In general, behavioral changes are sufficient to teach children how to sleep well; But the European guidelines release the use of melatonin in some cases, which is questioned by the experts
Disorders of sleep they are common in children AND teenagers and represent a frequent reason for consultations pediatric. Although a very small number of these groups suffers from a specific sleep problem (such as obstructive apnea, restless leg syndrome or narcolepsy), it is increasingly common than the public has this age group insomnia. The term includes difficulties in falling asleep, being sleeping or having early awakenings, which occur despite an adequate sleep environment.
In order for an image to be characterized by chronic insomnia disorder, it must happen more than three times a week and for a period of over three months. It is known that sleeping from 30 to 60 minutes less per night significantly reduces the quality of life linked to health and, when it becomes a persistent problem, affects the emotional, behavioral and cognitive functioning of the little ones.
Behind inappropriate sleep can be factors such as time on excessive screen, unhealthy eating habits and obesity. The effects are still expanding to the functioning and well -being of the whole family.
In Brazil, there are no official data on sleep problems in children. The Brazilian Sleep Association (ABS) works with European and US data which estimates that the prevalence of Pediatric insomnia varies from 15% to 30% in small children (from 3 to 5 years), from 11% to 15% in school age (from 6 to 12 years) and from 20% to 30% in teenagers . These percentages are considered alarming, in particular taking into account the consequences of insufficient sleep in these age groups.
Challenge for parents
The management of children for children is a challenge for parents and sleep specialists. Most of the time, the problem is exclusively behavioral: the influence of the child’s habits and even family habits. The treatment with standard gold in these cases involves sleep hygiene (which includes the setting routine, go to bed soon, turn on the lights and avoid screens, for example) and above all behavioral changes, which are often reached with help often achieved only from cognitive behavioral therapy (TCC).
“Most of insomnia in childhood has a strong behavioral component. The first step is to identify this problematic behavior and treat it. And this does not only involve the creation of a routine, but it is necessary to change the habits”, explains the neurologist Pediatric Leticia Soster, from the Israelite hospital Albert Einstein Hospital Assistance Group.
For example, when you go to bed, the child can have a sleep postponement behavior asking parents for a glass of water, to go to the bathroom or read a book. “The child does it as a way to resist sleep. While parents satisfy these requests, it becomes a routine and the child extends more and more to bed”, warns Leticia.
According to the neurologist, the basis of the treatment of insomnia is precisely to break this model of behavior. And this is the biggest challenge, since most parents cannot understand that the problem is much more complex. “The greatest difficulty is to demonstrate that it is not only to make the sequence of” bathroom bath “that will work. It is not enough to have a pastel room and to think that this is sufficient for an appropriate environment”, warns the neurologist.
Melatonin: Yes or not?
European experts have updated the guidelines for the care of insomnia in healthy children, without any neurological or development problem, in a document recently published in European Journal of Pediatrics. They strengthen the importance of sleep hygiene, the change of habits (including the use of sleep diary) and behavioral cognitive therapy as the first options to help parents in this task of regulating their children’s sleep.
In cases where none of this works, the guideline suggests the use of melatonin At low dosages, for a limited time and with follow -up. This is a hormone endogenous, produced by the pineal gland of brainAnd whose main function is regular the circadian cycle, stimulating sleep at the end of the day. Although it is naturally produced by the body, it is possible to obtain melatonin by integration.
The document underlines that parents should be informed about the potential adverse events of the use of melatonin and the lack of long -term security data. The guideline also underlines that the use of the supplement should not replace good practices, including sleep hygiene.
However, despite the considerations in the European document, the recommendation of melatonin has attracted the attention of experts, above all because it deals with the management of insomnia in healthy children. In the evaluation of Leticia, the proposal to use melatonin as part of the treatment of insomnia in children is “extremely delicate” and can be a false impression of being a facilitating path and increasing the indiscriminate consumption of the substance.
“If we are arguing that, most of the time, insomnia is caused by behavioral reasons, why prescribe a hormone that will make the body metabolically for sleep, if it is possible to make it turn the lights at night? Exogenous for a child who does not have lack of this element, and still without long -term safety studies?
Leticia underlines that indicating melatonin for healthy children is different from recommending the supplement in case with some neurological diseases, which is known to fall asleep (also influencing the production and release of melatonin). So yes, the substance can be an ally in the treatment.
“The problem with this guideline is that it can give the impression of having a simpler option at hand – just go to the pharmacy, buy and give the product to the child – and much more attractive for caregiver, which often not They are willing to do it do all this behavioral revision with the child.
Brazilian guidelines
Here, the last consensus involving the treatment of sleep disorders was published in 2019, when melatonin has not yet been released for use in the country. It was only in October 2021 that the national health surveillance agency (Anvisa) Authorized the sale of melatonin as a supplement, intended exclusively for people over 19 and in a maximum daily dosage of 0.21 mg.
“We mention the melatonin in the consent of 2019 because we use it in some children in very specific cases. But it must be clear that the ideal is not to medicate the child,” says the pediatric neurologist Rosana Cardoso Alves, ABS, coordinator of the part of the Brazilian children’s children. According to Alves, the little ones should be able to sleep spontaneously. “The family must know how to manage it and we have adequate sleep hygiene measures to help in this process.”
According to the ABS doctor, melatonin can be recommended in addition to the treatment of children with a certain development disorder, such as Autistic spectrum disorder (tea)Or some other changes in the development of neurosal that can stop night rest.
“In cases where we are already in treatment and we see that the family is exhausted, the attempt to give melatonin to improve sleep stability is valid. But, like any drug, it can have side effects, so we must monitor very close and, In the case of children, they use very low doses, “says Rosana Alves.
Source: Terra
Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.
