Thread by @DrMikeFarquhar

This story about melatonin use in children is in the Guardian today

A few key points:

@EvelinaLondon @maxdavie @RCPCHtweets

theguardian.com/society/2018/n…

As we better understand the importance of good quality sleep in childhood to short and long term health and development outcomes, more attention is being paid to sleep problems in children

Assessing, and deciding if/when intervention is needed, is therefore happening more often

Most childhood sleep issues can be managed without needing to use medications.

Medication for most sleep problems, as in adults, is only appropriate after thorough assessment and where non-medication options have been unsuccessful

@TheSleepCharity

thechildrenssleepcharity.org.uk/parents.php

An approach to dealing with common sleep problems in children, including when to think about medication, can be found in @ArchivesEandP here: ep.bmj.com/content/101/4/…

@jr_turnbull

(There are some caveats: young people with narcolepsy for example are very likely to benefit from early prescription of appropriate medication, ideally under the care of a paediatric sleep specialist)

Melatonin can be used very appropriately to support sleep problems where behavioural interventions alone have been unsuccessful.

In our @EvelinaLondon clinic, most common uses of melatonin are to support children w/neurodevelopmental conditions such as autism or ADHD, or teenagers with circadian rhythm (body clock) problems

Melatonin is used as *part* of an overall approach to treating sleep difficulties

The most important benefit of melatonin is often to increase the chances of behavioural interventions succeeding ... which in the long term are more likely to result in sustained improvement in children’s sleep

Melatonin is the hormone (message) produced by the brain as light falls; it is a signal sent from your body clock to the rest of your brain and body to signal it is time to sleep

It is NOT a sedative and its sleep-inducing effects can easily be over-ridden

Melatonin is NOT a magic sleep drug.

It has very specific uses, and its effects are relatively limited.

Primarily in children it is used to support sleep ONSET

(more specialist uses need a specialist usually!)

There is some evidence -most recently from a study led by @EvelinaLondon @SleepProf- that sustained release melatonin preparations can help ⬆️total sleep time in children w/ neurodevelopmental disorders, who often have significantly ⬇️natural sleep times

ncbi.nlm.nih.gov/m/pubmed/29096…

For children with conditions which benefit from treatment with melatonin, their sleep - and their family’s sleep, often crucial! - can be transformed.

It results in better daytime functioning of both child and parent, and can be the most important thing able to be done for some

There is a balance to use of melatonin in children.

As with ALL paediatric prescribing, we should only prescribe when we consider it is in the best interest of child and family, and where non-pharmacological interventions are not successful/sufficient.

But, equally, where melatonin CAN make a significant difference we should be prescribing it - disrupted sleep has a myriad consequences, acute and chronic, for child and family.

Improving sleep can transform lives - and lifetime health trajectories.

For those prescribing, there is an art to prescribing melatonin well!

Most common mistake is to ⬆️dose when efficacy appears to be lost.

If loss of efficacy IS related to dose, it’s usually because dose is too high, not too low: stop and restart at a lower dose!

We build in regular breaks from treatment for all children in our clinic who are prescribed melatonin, both to check melatonin is still needed, but to allow re-titration of dose to the lowest possible effective dose

(Loss of efficacy is also often because another factor - eg anxiety - is having a stronger effect on sleep onset than melatonin is capable of correcting)

Information for parents/families who have worries about melatonin after reading this article can read the @RCPCHtweets @MedsForChildren information sheet on melatonin here: medicinesforchildren.org.uk/melatonin-slee…

Further queries should be discussed with their children’s own doctor

We continue to work to improve education and awareness of sleep problems in children, and the new @RCPCHtweets #Progress curriculum has more sleep content for future paediatric consultants than before

twitter.com/i/moments/9569…

Bottom line:

Melatonin can be v effective to support specific sleep problems in children, with benefit to children AND families

It should be prescribed appropriately, as part of an overall assessment and management strategy for sleep, including behavioural interventions