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G429(P) Melatonin use in children with sleep difficulties: an audit of prescription practices amongst east of england community paediatricians
  1. ND Herberholz1,
  2. S Ozer2
  1. 1Community Paediatrics, Cambridgeshire Community Services, Huntingdon, UK
  2. 2Community Paediatrics, East and North Hertfordshire NHS Trust, Stevenage, UK

Abstract

Aims Disrupted sleep is commonly treated with melatonin, especially in children with Neurodevelopmental disorders. (BNF for Children 2014/2015). We surveyed melatonin prescription practices amongst Community Paediatricians in the East of England.

Methods In May 2014 we sent out an online survey to all Community Paediatricians in the East of England.

Results 17 responses in total were received from all over the region.

All Paediatricians prescribe melatonin to children with Neurodevelopmental disorders, Neurodisability (73%), Visual impairment (73%), Intellectual disability (67%) and to Children with Chronic Fatigue Syndrome (20%) and behaviour difficulties (20%). Sleep advice is given by all clinicians and promoted through leaflets (56%), referral to Specialist Sleep clinics (38%) and support from other professionals (School Nurses, 13%, Occupational Therapists, 6%, Intellectual Disability Services, 19% and Family workers, 13%). On average clinicians felt sleep hygiene should be tried for 3 months (range 1–6 months) before melatonin is started. Most (59%) clinicians do not routinely assess impairment of function before prescribing melatonin. The main preparation of melatonin prescribed is tablets (94%), followed by liquid (59%) then capsules (41%). Mostly (65%) slow release medication is given. The minimum dose of melatonin prescribed is 2 mg (range 0.5 mg–3 mg), maximum dose range (4–12 mg).

Practice varies in how often children are reviewed. Some (35%) review in the first 3–4 months, others 6 monthly (29%). Most (94%) clinicians offer at least yearly reviews. Routine trials off melatonin are offered by 65%. On average children stay 26 months on melatonin before withdrawal (range 6–120 months). In comments Paediatrician gave views regarding the management of disrupted sleep, the need for good sleep hygiene support, which patient groups melatonin is best suited for and management of melatonin treatment.

Conclusions This survey has highlighted variability amongst Community Paediatricians in the East of England in certain areas of melatonin prescribing, possibly due to lack of uniform standards. With these results we are therefore creating a generic regional algorithm for initiating melatonin in children with disrupted sleep pattern which may form a platform for developing a melatonin prescription and sleep guideline for individual Organisations.

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