Every expectant parent knows that with the arrival of a new baby an uninterrupted night’s sleep will become a longed for and distant memory, at least for some period of time. But while it’s normal for a two-month-old to wake frequently during the night, it isn’t normal for a two-year-old. Parents bring this and many other concerns about sleep behaviors to pediatricians and seek advice in books and online on how to develop healthy sleep habits in their children. “Eventually, most children outgrow frequent waking during the night and resistance at nap and bedtime,” says sleep specialist Dr. Gerald Suh. “But there are more serious pediatric sleep disorders that if uncorrected can seriously affect the child’s health and happiness and upset the family’s equilibrium.”
Dr. Suh recommends that parents consult the pediatrician or primary physician for children who exhibit one or more of these symptoms frequently or for an extended period:
• Snoring, snorting, choking and gasping for breath
• Breathing with an open mouth or sleeping with the neck extended
• Sleepwalking and/or sleep-talking
• Night terrors or nightmares
• Unusual or excessive movements during sleep
• Trouble falling asleep or staying asleep
• Persistent bed wetting
• Excessive sleepiness during the day
• Daytime behavioral issues such as difficulty concentrating, aggression or hyperactivity
The physician will take a complete history and may recommend a sleep study to pinpoint the cause of the disturbance. Pediatric sleep disorders cover a wide range. Primary disorders have a physiological basis and while some may be outgrown, others require medical intervention. Secondary disorders, such as night awakening and bedtime resistance, are more often behavioral in nature and can generally be overcome with appropriate parental attention.
Common primary pediatric sleep disorders.
Obstructive sleep apnea is a disorder in which breathing is repeatedly interrupted during sleep due to obstruction in the upper airway. With air unable to get to the lungs, the oxygen level in the blood drops and when the amount of oxygen reaching the brain decreases, the brain signals the body to wake up and take a breath. In children, the airway is most often obstructed by the tonsils and adenoids and removing them brings significant relief in 85% of cases. Obstructive sleep apnea affects 2-5% of all children and is most common in those with facial abnormalities, chromosomal disorders (such as Down syndrome) and obesity. A sleep study is generally needed for a definitive diagnosis.
Parasomnias are disorders that are characterized by unusual behaviors during sleep. Among the most common in children are sleepwalking and night terrors, which usually occur in children between the ages of four and twelve. Parasomnias appear to be reflective of immaturity of the central nervous system, which allows the intrusion of wakefulness into various stages of sleep. They tend to decrease in frequency and intensity as children get older and disappear over time without treatment.
• Sleepwalking: While a sleepwalking child’s eyes are open, he is actually asleep and there’s no benefit to waking him. The best action is to gently guide him back to bed. Children generally have no recollection of sleepwalking. Sleepwalking is harmless except with respect to injury. The child’s room should be free of obstructions and should have a bell or alarm that alerts parents to a wandering child.
• Night terrors differ from nightmares, which are frightening dreams that awaken a sleeping child who may have vivid memories of the dream. Night terrors are scarier to parents than to the child who, while apparently agitated and terrified, is asleep and will have no memory of the event. It is generally best not to intervene or try to calm or awaken the child, since he or she will likely return to restful sleep after just a few minutes.
Other prevalent sleep disorders in children include bed wetting (after the age of five); confusional arousal, in which the child exhibits confusion during or after arousal from sleep; periodic leg movements; and narcolepsy, in which the child falls asleep suddenly during the day.
“Sleep disturbances are worrisome for parents and some are potentially harmful for children,” Dr. Suh concludes. “Sufficient sleep and regular sleep habits are critical to a child’s health and well-being. We now have a greater understanding about sleep and how it occurs in children and help is available for most of these problems.”