Parents of newborns know that with the arrival of a new baby comes sleepless nights— at least for a period of time. While it’s normal for a 2 month old to wake frequently during the night, it isn’t normal for a 2 year old to do so. It is common for parents to bring concerns about how to develop healthy sleep habits in their children to pediatricians. In most cases, children outgrow frequent waking during the night and resistance at nap and bedtime. But there are more serious sleep disturbances that if gone unchecked can greatly affect a child’s health.
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. 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 percent of cases. Obstructive sleep apnea affects 2-5 percent 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 distinguished 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 4 and 12. Parasomnias appear to be reflective of immaturity of the central nervous system, which allows the intrusion of wakefulness into various stages of sleep. These disorders tend to decrease in frequency and intensity as children get older, as well as disappear over time without treatment.
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 has no memory of the event. It is generally best not to intervene or try to calm or awaken the child since they are likely to return to restful sleep after a few minutes.
Other prevalent sleep disorders in children include bed wetting (after the age of 5); 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.
After taking a complete medical history of the child, the physician may recommend a sleep study (see sidebar) to pinpoint the cause of the disturbance. In some cases, families are referred to a sleep specialist.
Primary pediatric 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.
Sleep disturbances are worrisome for parents and some are potentially harmful for children. 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.
Advice for Parents
Parents are encouraged to talk with their pediatrician or primary physician when a child exhibits one or more of the listed symptoms frequently or for an extended period of time.
- 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 or staying asleep
- Persistent bed wetting
- Excessive sleepiness during the day
- Daytime behavioral issues such as difficulty concentrating, aggression or hyperactivity