HNY Policy and Pathway Repository - Humber

The aim of these guidelines is to improve the services offered to children, young people and their families and to reduce reliance on melatonin.

This pathway applies to children and young people age 2-19 years with Special Educational Needs and Disabilities (SEND) who have identified sleep difficulties.

It applies to those who are treatment naïve and those already taking melatonin.

No Red Flag Symptoms Listed

SEND Sleep Service

NHS Hull CCG has commissioned KIDS Yorkshire and The Humber to deliver and coordinate a SEND Sleep Service and this should be the first line of treatment.  

Melatonin

Melatonin is commonly used for the treatment of sleep disorders in children with SEND but the evidence of its effectiveness is poor.

Only one form of melatonin (Circadin) is currently licensed in the UK for the short term treatment of primary insomnia, in adults who are aged 55 years or over. All other melatonin products are unlicensed “specials”. Thus there is no licensed product available for use in children.

Melatonin should not be considered unless confirmation can be obtained from the SEND Sleep service that the family have completed the recommended treatment programme and that this has been unsuccessful.

Children already taking melatonin

Existing patients are to remain under the shared care arrangements between the consultant and the GPs until such time it is appropriate for them to stop treatment.

These children/young people are to be invited to/referred to a paediatrician clinic review if they have not been reviewed in the last 6 months.

Aims for the review meeting for all children/young people:
- Discuss research information on melatonin and other medications
- Emphasise the benefit of behavioural approach
- Referral to the SEND Sleep Service/Sleep practitioner whilst melatonin is reduced
- Joint sleep plan
- Reduce melatonin dosage
- Stop melatonin treatment

Refer to the SEND Sleep service with clear messages about the added benefit of behavioural approach.

Do Not Refer

The SEND Sleep Service does not include children with neurotypical symptoms:
- Night terrors and other sleep problems in the preschool group should be dealt with by health visitors (with guidance from the SEND Sleep service)
- Sleep apnoea
- Nocturnal epilepsy

Referrals

SEND Sleep Service

The first line treatment is referral of the child/young person/family to the SEND Sleep service.

A referral will be accepted by a health or education or social care professional, or self-referral. 

Telephone: 01482 467540

Guidelines

Parent/Carer information on Melatonin

Referral form on ARDENS