What is the first-line pharmacotherapy for treating insomnia in pediatric populations?

Melatonin is widely recognized as the first-line pharmacotherapy for treating insomnia in pediatric populations due to its safety profile and physiological role in regulating sleep-wake cycles. It is a naturally occurring hormone that helps signal the body when it is time to sleep, making it particularly effective for children who have difficulty falling asleep. Its use is supported by multiple studies indicating efficacy in improving sleep onset and duration in children, especially those with conditions like ADHD or autism spectrum disorders, where sleep disturbances are common.

In addition to its effectiveness, melatonin has a favorable tolerability profile, with fewer side effects compared to other medications. This makes it an appealing option for pediatric patients, who may be more sensitive to the side effects associated with stronger sedatives or antidepressants.

While the other medications listed may have roles in managing sleep disturbances, they are not typically recommended as first-line options for children. For example, drugs like zolpidem and trazodone carry risks of dependence and adverse effects that make them less suitable for pediatric use. Doxepin, while effective for insomnia in adults, is generally not used as a primary treatment in children due to its side effect profile and the availability of safer alternatives. Consequently, melatonin stands out as the preferred choice in the treatment