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Sleep Difficulties (medication for)

Our six year old has been having difficulty maintaining sleep through the night. Recently he has been consistently waking up at 3:30 am as though ready to begin his day. We have ruled out possible medical causes such as ENT, GI, dental, etc. We also make sure to keep him on a structured bed time routine. In the past Melatonin, Hydroxyne and Amytripteline have helped but no longer seem to be working. Is there something else you can recommend?

We know that sleep difficulties are common in CdLS. From the psychiatry side there are generally 2 schools of thought about sleep medications for children. One, which I tend to follow, might use Melatonin or Benadryl for the occasional period when sleep is a problem but not on a regular basis. Another, which I follow sometimes, is to use a medication with sedative effects at night, but usually it is in combination with that medication treating another condition at the same time (Clonidine at night for ADHD, Remeron at night for depression, and so on). At 6 years of age, no medications are known to work that well (on a regular basis) unfortunately, those that work in adults can backfire in children at that age (benzodiazepines can agitate and so on). I would be tempted to use something that also has a second use as in the examples above. The age and the weight are a problem in this case as well. A psychiatrist might come up with a secondary diagnosis and use a medication that is appropriate.  Also, a sleep study might be indicated as well.

MG - TK 3/25/11



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