Prescriptions of Hypnotic Medications Up Among Children After COVID-19 Pandemic

Since the start of the COVID-19 pandemic, there has been a substantial increase in prescriptions of hypnotic medications for school-aged children, specifically among those aged 6 to 11 years. These are the findings of a study published in The Journal of Pediatrics.

Poor sleep negatively affects cognition and the well-being of children and is reported by up to 25% of typically developing children.

Researchers from Robert Debré University Hospital in Paris sourced data for this study from the X-ponent database and IQVIA France.

The primary outcome in this study was the monthly prescription rate of approved sleep aids for pediatric patients in France between 2016 and 2023.

Children were defined as age 6 to 11 years and adolescents as age 12 to 17 years. The COVID-19 pandemic was defined as starting on March 1, 2020.

Before the pandemic, hypnotic medications were prescribed at a rate of 1.9 monthly prescriptions per 1000 pediatric patients. Stratified by drug, the monthly prescription rates were highest for hydroxyzine (rate, 1.4 per 1000 pediatric patients), followed by alimemazine (rate, 0.2 per 1000 pediatric patients), Z-drugs (rate, 0.2 per 1000 pediatric patients), and melatonin (rate, 0.1 per 1000 pediatric patients).

Stratified by age, among children, prepandemic monthly prescriptions for all hypnotics (trend, 0.2%; P =.0078) and melatonin (trend, 2.2%; P <.0001) increased and Z-drugs (trend, -1.8%; P <.0001) and alimemazine (trend, -0.4%; P <.0001) decreased. Meanwhile, among adolescents, rates of melatonin (trend, 2.1%; P <.0001) and alimemazine (trend, 0.4%; P <.0001) increased and the rates of Z-drugs decreased (trend, -3.3%; P <.0001).

Since the COVID-19 pandemic, prescriptions for hypnotics increased among children (rate ratio [RR], 2.53; 95% CI, 2.25-2.80) and adolescents (RR, 2.15; 95% CI, 1.95-2.35).

The pandemic level of hypnotic prescribing increased by 15.3% (P =.0012) overall, and by 155.3% (P <.0001) for melatonin and 29.1% (P =.0036) for Z-drug.

Stratified by age, significant increases in the level of all hypnotics (18.8%; P <.0001) and melatonin (188.3%; P <.0001) prescribing and a decrease in the level of hydroxyzine prescribing (-8.3%; P =.005) were observed among children. An increase in all hypnotics (14.1%; P =.0073), melatonin (123%; P <.0001), and Z-drug (37.5%; P =.0006) prescribing were observed among adolescents.

The final level of monthly hypnotic prescriptions was 6.8 per 1000 pediatric patients, or 6.1 per 1000 children and 7.4 per 1000 adolescents.

Stratified by medication and age, increases in melatonin (RR, 5.04; 95% CI, 4.62-5.46), Z-drugs (RR, 2.51; 95% CI, 2.12-2.89), hydroxyzine (RR, 1.21; 95% CI, 1.16-1.26), and alimemazine (RR, 1.04; 95% CI, 1.02-1.06) were observed among children. In adolescents, increases in Z-drugs (RR, 5.28; 95% CI, 4.34-6.22), melatonin (RR, 3.90; 95% CI, 3.57-4.23), hydroxyzine (RR, 1.46; 95% CI, 1.38-1.54), and alimemazine (RR, 1.19; 95% CI, 1.16-1.21) were observed.

Pandemic trends in prescribing were higher than expected for all 4 medications based on prepandemic trends.

This study was only able to assess medication prescription and not medication use.

“[W]e provide evidence of recent substantial increases in hypnotic medication prescribing for children that were ongoing more than three years after the pandemic onset,” the researchers concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.