Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach

Nunes, Magda Lahorgue; Bruni, Oliviero

doi:10.1016/j.jped.2015.08.006

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

• J. Pediatr. (Rio J.) 91 (6 Suppl 1) • Nov-Dec 2015 • https://doi.org/10.1016/j.jped.2015.08.006 copy

Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach^☆ ☆ Please cite this article as: Nunes ML, Bruni O. Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach. J Pediatr (Rio J). 2015;91:S26-35.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

To review the clinical characteristics, comorbidities, and management of insomnia in childhood and adolescence.

Sources:

This was a non-systematic literature review carried out in the PubMed database, from where articles published in the last five years were selected, using the key word “insomnia” and the pediatric age group filter. Additionally, the study also included articles and classic textbooks of the literature on the subject.

Data synthesis:

During childhood, there is a predominance of behavioral insomnia as a form of sleep-onset association disorder (SOAD) and/or limit-setting sleep disorder. Adolescent insomnia is more associated with sleep hygiene problems and delayed sleep phase. Psychiatric (anxiety, depression) or neurodevelopmental disorders (attention deficit disorder, autism, epilepsy) frequently occur in association with or as a comorbidity of insomnia.

Conclusions:

Insomnia complaints in children and adolescents should be taken into account and appropriately investigated by the pediatrician, considering the association with several comorbidities, which must also be diagnosed. The main causes of insomnia and triggering factors vary according to age and development level. The therapeutic approach must include sleep hygiene and behavioral techniques and, in individual cases, pharmacological treatment.

KEYWORDS
Insomnia; Sleep disorders; Childhood; Adolescence

Age range	Ideal hours of sleep	Acceptable hours of sleep (maximum and minimum)
Newborns (0–3 months)	14–17	18–19 and 11–13
Infants (4–12 months)	12–15	16–18 and 10–11
Toddlers (1–2 years)	11–14	15–16 and 9–10
Preschoolers (3–5 years)	10–13	14 and 8–9
School-aged children (6–13 years)	9–11	12 and 7–8
Adolescents (14–17 years)	8–10	11 and 7
Young adults (18–25 years)	7–9	10–11 and 6
Adults (26–64 years)	7–9	10 and 6
Elderly (>65 years)	7–8	9 and 5–6

Disorder	Prevalence
Insomnia	20–30%
Sleep-disordered breathing	2–3%
Hypersomnia	0.01–0.20%
Circadian rhythm disorders	7%
Parasomnias	25%
Sleep-related movement disorders	1–2%

Age range	Causes
Infants	Sleep-onset association disorder (SOAD)
	Food allergies
	Gastroesophageal reflux
	Colic in infants
	Excessive nighttime fluid intake
	Acute otitis media or other infectious diseases
	Chronic diseases

2–3 years	SOAD
	Fear
	Parental separation anxiety
	Prolonged naps or at inappropriate times
	Acute infectious diseases
	Chronic diseases

Preschoolers and school-aged children	Limit-setting sleep disorder
	Fear
	Nightmares
	Acute infectious diseases
	Chronic diseases

Adolescents	Sleep hygiene problems
	Delayed sleep phase
	Psychiatric comorbidities (anxiety, depression, attention deficit hyperactivity disorder)
	Family, school pressure
	Sleep-disordered breathing
	Movement disorders
	Acute infectious diseases
	Chronic diseases

BEARS	2–5 years	6–12 years	13–18 years
Bedtime/sleep problems	Does your child have any problems going to bed? Falling asleep?	Does your child have any problems at bedtime? Do you have any problems going to bed?	Do you have any problems falling asleep at bedtime?
Excessive daytime sleepiness	Does your child seem overly tired or sleepy a lot during the day? Does he/she still take naps?	Does your child have difficulty waking in the morning, seem sleepy during the day, or take naps? Do you feel tired a lot?	Do you feel sleepy a lot during the day? At school? While driving?
Awakenings during the night	Does your child wake up a lot at night?	Does your child seem to wake up a lot at night? Any sleepwalking or nightmares? Do you wake up a lot at night? Do you have trouble getting back to sleep?	Do you wake up a lot at night? Have trouble getting back to sleep?
Regularity and duration of sleep	Does your child have a regular bedtime and wake up time? What are they?	What time does your child go to bed and get up on school days? On weekends? Do you think he/she is getting enough sleep?	What time do you usually go to bed on school nights? Weekends? How much sleep do you usually get?
Sleep-disordered breathing	Does your child snore a lot or have breathing difficulties at night?	Does your child snore a lot or have any breathing difficulties at night?	Does your child snore?

Overall recommendations
Place the baby/child in the crib/bed still awake
Encourage the practice of sleeping alone without intervention from parents/caregivers
Avoid making the child sleep while being held, in the stroller, or other place rather than his/her room/bed
Use a transitional object to help baby/child fall asleep
Avoid bottle-feeding the baby/child to sleep
Have regular hours for daytime and nighttime activities
Establish consistent sleep preparation routines that exclude activities with the potential to excite the child
Differentiate daytime from nighttime activities
Establish bedtime and wake up times that are appropriate to the age range and personal characteristics of the child and his/her daytime activities, as well as the nighttime routine of the family
Teach relaxation techniques that the child can follow on his/her own
Offer positive reinforcement with awards when the child reaches goals of not waking up at night
Do not encourage inappropriate behaviors or the bargaining of bedtime hours
Avoid foods/drinks with caffeine at night

Symptom	Medications
Difficulty in initiating sleep without nocturnal awakenings	Melatonin, antihistaminic
Difficulty in initiating sleep with multiple nocturnal awakenings	Antihistaminic, melatonin
Multiple nocturnal awakenings but no difficulty in initiating sleep	5-Hydroxytryptophan, antihistaminic
Awakens in the middle of the night with difficulty returning to sleep	5-Hydroxytryptophanantihistaminic in the middle of the night
Partial awakening with continuous crying	5-Hydroxytryptophan
Awakening with intense motor activity (restless leg syndrome)	Iron, gabapentin
Delayed sleep phase and insomnia in adolescents	Melatonin, zolpidem

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Autor para correspondência. E-mail:nunes@pucrs.br (M.L. Nunes).

Brasil

Brasil

Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach☆ ☆ Please cite this article as: Nunes ML, Bruni O. Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach. J Pediatr (Rio J). 2015;91:S26-35.

Abstract

Objectives:

Sources:

Data synthesis:

Conclusions:

Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach^☆ ☆ Please cite this article as: Nunes ML, Bruni O. Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach. J Pediatr (Rio J). 2015;91:S26-35.