Trends in medication prescribing for pediatric sleep difficulties in US outpatient settings

Sleep. 2007 Aug;30(8):1013-7. doi: 10.1093/sleep/30.8.1013.


Objectives: This study examined trends in physician-prescribing of medications for children with sleep difficulties in outpatient settings in the US. Additionally, we explored the incidence of physician prescribing patterns of medications with high abuse potential for children with sleep difficulties.

Methods: A cross-sectional study was conducted on patients aged < or =17 years with sleep difficulties from 1993-2004 using data from the National Ambulatory Medical Care Survey (NAMCS). Office visits were considered related to sleep difficulties if relevant ICD-9 codes were recorded and if sleep difficulties were reported as the reason for the visits. Medications were retrieved using the NAMCS drug codes, and all analyses were weighted to determine national estimates.

Results: During 1993 to 2004, approximately 18.6 million visits occurred for sleep related difficulty in children. The highest percentage of visits were by school-aged children (6 to 12 years). Pediatricians saw 35% of patients, psychiatrists saw 24%, and general/family practice physicians saw 13% of the patients. Eighty-one percent of visits among children with sleep difficulties resulted in a prescription for a medication. Many of these medications prescribed lack FDA approved labeling to assure their effectiveness and safety in this population.

Conclusion: The findings of this study suggest that physicians frequently prescribed medications for sleep difficulties in children in US outpatient settings. Of particular concern is prescribing of many unapproved medications for this population.

MeSH terms

  • Adolescent
  • Adrenergic alpha-Agonists / adverse effects
  • Adrenergic alpha-Agonists / therapeutic use*
  • Ambulatory Care / statistics & numerical data*
  • Antidepressive Agents / therapeutic use*
  • Behavior Therapy / statistics & numerical data
  • Benzodiazepines / therapeutic use*
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Cross-Sectional Studies
  • Drug Approval
  • Drug Prescriptions / statistics & numerical data*
  • Drug Therapy, Combination
  • Drug Utilization / statistics & numerical data
  • Female
  • Health Surveys
  • Histamine H1 Antagonists / adverse effects
  • Histamine H1 Antagonists / therapeutic use*
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Hypnotics and Sedatives / therapeutic use*
  • Infant
  • Male
  • Referral and Consultation / statistics & numerical data*
  • Sleep Wake Disorders / drug therapy*
  • Sleep Wake Disorders / epidemiology
  • Treatment Outcome
  • United States
  • United States Food and Drug Administration


  • Adrenergic alpha-Agonists
  • Antidepressive Agents
  • Histamine H1 Antagonists
  • Hypnotics and Sedatives
  • Benzodiazepines