Common Pediatric Sleep Disorders in Children: Causes, Symptoms and Treatment Options

Healthy Sleep for Kids: Understanding and Managing Pediatric Sleep Disorders

Sleep is a fundamental aspect of a child’s overall health and development. It plays a crucial role in physical growth, cognitive function, emotional regulation, and strengthening of the immune system. However, in modern times pediatric sleep disorders are a common concern among parents and healthcare professionals. They affect millions of children worldwide and can lead to daytime fatigue, behavioral issues, learning difficulties, and even long-term health complications if left untreated.

Understanding sleep disorders and addressing them with professional or personal assistance is essential for ensuring a child’s healthy growth and development.

How much sleep do children need?

The amount of sleep one needs, vary as per age. Thus, before diving into specific sleep disorders, it’s important to understand how much sleep children require at different ages. 

Newborns (0-3 months): 14-17 hours per day

Infants (4-12 months): 12-16 hours per day (including day naps)

Toddlers (1-2 years): 11-14 hours per day

Preschoolers (3-5 years): 10-13 hours per day

School-age children (6-12 years): 9-12 hours per day

Teenagers (13-18 years): 8-10 hours per day

A good night’s sleep is natural in children, however, if a child struggles to get enough quality sleep, then it can indicate an underlying sleep disorder.

Common Pediatric Sleep Disorders

Below are some common sleep disorders that may be found in children. 

Insomnia 

Insomnia refers to difficulty falling asleep, staying asleep, or waking up too early and not being able to go back to sleep. Treating child insomnia is crucial because it can impact concentration, mood, and overall health.

What can cause Insomnia in Children?

 A child may suffer from insomnia due to many reasons. Some of them include: 

• Anxiety or stress- This can particularly affect older children. Parents should encourage healthy communication with their children to know the reason for their anxiety or stress in them. 
• Poor sleep hygiene (e.g., irregular bedtime, excessive screen time)- Following good sleep hygiene is extremely essential for getting a good sleep. Parents and caregivers should help their children understand the importance of good sleep and make sleep a priority for the entire family. 
• Medical conditions (e.g., asthma, allergies)- Consultation from a specialist should be made if a child is unable to sleep due to health issues. 
• Certain medications (e.g., ADHD medications)

Treatment for Insomnia in Children

• Establishing a consistent bedtime routine- This helps maintain the body’s circadian rhythm and prevents sleep disorders.
• Reducing screen time at least an hour before sleep- When the outside light dims, the body naturally prepares for sleep by releasing melatonin, a hormone that signals the body to rest. However, blue light from screens can suppress melatonin production, disrupting the natural sleep cycle. Screens also stimulate the brain which can then lead to difficulty in sleeping. 
• Creating a calm and comfortable sleep environment- A part of sleep hygiene is preparing a calm and comfortable environment for sleep. Night lights, relaxing scents, and a non-stimulating routine like reading a book before sleeping could help. 
• Cognitive-behavioral therapy (CBT) for anxiety-related insomnia- CBT is a structured, evidence-based approach that helps children manage anxiety-related insomnia by changing negative thoughts and behaviors that interfere with sleep. Techniques include relaxation training, sleep restriction, and cognitive restructuring to reduce nighttime anxiety and promote healthy sleep patterns. 
• Melatonin supplements (only under medical supervision)- Melatonin supplements can help regulate sleep in children with insomnia or circadian rhythm disorders. However, they should only be used if prescribed by a healthcare provider. It’s crucial to ensure proper dosage to avoid potential side effects or hormone imbalances.

Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnea (OSA) is a medical condition where a child’s breathing is repeatedly blocked due to airway obstruction, often caused by enlarged tonsils, adenoids, or obesity. It leads to snoring, gasping, restless sleep, and daytime fatigue, requiring medical intervention for proper treatment.

Symptoms of Obstructive Sleep Apnea

Below symptoms if noted suggest obstructive sleep apnea: 

• Loud snoring
• Gasping or choking sounds while sleeping
• Daytime fatigue and irritability due to poor sleep
• Difficulty concentrating at school
• Restless sleep or if the child frequently wakes up during sleep 
• Mouth breathing

Treatment for Obstructive Sleep Apnea

This condition requires detailed medical attention correction. In case of doubt about OSA in children, a consultation from a healthcare provider must be sought at the earliest. Below are a few treatment options that could be employed: 

• Weight management (if obesity is a factor)- A multidisciplinary team of experts that can include pediatricians, pediatric endocrinologists, pediatric gastroenterologists, and dieticians plan and guide the best ways for weight management in children. 
• Removing enlarged tonsils or adenoids (surgical intervention)- If diagnosed a pediatric ENT surgeon can carry this procedure safely in children. 
• CPAP (Continuous Positive Airway Pressure) therapy- CPAP therapy is a common treatment for Obstructive Sleep Apnea (OSA) in children. It delivers a continuous stream of air through a mask to keep the airway open during sleep, reducing breathing interruptions and improving sleep quality.

Restless Leg Syndrome (RLS)

Restless Leg Syndrome (RLS) is a neurological disorder that causes an uncontrollable urge to move the legs, often due to uncomfortable sensations. Symptoms typically worsen at night, making it difficult for children to fall asleep and stay asleep, leading to fatigue and irritability during the day. 

What causes of restless leg syndrome in children? 

Below are some causes of restless leg syndrome in children: 

• Iron Deficiency: Low iron levels can affect dopamine function, triggering RLS symptoms. 
• Genetics: A family history of RLS increases the likelihood of developing the condition.
• Chronic Health Conditions: Conditions like ADHD, kidney disease, or diabetes can be linked to RLS.
• Certain Medications: Some antidepressants and antihistamines may worsen symptoms of restless leg syndrome.

Symptoms of Restless Leg Syndrome

Below is how RLS may look like in children: 

• An uncomfortable sensation in the legs which gives an urge to move the legs
• Worse symptoms (more restlessness in legs) when resting/sleeping
• Twitchy legs/ jerk in legs during sleep or even during the day 
• Urge to get out of bed at night to move legs
• Disrupted sleep
• Mood changes
• Irritability due to lack of sleep
• Fatigue during the day

How is RLS treated in children? 

A healthcare professional should be consulted at the earliest if this condition is suspected. A pediatric neurologist is the right expert to treat RLS in children. Apart from the treatments prescribed by the expert, home remedies may be suggested too. Below are a few measures that may be employed: 

• Iron Supplementation:  If iron deficiency is detected, supplements may help relieve symptoms.
• Medical Management: In severe cases, doctors may prescribe other medications that act on the nervous system under strict supervision. 
• Establishing a Sleep Routine: A consistent bedtime schedule and relaxation techniques can improve sleep quality and are encouraged. 
• Regular Exercise: Moderate physical activity can reduce RLS symptoms but should be avoided close to bedtime.
• Massage and Warm Baths: Gentle leg massages and warm baths before bed can help ease discomfort. Soaking your legs in a warm tub, and applying a heating pad or cold compress to the child’s legs can provide temporary relief from discomfort.
• Avoiding Triggers: Limiting caffeine and screen time before sleep can prevent symptom aggravation.
• Reducing overall stress: Stress exacerbates any symptoms; thus, an attempt should be made to reduce the overall stress levels in children. A mental health professional should be consulted if required. 

Parasomnias (Night Terrors, Sleepwalking, and Nightmares)

Parasomnias are disruptive sleep disorders that occur during transitions between sleep stages. Common types include night terrors, sleepwalking, nightmares, and confusional arousal. These episodes can cause sudden awakenings, confusion, or unusual behaviors during sleep. While often harmless, severe cases may require medical evaluation.

Types and symptoms of Parasomnias

 The various forms of Parasomnias that a child may experience include: 

Night terrors: This involves episodes of screaming and intense fear, often without memory of the event

Sleepwalking: This includes the child performing complex activities while still asleep

Nightmares: Frightening dreams that cause wakefulness and distress

Other symptoms of parasomnia include, teeth grinding, bed wetting, acting out dreams, etc. 

Treatment for Parasomnias

Parents can follow some tips to keep parasomnia episodes at a minimum: 

• Maintain a consistent sleep schedule
• Ensuring a safe sleeping environment (e.g., locking windows, removing hazards)- Involve children in preparation for the night so that they feel secure and informed.
• Addressing stress and anxiety triggers
• Consulting a specialist if episodes are frequent or severe.

Circadian Rhythm Disorders

Circadian rhythm disorders occur when a child’s internal body clock is misaligned with the natural sleep-wake cycle. This can lead to difficulty falling asleep, waking up too early or too late, and excessive daytime sleepiness. Maintaining a consistent sleep schedule and exposure to natural light can help regulate the body’s clock.

This disorder includes: 

Delayed Sleep Phase Disorder (DSPD): Difficulty falling asleep until very late at night

Advanced Sleep Phase Disorder (ASPD): Feeling sleepy too early in the evening and waking up very early

What causes Circadian Rhythm Disorder? 

Some reasons why a child may experience this disorder include-

• Irregular Sleep Schedules: Inconsistent bedtimes and wake-up times disrupt the body’s internal clock.
• Excessive Screen Time: Blue light from devices suppresses melatonin production, delaying sleep onset.
• Lack of Natural Light Exposure: Sunlight helps regulate the sleep-wake cycle, and insufficient exposure due to no outdoor play and excessive screen time can cause misalignment.
• Genetic Factors: Some children may have a natural predisposition to delayed or advanced sleep phases.
• Medical Conditions: Neurological disorders, ADHD, and autism spectrum disorder can affect circadian rhythms.
• Jet Lag or Shift Work in Parents: Environmental factors like frequent travel or changing routines can impact a child’s sleep cycle.

Tips to correct Circadian Rhythm Disorders

Parents should encourage healthy sleeping habits and strict sleep hygiene in children to set the circadian rhythm of the children right. Some tips include: 

• Maintain a strict sleep-wake schedule
• Exposure to bright natural light in the morning
• Avoiding blue light exposure before bedtime
• Introducing a bedtime routine for children to promote good sleep 

Melatonin supplementation if recommended by a doctor may also be required to correct circadian rhythm disorder. 

How to Promote Healthy Sleep for Kids?

Ensuring healthy sleep for kids involves developing good sleep habits from an early age. Here are some practical strategies that can help children get a good sleep. 

• Consistent Bedtime Routine: Establish a predictable routine that includes activities like reading or taking a warm bath.
• Limit Screen Time: Avoid electronic devices at least one hour before bedtime to reduce blue light exposure.
• Create a Comfortable Sleep Environment: Use blackout curtains, a relaxing scent, and a comfortable mattress.
• Encourage Physical Activity: Daily exercise promotes better sleep quality. Outdoor playtime for children is a must. 
• Monitor Diet: Older children should be strictly guided to avoid caffeine and aerated drinks before sleep. 
• Address Emotional Well-being: Teach relaxation techniques like deep breathing or meditation to manage anxiety.
• Seek Medical Help When Needed: If sleep problems persist, consult a pediatrician or sleep specialist.

Pediatric sleep disorders can significantly impact a child’s development and daily life. Recognizing symptoms early and implementing effective interventions can prevent long-term complications. Treating child insomnia, managing conditions like sleep apnea and RLS, and promoting healthy sleep for kids through good sleep hygiene are essential steps for ensuring their overall well-being.