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Are your kids little addicts?
As shocking health statistics go, this one is an eye-popper: Prescription sleeping-pill use is up 85% among older children and adolescents. The recent study that includes this information also shows a doubling of use among young adults.

So are we raising a generation of pill-dependent insomniacs — overscheduled kids so hyped up on caffeinated sodas, energy drinks and Frappuccinos that they need drugs to fall asleep?

Not really. A closer look at the data, and some additional information, suggests the actual number of kids getting sleeping pills is tiny and the reasons complex.

The study, from managed-care company Medco Health Solutions, looked at prescription data for 2.4 million customers. Among them were 554 kids ages 10 to 19 getting "hypnotic" medications (drugs classified specifically as sleeping pills) in 2000; four years later, 1,032 kids were getting the drugs — 0.3% of the 342,568 kids in the sample. That's 3 kids in 1,000. And the vast majority likely were teens, not children, says Medco's chief medical officer Robert Epstein.

Still, experts find any increase troubling — because, they say, the medications included in the study have not been tested on children and teens, and, even if safe, are probably inappropriate for most kids.


"I'm not sure why people are prescribing these medications. Sometimes children with

neurodevelopmental problems like autism have sleep problems that are very severe and we sometimes prescribe medication for them," says Thomas Anders, president of the American Academy of Child and Adolescent Psychiatry and a researcher in pediatric sleep disorders at the UC-Davis M.I.N.D. Institute. However, Anders says, most specialists don't use hypnotics in children — not even the new ones now heavily marketed to adults. Instead, they use other sedating drugs, often older antidepressants with long pediatric track records.

"But we never prescribe and shouldn't prescribe a sleep medication with a child who only has insomnia," he says. That's because insomnia — in children as in adults — is primarily a learned behavior that can be unlearned, specialists say. Behavior-changing techniques like enforcing a sleep schedule and insisting kids fall asleep only in their beds — work for most kids.

Judith Owens, a sleep specialist at Hasbro Children's Hospital in Providence, says she recommends that parents try a behavior-changing plan even if they try medication, too. She says newer medications should be studied to find better options for the few children — mostly with disabilities — who truly need them.

But she also suspects a lot of kids and teens getting pills aren't chronic insomniacs at all, but instead are kids going on overseas trips or facing other temporary sleep disruptions. Some parents have long coped with extended plane trips by slipping their children sedating antihistamines bought over the counter, she says.

After speaking with Anders and Owens, I asked Medco to look again at their data. Sure enough, 61% of the prescriptions in 2004 were never refilled — suggesting they were for one-time, not chronic, use. And Medco found that 39% of kids of all ages taking hypnotics also took some other behavioral drug, and 13% took at least two more. The most common were antidepressants (31%), followed by ADHD drugs (12%) and anti-psychotics (9%). Anti-psychotics are sometimes prescribed for children with autism and bipolar disorder. Antidepressants are used in a wide range of disorders, including anxiety, obsessive-compulsive disorder and autism. Those profiles suggest that many kids getting the pills — for sound reasons or not — have complex health problems, not just insomnia.

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