Abstract

Introduction
Children with neurodevelopmental conditions commonly experience sleep difficulties and are less likely to respond to behavioural sleep measures alone [1]. Melatonin is a lifeline for parents and caregivers to improve sleep in their children [2]. However, little is known about the willingness of prescribers in community settings to initiate or continue melatonin for children with neurodevelopmental conditions, like autism, who experience sleep difficulties.
Aim
To explore paediatrician’s experiences of melatonin prescribing for children with neurodevelopmental conditions and sleep difficulties.
Methodology
An online questionnaire using JISC was sent to paediatricians who were members of British Academy of Childhood Disability (BACD) and British Association of Community Child Health (BACCH) in their monthly newsletter in December 2024. Items in the survey focused on i) prescribing melatonin, ii) access to sleep services, iii) other sleep resources used, and a free-text response box to report issues related to prescribing melatonin. Quantitative data were analysed using descriptive statistics to summarise paediatrician’s perspectives and free-text responses were thematically analysed. Ethical approval was provided by Newcastle University.
Results
Eighty-eight paediatricians responded to the survey over 59-day period in 2024. Approximately 64% (n = 56) accepted new referrals for disabled children with sleep difficulties; 40% (n = 35) had a local sleep service available, but where a specialist sleep service was available, this was sometimes a barrier to accessing Melatonin. Almost all (99%, n = 87) respondents said they would prescribe melatonin and 80% (n = 70) had a local a shared care agreement in place for prescribing. Issues with prescribing melatonin were common and included: impact of GP industrial action to decline Shared Care Agreements; concerns about abuse; reduced time or capacity in primary care; deflecting professional responsibilities; formulation (liquid) being too expensive; diagnosis missing; access to behavioural support not tried; access to repeat prescriptions limited to every 28 days; GP concerns continuing melatonin and transitions of who was responsible for care as children transitioned into adulthood.
Discussion
Almost all prescribers said they would be willing to prescribe melatonin may suggests patients have easy access to this drug, however only 40% had a local sleep service and 20% did not have shared care agreements in place. Additionally, prescribers reported difficulties prescribing melatonin which may mean although willing, prescribers are unable. This indicates further work is needed to explore patient access to melatonin in community settings. The findings align to FIP Development Goal 13, 15 and 18. Further work is needed to explore clinician prescribing behaviours to standardised melatonin prescribing policies, ensuring person-centred care and equitable access to medicines. A limitation of the study is the low sample size, which means the findings may not be generalisable to other clinicians. Additionally, the survey was only completed by those willing to volunteer their time, so may include responder bias. Further work is needed to understand why decisions to prescribe melatonin vary and how this impacts access for patients with neurodevelopmental disability and sleep disorders.