Managing Common Sleep Disorders in Children

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1 Managing Common Sleep Disorders in Children For the general prac66oner and paediatrician Jennifer Kiing FRACP (CCCH) Child Development Unit Na6onal University Hospital

2 At the end of this talk par6cipants will: Know the Prevalence of sleep problems Know about sleep requirements in children Have a framework for sleep screening in clinic Understand about screen 6me and sleep associa6ons Be able to manage some common behavioural sleep problems in young children

3 What is a Sleep Disorder? Sleep disorders are condi6ons, either internal or external, that interfere with the refreshing nature of a child s sleep or that significantly disrupts other people.

4 Prevalence of Sleep Problems Worldwide Paediatricians report <25% of pa6ents # Parents report 12% (half)* In Singapore parents report problems in 44% of infants and toddlers(birth 36 months) (10% Vietnam 70% China) # Owens JA. The prac6ce of pediatric sleep medicine; results of a community survey. Pediatrics. 2001;108(3):E51 *Chervin RD, Archbold KH, Panahi P, Pituch KJ. Sleep problems seldom addresed at two general paediatric clinics. Pediatrics. 2001;107(6): **Mindell JA, Sadeh A, Wiegand B, How TH, Goh DY. Cross cultural differences in infant and toddler sleep. Sleep Med Mar;11(3):

5 Just Ask about the child s sleep Sleep is commonly not addressed within family prac6ce with low rates of preven6on, iden6fica6on and interven6on

6 What do I ask? Most primary care physicians use a single global ques6on about sleep problems as a screener Why is this an issue?

7 Parents may not think sleep is a problem in their child Parents may not raise problema6c sleep symptoms or pakerns due to a lack of knowledge about sleep, or cultural beliefs about what is appropriate to discuss with their family physicians There are gaps in parent knowledge about sleep

8 How much sleep are children in Singapore gelng? Children from predominantly- Asian countries had significantly later bed6mes, shorter total sleep 6mes, increased parental percep6on of sleep problems, and were more likely to room- share than children from predominantly Caucasian countries/regions *Mindell JA, Sadeh A, Wiegand B, How TH, Goh DY. Cross cultural differences in infant and toddler sleep. Sleep Med Mar; 11(3):

9 How much sleep are children in Singapore gelng (0-36 months)? Singapore Australia Bed6me 9:37 pm 7:42pm Nighlme sleep (hrs) Wake6me 7:28 am 6:35 am Total sleep 6me including naps Parent percep6ons - problems ~44% ~31% Co- sleeping 74% 27% Consistent bed6me rou6ne 60% 75% *Mindell JA, Sadeh A, Wiegand B, How TH, Goh DY. Cross cultural differences in infant and toddler sleep. Sleep Med Mar; 11(3): P values < 0.001

10 How much sleep does your child need? Age Newborn Recommended hours of sleep/day hours Preschool Age hours School age children Teens Adults At least 10 hours 9-10 hours 7-8 hours *Na6onal heart, lung and Blood Ins6tute, USA

11 What do I ask in clinic? Ask about the Quan6ty and Quality of a child s sleep at every well child visit

12 BEARS tool 1. Bed6me problems 2. Excessive day6me sleepiness 3. Awakenings during the night 4. Regularity and dura6on of sleep 5. Sleep- disordered breathing 6. Screen Time Owens JA, Dalzell V. Use of the BEARS sleep screening tool in pea pediatric residents con6nuity clinic: a pilot study. Sleep medicine. 2005;6(1)63-9

13 The BEARS Sleep Screening Tool (P) Parent- directed ques6on (C) Child- directed ques6on Source: A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems by Jodi A. Mindell and Judith A. Owens; LippincoE Williams & Wilkins

14 Sleep Management Strategies Most problems with sleep are learned behaviours Problems falling asleep (sleep ini6a6on) Frequent night- 6me wakening

15 1. Problems falling asleep Establish a good bed6me rou6ne Sleep associa6ons are important Put to bed awake Behavioural strategies include controlled crying & graduated ex6nc6on

16 2. Frequent Night 6me wakening Graduated Ex6nc6on Controlled Crying Camping out Scheduled Waking

17 Sleep Diary

18 Sleep Management Plan For : Date: / / Before Bed Pre Bedtime Routine: Bottle of milk. Remove milk bottle before child falls asleep At Bedtime: DO NOT OFFER BREAST. DO NOT ROCK. Place in cot and pat to sleep How to Manage Crying or Protesting at Bedtime: Stay with child until he falls asleep. DO NOT PICK UP FROM COT How to Manage Night time Waking: Reassure mummys here. Pat to sleep. DO NOT PICK UP FROM COT Daytime Nap SAME AS BEDTIME Remember stick with the plan and sleep pattern will improve. Sometimes things will seem a bit worse before they get better. Hang in there.

19 In summary Children need much more sleep than adults Percep6ons of sleep problems in children vary across predominantly asian or predominantly caucasian cultures Physicians to ask about sleep in the well child visit use screening tools where possible

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