Sleep in the Pediatric Practice

1
Sleep in the Pediatric Practice

• M. Mohammadi MD
• Professor of Pediatrics Neurology
• Childrens Medical Center Hospital
• October 2005

2
Some Common Scenarios
3
Some Facts Figures

• By the age of two years, 9500hr (13m) sleep vs.
  8000hr (11m) wakefulness
• In children of 2 to 5 years of age the figure is
  half-half, in older children adults its 60
  vs. 40
• Sleep is the primary activity of the brain during
  early development

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

5
Sleep problems are common!

• Approximately affects 25-50 of all children
• Snoring affects 3-12 of preschool children
  OSAS affects 1-3 of all children
• 40 of all adolescents have significant sleep
  complaints
• These figures are rapidly expanding!

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

7
Sleep problems are chronic!

• Many sleep problems are transient self-limiting
• But, the common wisdom that children usually
  grow out of problems is not valid
• some infantile sleep disorders grow to early
  childhood
• Some OSAS insomnias may persist into adulthood
• Early identification Rx of disorders are quite
  effective

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

9
Sleep disorders are treatable

• Many highly effective medical behavioral
  interventions are available
• Many patients promptly treated for sleep
  disorders will benefit also in developmental
  aspects
• Prompt diagnosis and intervention serve as a tool
  for prevention

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

11
Sleep disorders are preventable

• The pediatric visit serves as a means for
  parental education about normal sleep in children
  and preventable measures
• Primary prevention to teach them strategies for
  preventing to develop SDs
• Secondary prevention or preventing SDs to beget
  chronic
• Putting the infant to bed as drowsy but awake
  to foster the infants self-soothe abilities
• Information about good sleep hygiene

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

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Sleep problems have major impact on the family!

• A significant source of distress for the family
• Intensified by their direct effect on parents
  sleep, resulting in daytime fatigue, mood
  disturbances less effective parenting
• A source of child physical abuse!
• Good interventions help the sleep of whole family

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

15
Sleep problems constitute one of the most common
parental complaints

• Sleep concerns are very common parental
  complaints in pediatric practice
• 25 of parental complaints in a study of children
  between 6 months 4 years
• Sleep concerns were ranked as the 5th leading
  concern of the parents, following illness,
  feeding problems, behavioral problems, physical
  abnormalities

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

17
Sleep is necessary for childrens optimal function

• Sleep disturbances lead to daytime sleepiness,
  significant performance impairments, mood
  dysfunction
• Experimental sleep restriction (e.g., 6.5hr/night
  for 7 nights) has been associated with
  oppositional inattentive behavior, impaired
  verbal fluency creativity, impaired problem
  solving, decreased speed efficiency in
  completion of tasks
• Children with academic and behavioral problems
  are more likely to suffer from sleep disorders

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

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Sleep affects every aspects of child development

• Chronic poor sleep during critical periods of
  development of affective regulation may have
  long-term consequences on emotional health
• Impairments in mood regulation impulse control
• Higher-level cognitive functioning, such as
  cognitive flexibility abstract reasoning
  thinking is affected by sleep problems
• Attention memory is affected by more severe
  sleep problems

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

21
Sleep problems exacerbate virtually all other
medical disorders

• Sleep problems themselves tend to be more common
  in those children with chronic medical
  psychiatric conditions
• Attentional deficit academic dysfunction in
  ADHD is likely to be more severe in comorbid
  sleep disorders
• Depression become worse with SDs
• Chronic pain is exacerbated in juvenile RA with
  SDs
• Endocrine dysfunctions such as Diabetes Mellitus
  have poor BS control with SDs
• Immunologic problems as well as cardiovascular
  disorders may be exacerbated with SDs
• Epilepsy could be exacerbated or even triggered
  by SDs

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Top Ten Reasons for Pediatricians to Care More

• So common
• Chronic
• Treatable
• Preventable
• Major impact on family
• One of the most common parental complaints

• Necessary for childrens optimal functioning
• Effective on development
• Coexistence with other medical problems
• A public health issue

23
Sleep is a public health issue!

• Recent surveys indicate that sleep issues in
  pediatric practice are frequently inadequately
  addressed
• Many pediatrician do not check their patients for
  SDs in their well-child visits
• Studies suggest that physicians are not
  adequately trained in sleep medicine
• Cost of SDs in US is about 104 million /year

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Some Common Scenarios
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RECOMMENDATIONS

• SDs are fairly common in children and
  pediatricians should be familiar with it.
• Current curriculum is not efficient and
  sufficient in this regard.
• Curriculum should be corrected to deal with this
  common problem.
• Till curriculum development, more program should
  be organized and performed esp. for pediatric
  residents in the field of sleep disorders in
  children.

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