I enjoyed the Parent Coach feature “When Johnny Can’t Sleep,” by Heather Clawges, MD, and Linda S. Nield, MD (CONSULTANT FOR PEDIATRICIANS, August 2009, page 298). First, let me say that I agree completely with the authors’ comments on sleep hygiene and the importance of removing the television set from the bedroom. When parents say they will just turn it off, I point out that when a television set is plugged in, it is still on and can still cause sleep disturbances; it is better to remove it altogether.
The authors’ comments on the use of melatonin to treat insomnia in children were very helpful as well. Melatonin is also quite effective in children who have neurodevelopmental problems, such as autism spectrum disorders. In these patients, I usually start with a dosage of 1 mg/d and titrate up to the lowest effective dosage. I will go as high as 9 mg/d; however, most children who respond will do so at a dosage of 3 mg/d. Melatonin is sold in liquid and pill forms. The pills are usually 1 mg or 3 mg, and the concentration of the liquid is usually 1 mg/mL. I typically tell parents to administer melatonin early on in their child’s bedtime routine, so that it is ingested 1 to 2 hours before sleep onset.
— John W. Harrington, MD
Associate Professor of Pediatrics
Eastern Virginia Medical School
The Children’s Hospital of The King’s Daughters
Norfolk, Va
Thank you for sharing your experience with the use of melatonin in children who have neurodevelopmental disorders (NDD). The dosing specifics are particularly helpful. We agree that difficulty in falling asleep may persist despite strict adherence to sleep hygiene suggestions; sometimes children themselves—not just their parents— may ask for further help. Your clinical success with melatonin, along with reassuring safety and efficacy studies,1 provide pediatric health care providers with another treatment option for insomnia associated with NDD. Children with attention-deficit/hyperactivity disorder (ADHD) also often have sleep difficulties. Melatonin dosages as high as 10 mg/d have been shown to be safe and effective in 6- to 12-year-olds with ADHD.2
— Linda S. Nield, MD
Associate Professor of Pediatrics
— Heather Clawges, MD
Assistant Professor of Pediatrics
West Virginia University School of Medicine
Morgantown
