Melatonin for sleep disorders

Transcription

1 2.5 ml 5.0 ml Melatonin for sleep disorders information for parents and carers This leaflet is about the use of melatonin for particular sleep problems in childhood. It is used to help children who have problems getting to sleep at the start of the night. This leaflet has been written specifically for parents and carers about the use of this medicine in children. The information may differ from that provided by the manufacturer. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again. Name of drug Melatonin Common brand: Circadin Melatonin is available in a range of branded products. Why is it important for my child to take this medicine? Melatonin is mostly used for children with partial or complete blindness, cerebral palsy, attention deficit hyperactivity disorder, autism or learning disabilities. It is unlikely to be used for an otherwise healthy child who has sleep problems. Poor sleep can affect your child s physical health, mood, behaviour and development. Melatonin may help your child to get into a regular sleep pattern. What is melatonin available as? Modified-release tablets (Circadin): 2 mg Tablets and capsules from 0.5 to 5 mg can be ordered specially from your pharmacist. Liquid medicine: 5 mg per 5 ml (this has to be ordered specially from your pharmacist) When should I give melatonin? Melatonin is best given between half an hour and an hour before your child s agreed bedtime. Give the medicine at about the same time each day so that this becomes part of your child s daily routine, which will help you to remember. How much should I give? Your doctor will work out the amount of melatonin (the dose) that is right for your child. The dose will be shown on the medicine label. You will probably start with a low dose and the dose will be increased a little each week until the sleep problems have been improved, or up to an agreed maximum. It is important that your child has the minimum they need to help them get to sleep. It is important that you follow your doctor s instructions about how much to give. How should I give melatonin? Tablets should be swallowed with a glass of water, milk or juice. Your child should not chew the tablets. Capsules should be swallowed with a glass of water, milk or juice. Your child should not chew the capsules. You can open the capsules and mix the contents with a small amount of soft food such as yogurt, honey or jam. Your child should swallow it all straight away, without chewing. Liquid medicine: Measure out the right amount using a medicine spoon or oral syringe. You can get these from your pharmacist. Do not use a kitchen teaspoon as it will not give the right amount. When should the medicine start working? If the medicine is helpful, your child should start to feel sleepy about half an hour after taking a dose. What if my child is sick (vomits)? If your child is sick less than 30 minutes after having a dose of melatonin, give them the same dose again. If your child is sick more than 30 minutes after having a dose of melatonin, you do not need to give them another dose that night. What if I forget to give it? If you miss a dose, wait until the next normal dose. Do not give the missed dose. What if I give too much? If you think you may have given your child too much melatonin, contact your doctor or NHS Direct ( in England and Wales; in Scotland). Have the medicine packet with you if you telephone for advice. Are there any possible side-effects? We use medicines to make our children better, but sometimes they have other effects that we don t want (side-effects). Side-effects that you must do something about If your child has a seizure (fit) for the first time, or has 999 more seizures than normal if they have epilepsy, contact your doctor straight away. If your child gets a fast heart rate (they may have a fluttering feeling in the chest or feel the heart beating fast), contact your doctor before giving the next evening s dose. 999 If they seem unwell, take them to hospital. Other side-effects you need to know about Your child s temperature may fall a little after taking melatonin. This is a normal reaction to melatonin.

2 Can other medicines be given at the same time as melatonin? You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to. Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines. Is there anything else I need to know about this medicine? Treatment with melatonin is usually started by a specialist. We do not know what effects melatonin may have on a child s development if it is taken for a long time. Your doctor will review whether your child still needs melatonin every 6 months. A specialist may suggest that your child takes just one dose of melatonin before having a CT scan, MRI scan or EEG, when they might be expected to lie still for a while. General advice about medicines Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm. If you think someone else may have taken the medicine by accident, contact your doctor straight away. Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out. Make sure that the medicine you have at home has not reached the best before or use by date on the packaging. Give old medicines to your pharmacist to dispose of. Where should I keep this medicine? Keep the medicine in a cupboard, away from heat and direct sunlight. It does not need to be kept in the fridge. Make sure that children cannot see or reach the medicine. Keep the medicine in the container it came in. Who to contact for more information Your child s doctor, pharmacist or nurse will be able to give you more information about melatonin and about other medicines used to treat sleep disorders. You can also get more information from: NHS Direct (England) NHS 24 (Scotland) NHS Direct Wales/Galw lechyd Cymru NI Direct (Northern Ireland) Version 1.3, June 2010 (November 2011). NPPG, RCPCH and WellChild 2011, all rights reserved. Reviewed by: June 2012 The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.

3 Day Daytime sleep Time put to Handsel Project Sleep Diary Name. DOB. Start Date.. Monday Tuesday Wednesday Thursday Friday Saturday Sunday bed Time fell asleep Night waking: Time? / How long? / What happened Time awoke

4 Sleep Interview Schedule 1

5 This sleep assessment tool has been designed for use with families of disabled children. The Sleep Practitioner working with the family will need to consult with parents/carers/siblings and the child as far as their communication will allow. It is also important to liaise with other key people in preschool settings; children s centres, nurseries, schools, colleges, short break facilities etc. in order to gain a complete picture and thorough understanding of the sleep problem. This schedule is split into 7 sections and asks 42 questions in total. Sections 3-7 apply to a typical week, Monday Friday night. Any notable differences in routine or presentation at weekends or holidays should be documented. 1. Background 1. Please describe the child s sleep problem. 2. When did the sleep problem begin? 3. What was happening in the child s life around that time, any major changes? 4. Has the child experienced any traumatic events in their past? 2

6 5. What strategies have already been tried? Please detail how long for and level of consistency. In hindsight, was this a good time for the family to undertake sleep work? 6. Does the child sleep anywhere else in a typical week e.g. short break settings, extended family? How do they sleep in these settings? 7. Are there cultural issues which may affect how the child sleeps eg. Religious festivals? 8. Please describe the child s sleeping environment e.g: Bedroom decoration, comfortable mattress, toy storage, computer, T.V. or other electronic equipment. Own room or shared? 9. Are there any sensory distractions which may affect the child s ability to sleep e.g: Noise from heating system or flickering street lights? 3

7 10. Does anyone else in the family have problems sleeping, currently or in the past? 2. Medical 11. Does the child have any medical conditions? 12. Sleep Medication Does the child take any and how long have they been taking it for? Is it as effective as when it was first started? Has it ever been stopped and what was the effect? 13. Does the child take any other medication prescribed or over-the-counter? 4

8 3. Evenings 14. Between 5pm and bedtime what activities does the child engage in? 15. At what time does the child eat in the evenings (include tea-time and supper meals)? 16. What do they typically eat at these times, any caffeine containing drinks? 5

9 4. Bedtime 17. Does the child have a bedtime routine that is always done in the same way? 18. Who helps the child prepare for bed, is it always the same person? 19. What time does the routine start? does the child go to bed? does the child fall asleep? 20. Is the child put to bed asleep or awake? 21. How and where does the child fall asleep? Alone or with carer, own bed or downstairs? 6

10 22. Does the child need comforters or bottles to fall asleep with? 23. Does the child find it hard to relax at bedtime, either because recounting day, planning next day or expressing fears about sleep? 24. When falling asleep, does the child have any unusual experiences? 25. What happens if the child refuses to go to bed or cannot settle? Who deals with this and is this always in the same way? 7

11 5. Night-time 26. Does the child wake in the night? How often and for how long? Do they use the toilet, need a drink, stay quiet and return to asleep alone, become disruptive or need carers to settle them back to sleep? 27. Is their sleep interrupted in other ways e.g nightmares, sleep talking, sleep walking, screaming, teeth grinding, distressed or unusual body movements? At what time of night do they happen and how long do they last? How common are they? How do their carers deal with them? 28. Does the child snore, have trouble breathing? Are they overweight? 29. Is the child incontinent of urine or faeces in the night? Are there any behaviours associated with this? 30. How long does the child normally sleep continuously for? 8

12 6. Waking 31. What time do they wake for the day? 32. Does the child wake up naturally or need a carer to wake him? 33. What mood does the child wake up in? Any problems with headaches? 34. Is their bed linen in extreme disarray when they wake? 35. Do they have any odd experiences upon waking? 9

13 7. Daytime 36. Does the child sleep in the day? When, how long for and how often? 37. Are they able to resist the urge to sleep or do they fall asleep even when occupied? 38. Do they fall asleep instantly, possibly falling if stood at the time? 39. Does the child seem tired in the day, despite having a reasonable nights sleep? 40. Does the child have behavioural difficulties during the day? 10

14 41. What physical activity does the child do in the day? 42. What is the child s estimated total sleep time in 24 hours? Name Role Signature Date Based on/ evidenced by: Stores G, Wiggs L Eds (2001) Sleep Disturbance in Children and Adolescents with Disorders of Development: Its Significance and Management Cambridge University Press Durand V (1998) Sleep better - a guide to improving sleep for children with special needs. Paul H Brookes Publishing Co. 11