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When kids can’t sleep

  Thursday, 16 l 12 l 2010 Source:  Mind Your Body; The Straits Times   
By: Lee Hui Chieh

It can be due to blocked airways or behavioural problems; doctors report more parents seeking help for their children 

Parents are becoming proactive about getting treatment for their children when they do not sleep well. They now seek help for behavior traditionally seen as “normal”, like not sleeping unless they are rocked. As a result, KK Women’s and Children’s Hospital now does 350 to 400 sleep studies a year, up from about 150 a decade ago, said Dr Teoh Oon Hoe, who heads its respiratory medicine service.  

children-sleep-problemsIn a sleep study, patients are hooked to monitoring equipment as they sleep through the night and checked for the number of times they stop breathing. The National University Hospital, the other public facility here that treats paediatric sleep disorders, has seen about 260 children up to last month this year. Of them, about 160 needed a sleep study, said Dr Mahesh Babu Ramamurthy, senior consultant in its division of paediatric pulmonary, sleep and critical care.  

With the number seeking help on the rise, the first private sleep laboratory for  children was set up in August this year. It is a partnership between the Parkway-owned Gleneagles Medical Centre and private paediatric care chain SBCC Baby & Child Clinic. It sees two to three children with sleep disorders each week, when it used to see very few, said its sleep specialist, Dr Jenny Tang.   

Obstructive sleep apnoea
The most common sleep disorder among those who seek help is obstructive sleep apnoea, when the airway becomes blocked during sleep and causes frequent pauses in breathing. In children, the airway tends to be blocked by enlarged adenoids and tonsils – tissue masses that fight infections. Tonsils are at the back of the throat and adenoids behind the nose and roof of the mouth. 

Symptoms include snoring and gasping during sleep and excessive sleepiness in the day. About 1 to 3 per cent of children here have the disorder, often between the ages of two and six. This number is rising in tandem with that of children who survive prematurity, are obese and have allergic conditions – risk factors for the disorder, said Dr Tang. 

Lifestyle changes have contributed to the increase.In 2007, 3.6 per cent of children here were obese, up from 2.8 per cent in 1994. This is probably because children exercise less and eat more fat and refined sugars. More are also being treated now due to greater awareness among doctors and parents of the disorder and its complications, Dr Teoh said. These include hypertension, delayed development, and death. In a 2002 study by Dr Tang on about 180 obese children with sleep apnoea, their intelligence quotient (IQ) grew by an average of five to six points one year after the sleep disorder was treated. It can be treated with surgery to remove the tonsils and adenoids, or by wearing an oxygen mask to sleep. 

Behavioural sleep problems
Another set of sleep disorders are behavioural. They are more common than obstructive sleep apnoea, but generally milder. They include sleep onset association disorders, which occur when the baby or toddler becomes overly reliant on certain actions or objects, like a pacifier, to fall asleep. These affect 25 to 50 per cent of babies aged six to 12 months and 15 to 20 per cent of toddlers. About 10 to 30 per cent of preschoolers develop limit-setting sleep disorder and delay bedtime.  

Parents are taught to train their children to sleep without help and to enforce a fixed bedtime. Preschoolers may also develop night-time fears, such as of loud noises or being alone, but usually outgrow these. In the meantime, parents should reassure them and teach them coping skills, say, by using a night light. Almost a third of Dr Tang’s patients have behavioural sleep problems, up from less than 10 per cent a year ago. Parents are now more aware that these are treatable problems, rather than behavior that they have to wait for the child to outgrow, she said. But the incidence of behavioural sleep disorders may also be rising, as children put off sleep to spend more time on computers and mobile phones, suggested Dr Teoh. 

The third largest group of sleep disorders treated are parasomnias, which cause physical reactions while sleeping or being woken. One of the best known is sleepwalking, when the child gets up and walks as if he is awake, but is actually asleep. Between 15 and 40 per cent of children sleepwalk at least once, with 3 to 4 per cent doing so weekly or monthly. Another is sleep drunkenness, which occurs in 5 to 15 per cent of children. They wake up disoriented, with no memory of what they did.  

About 60 per cent of infants exhibit sleep-related rhythmic movements like head-banging and body-rocking, but by the age of five, only 5 per cent do so. Other parasomnias are sleep terrors, nightmares, sleep paralysis, teeth grinding and bedwetting. Parasomnias are the most bizarre sleep disorders but are usually benign and disappear on their own. In the meantime, parents should take precautions to prevent the child from hurting himself and help him avoid conditions that trigger them.

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