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Question 1: Effectiveness of melatonin in treating sleep problems in children with intellectual disability
  1. Irwin Gill,
  2. Jacqueline McBrien
  1. Department of Developmental Paediatrics, Children's University Hospital, Temple Street, Dublin, Ireland
  1. Correspondence to Dr Irwin Gill; irwingill{at}gmail.com

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Scenario

A 6-year-old boy with mild intellectual disability (ID) attends your clinic with sleep problems ongoing for 2 years; on most nights he has difficulty going to sleep and often wakes during the night. Behavioural approaches have been ineffective. MRI of brain and comparative genomic hybridisation microarray are normal and he has no other medical problems. His parents, who are exhausted, have heard about melatonin and ask you to prescribe it.

Structured clinical question

In children with intellectual disability (patient), does exogenous melatonin (intervention) have a positive effect on measurable sleep parameters (outcome)?

Search strategy

Primary sources

An advanced search of MEDLINE using the terms ‘(intellectual disability OR learning disability) AND (melatonin) AND (child OR teenager)’ up to November 2016 was used. Non-systematic reviews were excluded, as were articles which did not provide quantitative data on sleep parameters or those in languages other than English. Additional potentially relevant studies were identifed by manual review of references.

Ninety-eight articles were found in total; all titles were assessed, 32 articles qualified for further assessment and 19 were found to be relevant.

Secondary sources

A search of the Cochrane Library using the terms detailed above yielded one meta-analysis, which is also identified in the MEDLINE search.

Commentary

Sleep problems are common in children, and especially common in children with ID with prevalence rates of up …

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