What investigations are recommended for insomnia in a 12-year-old?

Investigations for Insomnia in a 12-Year-Old

A comprehensive clinical history and focused physical examination are the primary investigations needed for insomnia in a 12-year-old, with laboratory testing only indicated when specific medical conditions are suspected based on the initial assessment. 1

Initial Screening and Assessment

• Begin with screening questions to identify the presence and impact of sleep disturbance:

  1. Does the child have problems falling asleep within 20 minutes of going to bed?
  2. Does the child fall asleep in parent's or sibling's bed?
  3. Does the child sleep too little?
  4. Does the child awaken during the night? 1

• Utilize age-appropriate sleep questionnaires to assess the severity and characteristics of insomnia 1

• Maintain a 2-week sleep diary documenting:

  • Sleep onset and wake times
  • Total sleep duration
  • Night wakings
  • Daytime napping
  • Daytime functioning
  • Evening activities and routines
  • Caffeine, food, and medication intake 1

Medical Evaluation

• Assess for medical conditions that may contribute to insomnia:

  • Neurological conditions (epilepsy, headaches)
  • Gastrointestinal disorders (reflux, abdominal pain)
  • Pain syndromes
  • Respiratory issues (asthma, sleep-disordered breathing)
  • Restless legs syndrome symptoms 1

• Review current medications that may affect sleep:

  • Stimulants (for ADHD)
  • Antidepressants (SSRIs)
  • Corticosteroids
  • Decongestants
  • Over-the-counter medications containing caffeine or pseudoephedrine 1, 2

• Evaluate for psychiatric conditions commonly associated with insomnia:

  • Anxiety disorders
  • Depression
  • Autism spectrum disorder
  • ADHD 1

Physical Examination

• Conduct a focused physical examination based on findings from the clinical history 1
• Pay particular attention to:
  • Growth parameters
  • Signs of neurodevelopmental disorders
  • Evidence of upper airway obstruction
  • Neurological abnormalities 1

Laboratory and Additional Testing

• Laboratory evaluation should only be ordered when specific medical conditions are suspected based on history and physical examination 1

• Consider referral for polysomnography (sleep study) if there are concerns for:

  • Sleep-disordered breathing
  • Periodic limb movement disorder
  • Parasomnias
  • Narcolepsy 1

• For children with autism spectrum disorders or neurodevelopmental conditions, more comprehensive evaluation may be needed as these populations have higher rates of insomnia 1, 3

Common Pitfalls to Avoid

• Avoid immediately attributing insomnia to behavioral issues without ruling out medical contributors 1

• Do not rush to pharmacological management without proper assessment and trial of behavioral interventions 2, 3

• Remember that melatonin should only be considered after proper evaluation of insomnia and implementation of sleep hygiene measures, not as a first-line approach 4, 3

• Be aware that insomnia in children often goes unidentified and untreated, leading to significant impacts on development, mood, and academic achievement 3

By following this systematic approach to investigating insomnia in a 12-year-old, clinicians can identify underlying causes and develop appropriate treatment plans that prioritize behavioral interventions before considering pharmacological options.