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Kids are particularly prone to parasomnias. Some can be scary to the child and to the parents, although many are not medically serious and disappear before adolescence. Such phenomena as night terrors, sleepwalking, wetting the bed, and talking while asleep are more common in children, although they can occur at any age. Adult parasomnias such as bruxism and restless legs do not tend to disappear with age. Childhood parasomnias might be associated with separation anxiety but they do not usually shorten sleep duration.
Dyssomnias in young children include trouble getting to and staying asleep. Behavioral insomnia is more common in children than adults:
Limit-setting sleep disorder is one of those things that make lay people wonder about over-medicalization of normal behavior. It is basically when kids stall and make excuses for not going to sleep. This takes the form of a negotiation or parlay with the parent (or caretaker). Kids may make many requests or questions nominally in preparation for bedtime, but transparently to delay getting to bed. They may also act out and scream in resistance.
There is no treatment for limit-setting sleep disorder and parents have their own styles of dealing with individual kids. Many psychologists recommend a firm bed time and say the parents should not negotiate on it. Ignoring the child’s protests is the best course. Some parents install guards or gates on the bedroom door to keep the child in the bedroom, although an obstacle like this poses safety hazards. A short gate that both the child and parent can see over can help provide a psychological designation of a sleep space in the kid’s mind. Eye contact between parent and child lessens the gap between waking time and sleep time. Sleep hygiene for kids includes not letting them exercise much before bed, in an effort to get them to calm down. Indeed, poor sleep hygiene has been shown to be correlated with behavior problems in children.
Limit-setting sleep disorder is strictly speaking a form of insomnia because it can result in shortened sleep time and subsequent daytime sleepiness. It is therefore considered a behavioral insomnia. The other common childhood behavioral disorder is sleep onset association disorder. Kids with attention deficit disorder seem more prone to these types of insomnias.
It’s estimated that up to a quarter of kids have some sort of behavioral insomnia at some point when growing up. Colloquially called “bedtime problems”, these disorders usually disappear when the child reaches age 6 or so.
Apnea is an increasing problem as childhood obesity rates go up, and apnea is a greater risk for developing brains than it is for adults because temporary restrictions of oxygen might stunt future cognitive ability. Researchers recommend intervention as soon as possible. It has also been found that young children who snore are much more likely to be hyperactive, anxious, and prone to temper tantrums. Removal of the adenoids and/or tonsils (adenotonsillectomy) can help improve breathing in kids with apnea. However, studies have shown that cognitive decline is not reversed when the breathing problems are corrected. This means it is important to address sleep-disordered breathing in children as soon as it is detected.
The federal government states: “African American children are at least twice as likely to develop SDB than children of European descent.12 The risk of SDB during childhood is associated with low socioeconomic status independent of obesity and other risk factors”. The American Academy of Otolaryngology website claims “Approximately 10 percent of children snore regularly and about 2-4 % of the pediatric population has OSA.”
A survey of doctor visits for childhood insomnia in the US from 1993 to 2004 found 80% resulted in prescriptions for medication. This despite that fact that the FDA has never approved a drug label for pediatric insomnia, and professional societies publically discourage such use of medication. The reason can probably be attributed to doctors’ desire to please parents and show they are actively trying to solve a problem where behavioral therapy strikes many as ineffective or quackery.
Most drugs are not approved by the FDA for use in children (about three quarters of drugs do not include labeling for patients under 18), Off-label prescription is common and accepted practice. The FDA-labeling influences the medical profession’s use of medicine, but doctors are free to prescribe most drugs for any problem they deem appropriate.
According to the NIH Sleep Research plan, studies have found an association between partial arousal parasomnias and migraine headaches in children. The pathophysiology of migraine headache isn’t understood (and neither are the underlying mechanisms of parasomnias, but it is known that serotonin agonist drugs are effective in many migraine cases.
There are suggestions that stress on children results in sleeping problems later in life. The reasons for this are unknown, but it must have something to do with the development of the nervous system.
Researchers have found that body fat quantities are correlated with sleep times even in young children. Following body mass indices and reported sleep times among 3, 4, and 5 year olds the scientists concluded less sleep was correlated with greater levels of body fat even more than for adults. One hour extra of sleep per night resulted in a 61% reduced risk of the child being overweight at age 7.
Other researchers at the Center for Obesity Research and Education found that children aged 8 to 11 could reduce their risk of being overweight and the level of leptin in their body by sleeping more. Further study of older children aged 11 to 17 found a relationship between parent-reported sleep time and body mass index.
You might think: they’re just kids. Leave them alone. Don’t hassle them until they grow up. But it turns out childhood is the perfect time to hassle people about their weight. One reason public health practitioners worry about childhood obesity is that obese children tend to turn into obese adults and obesity is notoriously hard to beat as an adult and costs society a lot. So some call for age-specific interventions – e.g. limiting caffeine consumption and electronic screen time for kids and teens in an effort to get them to go to bed.
Researchers have found that kids with irregular bedtimes have lower rates of cognitive development. Routines reduce stress on the mind and body and may be more conducive to development of the body’s organs. A study of over 10,000 UK children found that 3-year-olds often have irregular bedtimes – more so than 5-year-old and 7-year-olds. Kids without a regular bedtime had a harder time getting ready for school.
Further, to some extent, earlier bedtimes are better. The study of 7-year-olds found those with a bedtime past 9 PM had lower test scores in reading and math.
Diagnosis of sleep problems is even tougher in children than in adults. Sleep history and a full accounting of health issues gets to the diagnosis faster, but these are often cut short by the demands of parents who just want the problem to go away and for the doctor to issue a prescription. This is also a detriment to behavioral therapy, which is also expensive.
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