2/22/2017 1 Comment Insomnia In ChildrenSleep disorders are a frequent complaint in routine medical appointments. The pediatrician must be able to adequately establish their diagnosis and management, thus avoiding referral to specialist consultations as well as unnecessary and excessive interventions. Sleep disorders are present as the primary entity, but may also be associated with several organic diseases (e.g. asthma, obesity, neuromuscular diseases, attention disorder) or psychiatric co morbidities (anxiety, depression, bullying). During the first years of life, the most frequent complaints are difficulty in falling asleep and frequent nocturnal awakenings, followed by parasomnias and sleep-disordered breathing. From pre-school age onwards, disorders related to inadequate sleep hygiene occur and also the disorder related to circadian issues or excessive movements during sleep. Nocturnal awakenings occur frequently in childhood and its distribution varies with age. In the first six months of life, they are concentrated in one to two evening peaks; after the six month, they follow a distribution that accompanies the sleep cycle and occur more commonly in the REM stage. In these cases it is common that the child goes back to sleep spontaneously. The classification of sleep disorders are proposed by the American Academy of sleep Medicine and the Chronic Insomnia which is the updated version of ICSD-2 published in 2005. This classification review maintained the basic principles of the previous one, identifying seven major sleep disorder categories; insomnia, sleep-disordered breathing, central hypersomnia, circadian rhythm disorders, movement disorders during sleep, parasomnias and others. There was a standardization of diagnostic criteria for adults and children, maintaining the recognition of specific age-dependent situations. Insomnia can be defined as difficulty initiating sleep; maintaining sleep; or waking up earlier than the usual schedule with inability to return to sleep. Insomnia can cause distress and social, professional, educational-academic, or behavioral impairment and many more impacts. Insomnia is a sleep disturbance in which children have trouble falling asleep or staying asleep at night. Sometimes the complaint is of waking up too early. While older children may complain of this on their own, often it is the parent of the youngster who brings this to attention. Insomnia complaints are generally associated with a feeling of non-restorative sleep and impairment in daytime functioning. Insomnia can be classified based on duration, severity and frequency of the problem. Short-term insomnia may occur for just few days to a week and is caused by factors that will usually easily pass. Long-term insomnia occurs three times a week for a month or longer and may be caused by factors for which you would seek medical advice for your child (eg. depression, anxiety, pain, medical problems). Sometimes, there may be no obvious reason at all. In children, bedtime resistance and problem to initiate sleep is also considered as a form of insomnia. Symptoms of insomnia-
Causes of childhood insomnia there are a number of possible causes of insomnia, including- Side-effects of certain medications- for example, drugs used to treat attention deficit hyperactivity disorder, antidepressants, corticosteroids and anticonvulsants can cause insomnia Environmental factors- Noise, heat, cold and light conditions in the bedroom can interfere with sleep. Make sure the bed and mattress are comfortable and the bedroom is organized to reduce environmental interference. This includes restrictions on the use of electronics in the bedroom.
Stress- Kids, just like adults suffer from stress. So don’t hesitate to show interest in your child’s life and build trust so that they feel comfortable sharing their worries with you. Children worry more than you might think and excess worry and stress can lead to insomnia. Medical and other sleep disorders- Uncontrolled nighttime asthma, a stuffy nose from allergies or itchy skin from eczema can get in the way of good sleep. If these conditions are chronic, they may be easily ignored until they flare up. Other medical disorders, including muscle cramps, growing pains, and heartburn and thyroid disease can all cause insomnia. Be sure to have your child’s physical health examined as a possible cause of insomnia. Sleep disorders such as obstructive sleep apnea and restless legs syndrome may interfere with your child’s sleep. Neuro-developmental disorders, such as autism, mental retardation and Asperser’s syndrome, can also be a cause of insomnia. Finally, psychiatric conditions like depression or bipolar disorder can be associated with poor sleep. Treatments for childhood insomnia- Although parents often want to turn to a prescription to treat their child’s insomnia, it is much more important to look for any underlying medical or psychological problems first. The sleeping pills that we all see marketed on TV, such as Ambien CR and Lunesta have not been approved for use of children. Medications which are sometimes used when necessary and appropriate include;
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