Sleeping disorders in children

Children are no strangers to sleep disorders. It is estimated that between 25–30% of visits to the pediatrician are related to a problem related to sleep, and parents can do much to help their children have the deep and restful sleep they need to grow, live healthily and stay Well awake during the day.

Whatever the night problems in a family (get them to go to bed, or stay in it), you have to keep in mind that they are frequent in many homes, at least occasionally.

How many hours do children need to sleep?

A newborn sleeps a total of 16 hours a day, in 6–8 sleep episodes of 4 hours each, with interspersed periods of wakefulness. Thus, the newborn does not respect the night, waking up once or several times throughout it.

From the first month until 3–6 months, the duration of night wakings is decreasing and begins to sleep continuously practically throughout the night. However, these night awakenings persist in almost a third of preschoolers, as a result of inadequate consolidation of the nighttime sleep period.

Between 2 and 4 years they sleep at night for about 10 hours, plus the two usual naps. After three years of age, the “need” to sleep during the day decreases until it practically disappears before the age of six.

From 5 to 10 years of age, sleep reaches a sufficient level of maturity to allow comparison with the adult. Although there are important individual variations, the number of hours of sleep is usually 2.5 times higher than the adult and the proportion of REM sleep is similar to that of the adult.

After 7 years, it is not usual for the child to need to take a nap. If it happens, it is most likely that you sleep less than you need at night or suffer from a problem during night time rest.

From adolescence, the number of hours of sleep will decrease to an average of 7 to 8 hours, which could be insufficient since there is an increase in daytime sleepiness, which has led to the idea that total sleep needs do not decrease but increase during adolescence.

When should we suspect a sleeping problem in a child?

Sleep needs vary considerably. There is no homogeneous sleep pattern and what a child need does not have to be applicable to another. However, if you find it difficult to fall asleep regularly or keep it up at night or if you are tired and sleepy during the day, you should suspect the existence of a sleep problem or the habits that lead to it.

Some behavioral and psychological causes of childhood sleep problems:

Bad habits:

As in adults, children may find it difficult to initiate or maintain sleep, although they rarely complain about this problem and are usually happy to stay awake.

The initiation of sleep requires complex coordination of biological circumstances and learned behaviors: On the one hand, the organism has to be physiologically prepared for sleep. On the other hand, the behaviors we perform in the moments before sleep, end up becoming rituals that facilitate sleep when they are missing, prevent us from sleeping.

Reconciliation rituals are also necessary for children, and often the problem of childhood insomnia is not due to waking at night, but not being able to fall asleep again, because the stimuli associated with the onset of sleep are not present in the middle of the night when they wake up (dad or mom, light, story …)

Stress :

Due to irregular schedules, over activation, family problems, childhood fears or separation anxiety

Children need the routine to develop since it offers them security. When this security is threatened, children react by showing their anxiety through crying, behavioral changes, and resistance to falling asleep at night. They behave in the same way when, after an exciting day they are told that they have to go to bed, since falling asleep means a change about the activity they are enjoying so much. Sometimes, the problem can come from the existence of excessively irregular family hours.

Another frequent cause of the difficulties to initiate the dream is the realization of long naps in the afternoon, for that reason, before a problem of infantile insomnia, one of the first measures to consider is going to be the reduction or even suppression of the daytime sleep (naps ).

A child may have difficulty separating at night from the rest of the world, or they may capture subtle changes in the family environment, and be a cause of bedtime problems. Even in the safety of a happy home, children may be afraid of the dark or imaginary creatures located in the dark corners of the bedroom.

Whatever the case, the parents’ response must always be supportive. You have to talk to your child about your fears and fears.

In children over three years of age, positive reinforcement techniques can be used as rewards if their behavior is appropriate.

Insomnia in children:

From before birth, children have brain neurons with the ability to act as a “biological clock” and the control of sleep and wakefulness is determined by this biological clock, which allows the child to sleep at certain times and be awake to others. However, the functioning of this biological clock is also influenced by the environmental conditions of light-darkness, so that in dark conditions, our brain secretes a hormone called melatonin, which facilitates sleep, while this hormone is inhibited by The exterior luminosity. Approximately, from the third month of life, you learn to synchronize this two information so that the wake-sleep cycle can begin to coincide with the day-night cycle.

Pediatric insomnia: Some medical causes of childhood insomnia

Some medical problems that should be ruled out before a child with insomnia:

• Allergies: Affected children will sleep in a fragmented and interrupted manner.
• Pains: Otitis and colic are very common in children. Any picture that causes pain, discomfort or night fever will interrupt the night’s sleep. If the condition becomes chronic, bad sleep habits in the child have usually been conditioned over time, which may persist despite the disappearance of pain, probably due to mismatches in the rhythm of sleep and the acquisition of bad habits.
• Bedwetting: Bedwetting is likely to be the most stressful of sleep disorders for the child since it is not only a source of sleep loss but also of shame. Enuresis is considered to exist when at five years of age there is still no control over the bladder sphincter. Bedwetting affects 15% of boys and 10% of girls, although most of them improve as they grow, it is advisable to go to the doctor to find a solution and accelerate the process.
• Chronic diseases: In principle, any chronic disease is likely to cause persistent sleep disturbances. Disorders such as headaches, asthma, diabetes mellitus, gastroesophageal reflux or epileptic seizures can alter the sleep of those who suffer from it. The problem of insomnia can be a direct consequence of the problem, of the treatment, or of the anxiety generated by the disease. For all this, it is convenient that as a first step the child is subjected to a medical examination as complete as possible by his pediatric neurologist.
• Medications: Any medication can alter sleep. Relatively safe medications that are prescribed to treat acute or chronic diseases can disturb sleep (eg antibiotics, bronchodilators, etc.)
• Once the problem is located (due to a temporary association between the start of the treatment and the sleep disorder), the treatment should be discontinued whenever possible. If it is not, it should be tried; change the time of taking, modify the dose, use another similar medicine, keep the same drug but use a different preparation, vary it via administration.

Other medical causes that must be taken into account are dental, gastrointestinal problems, allergies and sleep apnea. It is also convenient to rule out the presence of parasites.

The dream of children with childhood hyperactivity:

They are generally restless children, have difficulty staying and completing the tasks they perform, are distracted and often bother other children in school, cry easily, and have mood swings. They often show restlessness and hyperactivity. They are easily frustrated with efforts and may have destructive behavior. During sleep, the most characteristic symptom is the presence of frequent awakenings and restless sleep.

Sleep-related problems are common in these children, presenting 16.5% difficulties with sleep initiation and 39% nighttime awakenings. Early diagnosis and treatment is important, since hyperactivity disorder and lack of sleep feed each other back, so that an overactive child usually has sleep problems, and in turn, lack of sleep causes hyperactivation and attention deficit daytime

Parasomnias, anxiety caused by separation and insomnia caused by bad habits, stress, disease, some medications or overexcitation is sufficient causes to alter sleep, which can occur in any family at any time.

What to do? The treatment plan for childhood insomnia:

• If we suspect that the cause may be medical, we must go to the Pediatric specialist with the child, to solve the problem.
• If we suspect that the cause may be poorly learned sleep habits or behavioral problems, we can try to implement the following plan, going to the psychologist or the doctor who specializes in these problems if after a week we do not get results.
• The basis of treatment is so simple how to make the child learn to make the transition between wakefulness and sleep without the participation of his parents. All treatment must be performed in less than a week and, if you follow the instructions faithfully, the chances of success are high.
• The child must learn to fall asleep alone, under conditions that can reproduce when he wakes at midnight.

It is advisable that throughout the treatment the parents complete a sleep diary in order to document the progress. This will serve both the parents and the doctor to supervise the process. Once the child has learned to fall asleep alone, he will continue to do so in the future. However, it is possible that there are slight alterations in times when the usual schedule is altered as in holidays, birthdays, etc. The persistence of these relapses will depend on the way in which the parents respond: If the response occurs according to the plan stated, the relapses will resolve themselves and the child will continue to sleep well.

Don’t forget to consult a Pediatric Neurologist if your child shows symptoms.

While living in a city like Dubai, it is hard to keep a tab on the nutrition and health of your kids and loved ones, but consulting a good Pediatric Neurologist in Dubai at regular intervals is advised in case of any kind of abnormality arises related to your child’s health, even if it is a cough.

Dr. Aman PS Sohal is a U.K Board-certified Consultant Pediatric Neurologist with over 11 years of experience in Pediatrics which includes more than six years of experience as a Consultant in Pediatric Neurology.