What is the mainstay nonpharmacologic approach to pediatric dyssomnias?

• A. Diphenhydramine
• B. Lorazepam
• C. Behavioral therapy and sleep hygiene
• D. Zolpidem

Answer: (C)

Nonpharmacologic management of pediatric dyssomnias focuses on behavioral strategies and sleep hygiene. Establishing a consistent, calming bedtime routine and regular wake times helps the child learn to fall asleep and stay asleep without cues that promote wakefulness. Sleep hygiene includes a conducive sleep environment (dark, quiet, comfortable), avoiding screens and stimulating activities before bed, limiting caffeine, and keeping naps from interfering with nighttime sleep. Behavioral approaches, often involving parent coaching, address bedtime resistance and sleep-onset associations through structured routines, gradual withdrawal of parental presence if needed, and reinforcement for consistent sleep behavior. These strategies tackle controllable factors and are safe, with durable improvements when applied consistently. In contrast, medications like diphenhydramine, lorazepam, and zolpidem carry risks—sedation, cognitive effects, next-day drowsiness, or dependence—and are not the preferred first-line option for children.