Over 80% children with neurodevelopmental diagnoses have sleep difficulties, including bedtime resistance, night-time awakenings and shortened sleep duration (McDonald 2019). The impact on the wellbeing of the child and family can be considerable. Behavioural interventions can be highly effective (Elphick 2019) but many children in the UK are prescribed melatonin due to inconsistent access to trained sleep practitioners.
The study aimed to support children with neurodevelopmental problems to develop long-term strategies for promoting sleep, in turn improving the health and well-being of the child and family and to reduce drug prescriptions where not needed.
A longitudinal randomised case control study with delayed intervention in the control arm was carried out with children aged 4–11 years with a neurodevelopmental condition who had been taking melatonin for at least 12 months for severe sleep disturbance. Each child’s parents/carers received support from a trained sleep practitioner for 8 weeks.
Melatonin was actively weaned or stopped. Evaluation of sleep and wellbeing parameters was completed at 3 time-points.
32 participants were recruited and randomised; 20 completed the intervention and evaluation at all 3 timepoints. From baseline to final evaluation, time to settle to sleep improved from 137.9 to 81.7 minutes (p<0.05); mean total CSHQ score improved from 55.8/99 to 46.7/99 (p<0.05); mean total wellbeing scores improved from 18.8/30 to 13.8/30 (child - p<0.05); and from 22.1/45 to 17.9/45 (parent - p<0.05); mean quality of life score (CHU 9D) improved from 18.8/45 to 13.8/45 (p<0.05); mean total SDQ score improved from 22.3/40 to 19/40 (p=0.052). 42% participants stopped melatonin and a further 35% reduced the dose. Cost savings for melatonin prescriptions was equivalent to £5,937.48/year for the 26 patients analysed (p<0.05).
We suggest that, even in a complex group of children, a non-pharmacological approach to sleep support delivers an effective, sustainable alternative to melatonin prescribing.
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