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induce dependence, and often result in ‘rebound’ worsening of sleep
problems when they are finally discontinued. Sedating antihistamines are
commonly prescribed, but without good evidence that they do more good
than harm. There has been considerable interest in the use of melatonin:
it is not a cure-all but probably does have a useful, though limited, role in
the treatment of circadian rhythm disorders in some children with autism
(where several trials have proven its usefulness) and severe intellectual
disability. However, meta-analyses of trials in normal IQ adults with
circadian rhythm disorders do not suggest any benefits, so prescribing
melatonin in most children as a ‘sleeping pill’ should probably be avoided,
despite its increasing popularity.
Further reading
Buscemi, N.et al. (2006) Efficacy and safety of exogenous melatonin
for secondary sleep disorders and sleep disorders accompanying sleep
restriction: Meta-analysis.BMJ 332 , 385–393.
Hill, C. (2011) Practitioner review: Effective treatment of behavioural in-
somnia in children.Journal of Child Psychology and Psychiatry 52 , 731–740.
Owens, J.A. (2009) Pharmacotherapy of pediatric insomnia.Journal of the
American Academy of Child and Adolescent Psychiatry 48 , 99–107.
Rossignol D, Frye R. (2011) Melatonin in autism spectrum disorders:
A systematic review and meta-analysis.Developmental Medicine & Child
Neurology 53 , 783–792.
Stores, G. (2001)A Clinical Guide to Sleep Disorders in Children and Adolescents.
Cambridge University Press, Cambridge.
van Geijlswijk, I et al.(2010) Dose finding of melatonin for chronic
idiopathic childhood sleep onset insomnia: An RCT.Psychopharmacologia
212 , 379–391.