Abington Gives Pediatric Sleep Problems Child-Centered Analysis and Treatment

By Jacqueline K. Genova, MD

When a child is having sleep-related difficulties, it’s highly stressful for the whole family. Yet parents might not think of seeking medical advice for the situation unless the child’s physician directly asks them about sleep problems.

Organic and behavioral sleep disorders in childhood are prevalent concerns. At Abington Memorial Hospital’s Sleep Disorders Center, we see pediatric patients between the ages of two and 18 years old. These children originally present in pediatricians’ offices with one or more symptoms, including heavy, persistent snoring, pauses in breathing while asleep, choking sounds during sleep, or difficulty awakening. They might also be experiencing daytime sleepiness, moodiness, attention problems, hyperactivity or have trouble falling asleep or staying asleep.

Most children with sleep disorders are otherwise healthy. Our initial consultation with the family and child usually identifies whether the problem is organic—such as obstructive sleep apnea, periodic leg movements, or narcolepsy—or behavioral, such as needing the parent nearby in order to fall asleep.

If we suspect that the child may have an organic problem, we schedule an overnight sleep study. This evaluation is similar to studies performed on adults, but in a pediatric study, a parent stays overnight with the child. The parent sleeps in a bed next to the child; for adolescents, we can arrange for the parent to sleep in an adjacent room, if that is preferred.

We encourage children to bring a favorite stuffed animal, toy or pillow, to make it easier to fall asleep. The study bedrooms are comfortable and friendly, with private bathrooms and without intimidating machinery or equipment.

Our technicians are specially trained for working with pediatric patients. These professionals make the set-up process in the study bedroom more like a play session, so children have time to relax and adjust to the surroundings. A sleep technologist stays in a control room next to the study bedroom throughout the night, monitoring the child on a screen. Parents report that their children have a positive experience during the study.

The raw data collected while the child sleeps is transmitted on our secure web-based system, which helps speed processing. First, the technologist attending the study notes any significant occurrences and provides a preliminary assessment.

Another technologist scores the study pages, each of which represents 30 seconds of the study. Each page is scored for the stage of sleep present and any events that may have happened. After scoring, I receive the data for analysis, final interpretation, diagnosis and recommendation for further action, if needed.

Children with obstructive sleep apnea—unlike adults with the condition—usually have an airway obstructed by enlarged tonsils and adenoids. Pediatric patients usually do not need CPAP (continuous positive airway pressure) treatment, as many adults do. Instead, after using the overnight sleep study to determine the cause and extent of children’s sleep apnea, we refer them to an otolaryngologist for treatment.

Restless leg syndrome affects about 2% of U.S. children and presents with uncomfortable sensations or pain in the legs, accompanied by the urge to move the legs. Symptoms worsen at night and during inactivity. The course of the condition is very variable, and it is sometimes inaccurately labeled, “growing pains.” An overnight sleep study usually is not necessary. The pathogenesis of the disorder may be genetic or due to iron deficiency, among other causes. Treatments include improved sleep hygiene and supplemental iron, when indicated.

The typical pediatric narcolepsy with cataplexy patient may have excessive daytime sleepiness and sudden loss of postural muscle tone. We usually reach a diagnosis after an overnight sleep study and Multiple Sleep Latency Test, which measures the readiness to fall asleep and how quickly the patient enters REM sleep. Once diagnosed, patients receive medication to control this disorder.

Behavioral insomnia in childhood is common and diagnosed without an overnight sleep study. In sleep onset association conditions, the child uses clues from the environment (presence of parent, for example) in order to sleep. If the parent is not there at bedtime, or if the child wakes up and the parent has gone to bed in another room, the child cannot sleep. Another common behavioral difficulty is limit-setting disorder, in which children stall relentlessly before bedtime and parents are unable to put them to sleep.

These conditions are usually identified during the family interview. If there are no indications that something organic could be disrupting the child’s sleep, then we teach parents the behavioral techniques that work best to alleviate such problems.

Jacqueline K. Genova, MD, is a board-certified pediatric sleep disorders specialist in the Sleep Disorders Center at Abington Memorial Hospital, Schilling Campus (www.amh.org).