ABSTRACT
INTRODUCTION In a general sense, the operational definition of insomnia in children may be construed as similar to that in adults, i.e., significant difficulty initiating and/or maintaining sleep and/or non-restorative sleep (early morning awakening is an infrequent complaint in children). However, practically speaking, the most frequent clinical manifestations of childhood insomnia, particularly in younger children, are bedtime refusal or resistance, delayed sleep onset, and/or prolonged night wakings requiring parental intervention. It is estimated that overall 20% to 30% of children in cross-sectional studies are reported to have some significant bedtime problems and/or night wakings (1-7), and a recent study suggests that lifetime prevalence of insomnia in 13 to 16-year-old adolescents approaches 11% (8). These percentages are substantially higher in children with psychiatric comorbidities (9,10) and with a variety of neurodevelopmental disorders (11). Furthermore, there is clear evidence from both experimental laboratory-based studies and clinical observations that insufficient and poor quality sleep in children results in or exacerbates mood instability and behavioral dysregulation, impacts negatively on neurocognitive functions and academic performance (12-14), and affects caregivers, with significant repercussions on family functioning. Therefore, appropriate and effective management of insomnia in the pediatric population is an important therapeutic goal for mental healthcare providers.
