Do physicians overprescribe meds?

• Position: Pediatric Insomnia

Despite a dearth of information about the use of sedatives for treating sleep disorders in youngsters, about 75% of community-based pediatricians recommend nonprescription medication, and more than 50% prescribe a sleep aid to patients with difficulties falling and staying asleep, notes a Brown University, Providence, R.I., survey. Sleep disturbances in infants, children, and adolescents are among the most common and challenging complaints in pediatric practice. Although studies have examined the effectiveness of behavioral treatments for sleep disorders, pharmacologic treatment is a poorly researched area. There currently are no guidelines for use for sleep disturbances in children by the Food and Drug Administration.

"While many pediatricians perceive a need for medications in selected cases, they generally lack confidence in the currently available medication options," remarks Judith A. Owens, associate professor of pediatrics at the Brown Medical School. "The pediatricians in our study expressed many reservations, particularly given the absence of clinical guidelines for the use of these drugs in children."

The respondents were asked when, what, and why they had prescribed for children with difficulties in initiating or maintaining sleep during the previous six months, and about their beliefs and attitudes regarding the use of both nonprescription and prescription drugs. Overall, practitioners appear to be conservative in their approach to the use of these drugs and express concern about a variety of potential negative effects.

The use of prescription and nonprescription treatments for pediatric insomnia seems to fall into two general patterns: short-term situational use of...