Are Sleep Medicines an Option for Kids with Atopic Dermatitis?

Sleep is supposed to offer rest and rejuvenation, but for children with atopic dermatitis (AD) and their families, it often brings little relief. Up to 87% of children with AD between the ages of 2 and 10 experience sleep disruptions.¹ 

Much of this has to do with children’s shorter sleep cycles, which last about one hour compared to 90 minutes to two hours for adults. At the end of each sleep cycle, we wake briefly and typically go back to sleep, often without being aware of it. But for people with AD, this waking period can be when they feel the itch kick in and begin scratching, making it difficult for them to go back to sleep.

This nightly cycle of itching and waking can leave both kids and parents exhausted and in search of solutions, including sleep medicines. 

A family’s journey

For Stephanie Mejia, from New York, the struggle began last winter when her then 3-year-old daughter, Luna, who has AD, began intense scratching after falling asleep each night. “Winter seems to be a trigger because she doesn’t really itch as much in warmer weather,” Mejia said.

The itching became so severe and frequent that Luna could no longer sleep alone in her room and had to share Mejia’s bed.

“When she’d start scratching, I would wake up immediately, grab her arms to stop her, and then moisturize her skin. And then I’d be up for a while,” she said. 

Even when Luna wasn’t scratching, Mejia would wake up to check on her. Naturally, both were exhausted. Luna was often cranky and would fall asleep frequently at preschool. Concerned, Mejia reached out to their pediatrician, who suggested trying Benadryl.

“I wasn’t comfortable with [the idea of using sleep medicines],” Mejia said. “There were just so many questions. How would they affect a child?”

They then met with an allergist who recommended measures to reduce itching triggers, such as removing stuffed animals that can trap dust from the bedroom, switching laundry detergents and using cotton fabrics. Stephanie also switched moisturizers for Luna, moving from Aquaphor, which contains lanolin (a potential allergen for some kids), to Vanicream.

While these measures have provided relief, Mejia is concerned that the nightly itching and sleeplessness might return, especially in the winter. As Luna, now 4, grows older, Mejia is becoming more receptive to the idea of using sleep medicines, but still has many questions and concerns. Mejia’s worries about sleep medicines are common among parents managing similar challenges. To provide more clarity and support for parents, we reached out to Dr. Rupam Brar, pediatric allergist and immunologist at NYU Langone Health and assistant professor at NYU Grossman School of Medicine (and Luna’s allergist). We also talked to Dr. Jeff Yu, a board-certified dermatologist and fellowship-trained pediatric dermatologist at Massachusetts General Hospital. Here’s what they had to say.

What are the general guidelines for sleep medicines for children?

Dr. Jeff Yu (JY): They should be used cautiously and only when absolutely necessary. And they shouldn’t be used nightly for extended periods of time. 

That said, there are several medications that can help improve sleep in children with AD. The most commonly prescribed ones are first-generation antihistamines, which can make children drowsy. Diphenhydramine (Benadryl) and hydroxyzine (Atarax) are often used, and some parents have seen improvements in their children’s sleep with these.

Also, melatonin has been studied in a randomized controlled trial in children, which showed that 3 milligrams a day led to improved sleep onset and a decrease in eczema severity.²

Dr. Rupam Brar (RB): Sleep medicines should be used under the guidance of a physician. Be aware that some sleep medicines, like first-generation antihistamines, can sometimes make children more hyperactive instead of sleepy. Also, these medicines might not effectively relieve itching because itching can be caused by factors beyond histamine and can be quite complex.

Melatonin is a hormone naturally produced by our bodies, but taking melatonin gummies regularly might disrupt a child’s natural sleep-wake cycle and affect their own melatonin production.

Are there any age-specific recommendations parents should know?

JY: I would check with your pediatrician, but antihistamines are usually recommended for children over 2 years of age.

For melatonin, the general guideline is to use it in children over 5 years of age. However, the clinical trial cited earlier used it safely in children over 1. While there is likely a wide range of safety, it is best to discuss this with your child’s pediatrician or pediatric dermatologist. In the trial, no side effects were noted for children with AD.

RB: Melatonin should not be given to children under 3, as their brains are still developing. There’s limited data on its use for AD, and while it may help with falling asleep, it is unlikely to address nighttime awakenings.

What are the potential risks and side effects of sleep medicines?

JY: The most common side effect of sleep medicines is drowsiness and sleepiness. There has been some discussion about a potential link between antihistamines and dementia risk, but these studies are inconclusive and mainly involve adults, not children. While using these medications on a limited, as-needed basis should be safe, longer-term studies are needed to confirm their safety.

RB: I mentioned previously that some antihistamines can make children hyperactive. They may also have a drying effect, which is not great for skin. Second-generation antihistamines, such as Zyrtec and Claritin, may not provide much relief for itching. They can help allergies, but not all children, especially young children, have allergies driving the AD.

What are the key points parents should discuss with their child’s doctor?

JY: The main issue to address is the itch associated with AD, as it often disrupts sleep. Managing itching typically requires controlling the underlying AD with topical or systemic treatments. Oral antihistamines and melatonin should be considered only as supplementary options.

RB: It’s very important to mention to your physician if AD is affecting sleep. If AD is severe enough to cause sleep disturbances, make sure you’re also using treatments like topical steroids, wet wraps or prescription medications like Dupixent, all of which can improve sleep.

What’s the most important piece of advice you would give to parents dealing with a child who has sleep issues due to AD?

JY: The key is to effectively and thoroughly treat the underlying AD to ease the itch.

RB: Establish a consistent sleep routine and practice good sleep hygiene. Avoid blue light and screens two hours before bedtime, and ensure exposure to sunlight during the day to support melatonin production. A warm bath with moisturizers or medications can help treat AD lesions and relax the child. Keep the room cool and use a fan if heat triggers itching. For nighttime awakenings, use cool treatments like refrigerated lotions and creams applied with a cool washcloth to soothe itchy skin.

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References:

¹Ramirez FD, Chen S, Langan SM, et al. Association of Atopic Dermatitis With Sleep Quality in Children. JAMA Pediatr. 2019;173(5):e190025. doi:10.1001/jamapediatrics.2019.0025
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2725861

²Chang Y, Lin M, Lee J, et al. Melatonin Supplementation for Children With Atopic Dermatitis and Sleep Disturbance: A Randomized Clinical Trial. JAMA Pediatr. 2016;170(1):35–42. doi:10.1001/jamapediatrics.2015.3092
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2470860#