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Management of Paediatric Chronic Insomnia in Primary Care
Abstract
Behavioural insomnia, a form of chronic insomnia, is highly prevalent in children. Persisting sleep
problems can have multiple impacts on the child and family. Behavioural/sleep hygiene
interventions are effective management strategies, and primary care provides the potential for
early management and prevention. This thesis explores the management of chronic insomnia in
children within primary care.
A systematic review explored the evidence-base for primary care practitioners’ (PCP)
knowledge, beliefs/attitudes, and practice. A systematic narrative synthesis of 26 studies found
that PCPs are aware of the impacts of chronic insomnia, perceive management to be within their
role, and endorse behavioural management strategies, but have varied knowledge and
confidence for management. However, the methodological quality of the studies varied, and they
were from limited primary care settings and countries (usually UK health visitors or US
paediatricians). Higher quality UK research for both GPs and health visitors was lacking.
A qualitative study analysed posts in online discussion forums to explore parental concerns
about children’s sleep problems, awareness of management resources, and perception of
management within primary care. Results from 93 discussion threads across two forums
suggested that: parents have multiple and varied concerns relating to their children’s sleep; that
parents often turn to one another online for emotional and practical support; and use resources
online, non-PCPs (such as private sleep consultants) and books. It is uncertain how many of these
resources are evidence-based. Parents posted about primary care less frequently but had mixed
experiences of and attitudes towards health visitors, and limited experiences with GPs.
A mixed-methods study (surveys and qualitative interviews) of UK practicing PCPs was
conducted to explore their knowledge, training, beliefs and practice for insomnia management in
children up to the age of five. Survey findings (n=355, mainly GPs) suggested that PCPs perceive
negative impacts of chronic insomnia on children and their families and believe that it should be
addressed in healthcare. However, insomnia is infrequently discussed in consultations, PCPs have
varied knowledge and confidence regarding management, and limited training and knowledge of
resources. Interview findings (n=21) echoed the survey findings, providing greater depth and
insight. Health visitors had greater training opportunities and were perceived to be more suited to
in-depth management, whereas the general practitioner’s role was perceived as excluding the
presence of other conditions, brief advice and signposting to health visitors and other resources.
GPs were interested in undertaking brief training.
Further health visitor research and support, Increased discussions of insomnia in primary care
consultations, improved access to GP training, and greater awareness of available resources has
the potential to improve paediatric chronic insomnia management in primary care.
Author
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Date
2022-09
Type
Article
Subject
Insomnia, Paediatrics, Primary care
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Citation
Hornsey, S. (2022) Management of Paediatric Chronic Insomnia in Primary Care, University of Southampton, Faculty of Medicine, pp 1-481
Journal / Source Title
DOI
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Publisher’s statement
This thesis relates to a research study that included patients or members of the workforce as study participants from GP practices in Nottingham and Nottinghamshire.
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Paediatric insomnia.pdf
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