Aims To audit current Melatonin use in children seen in a District General Hospital including parental satisfaction, and to improve quality of care of children with sleep disturbance.
Methods Pharmacy records identified all patients on melatonin. Clinic letters were audited from a shared computer drive using a questionnaire. Patients and parents were sent a self-administered questionnaire with one reminder.
Results 109 children on melatonin were identified and 100% of clinic letters were analysed. 31% had ADHD, 32% had ASD and the remaining 30% had a variety of neurodisability and behavioural conditions.
Sleep latency (69%) was the most common reason for initiating melatonin. Documentation about sleep hygiene (39%) and melatonin effectiveness (56%) was difficult to establish from clinic letters. Parental satisfaction questionnaires were used to elucidate further information (56% response rate.) 98% noticed benefits, 13% noticed negative effects.
Benefits included reduced sleep latency, improved quality of sleep and daytime effects such as: improved mood, concentration, social communication and decreased sensory difficulties.
Negative effects included difficulty waking in the morning, worsened bed wetting and initial mood swings.
Prior to starting melatonin parents were advised about a variety of sleep strategies by paediatrician, GP, health visitors and other therapists. These included advice on: routine, relaxation techniques, reward systems, sleep hygiene and referral to other agencies.
A free text space was perhaps most illuminating including themes such as: improved quality of life “Melatonin has literally been life changing”, difficulties with medication “medication hard to take”, “I don't like medication but no sleep has far worse side effects” and the difficulties at transition “now he is 18…. our PCT won't allow our GP to prescribe it”.
Children with ADHD formed a large proportion of our study group. Parents also commented sleep difficulties were worse when “taking ADHD medication … he was not sleeping or feeling sleepy at all”.
Conclusion Prior to starting melatonin, better documentation about sleep strategies and discussion with families is required. At each clinic appointment this needs to be updated. To facilitate this, a local guideline has been written.
Melatonin is in general viewed positively by families “Melatonin has been a miracle…..it has transformed bedtimes”.
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