parent training on infant sleeping patterns, parents' stress, and perceived parental competence.
        J Consult Clin Psychol. 1992; 60: 41-48
        • Hohagen F.
        Nonpharmacologic treatment of insomnia.
        Sleep. 1996; 19: S50-S51
        • Wiggs L.
        Sleep problems in children with developmental disorders.
        J R Soc Med. 2001; 94: 177-179
        • Johnson C.
        Sleep problems in children with mental retardation and autism.
        Child Adolesc Psychiatr Clin N Am. 1996; 5: 673-681
        • Didden R.
        • Curfs L.M.
        • van Driel S.
        • et al.
        Sleep problems in children and young adults with developmental disabilities: home-based functional assessment and treatment.
        J Behav Ther Exp Psychiatry. 2002; 33: 49-58
        • Sachs H.
        • McGuire J.
        • Sadeh A.
        • et al.
        Cognitive and behavioural correlates of mother reported sleep problems in psychiatrically hospitalized children.
        J Sleep Res. 1994; 23: 207-213
        • Dahl R.E.
        • Ryan N.D.
        • Matty M.K.
        • et al.
        Sleep onset abnormalities in depressed adolescents.
        Biol Psychiatry. 1996; 39: 400-410
        • Owens J.A.
        The ADHD and sleep conundrum: a review.
        J Dev Behav Pediatr. 2005; 26: 312-322
        • Rose M.
        • Sanford A.
        • Thomas C.
        • et al.
        Factors altering the sleep of burdened children.
        Sleep. 2001; 24: 45-51
        • Lewin D.S.
        • Dahl R.E.
        Importance of sleep in the management of pediatric pain.
        J Dev Behav Pediatr. 1999; 20: 244-252
        • Bloom B.J.
        • Owens J.A.
        • McGuinn M.
        • et al.
        Sleep and its relationship to pain, dysfunction, and disease activity in juvenile rheumatoid arthritis.
        J Rheumatol. 2002; 29: 169-173
        • Sadeh A.
        • Horowitz I.
        • Wolach-Benodis L.
        • et al.
        Sleep and pulmonary function in children with well-controlled, stable asthma.
        Sleep. 1998; 21: 379-384
        • Owens J.A.
        • Rosen C.L.
        • Mindell J.A.
        Medication use in the treatment of pediatric insomnia: results of a survey of community-based pediatricians.
        Pediatrics. 2003; 111: e628-e635
        • Rosen C.L.
        • Owens J.A.
        • Mindell J.A.
        Use of pharmacotherapy for insomnia in children and adolescents: a national survey of child psychiatrists.
        Sleep. 2005; 28: A79
        • Sheldon S.
        • Ferber R.
        • Kryger M.
        Principles and practice of pediatric sleep medicine.
        Elsevier, Inc., New York2005
        • Kryger M.
        • Roth T.
        • Dement W.
        Principles and practice of sleep medicine.
        W.B. Saunders, Philadelphia2000
        • Israel A.
        • Kramer J.
        Safety of zaleplon in the treatment of insomnia.
        Ann Pharmacother. 2002; 36: 852-859
        • Kurta D.
        • Myers L.
        • Krenzelok E.
        Zolpidem (Ambien): a pediatric case series.
        Clin Toxicol. 1998; 36: 143-144
        • Owens J.A.
        • Dalzell V.
        Use of the ‘BEARS’ sleep screening tool in a pediatric residents' continuity clinic: a pilot study.
        Sleep Med. 2005; 6: 63-69