What is it about ?
Children’s sleep needs vary widely and decrease with age. Children under 6 months of age sleep an average of 20 hours a day, and adolescents 9 hours. During early childhood, naps form an essential part of total daily sleep time. Naps are shorter and shorter as the child grows. They are no longer needed once he is 4 to 5 years old.
During the first weeks of life, the longest period of uninterrupted sleep is 2-4 hours. From 6 weeks, this period extends to 6 hours, usually overnight. The periods of sleep in the newborn are evenly distributed throughout the day and night. A 3 month old baby sleeps on average 14 to 15 hours, most of it at night. Sleeping at night is defined as uninterrupted sleep from midnight to 5 a.m. for at least 4 consecutive weeks. Adolescents often stay on their feet longer, partly because of social pressure and partly because of the decreased secretion of a hormone in the brain (melatonin).
How to recognize them?
In the group of sleep disorders, we distinguish sleep rhythm disturbances, parasomnias, sleep apnea, insomnia and sleep problems due to excessive fatigue during the day.
Sleep rhythm disturbances
In sleep rhythm disorders, the succession of periods of sleep and awakening is disturbed. In infants and toddlers, this usually involves difficulty falling asleep, sleep interruptions, and / or waking up early.
Parasomnias
Parasomnias are abnormal behaviors or phenomena that occur during sleep. They result from arousal, partial arousal or disturbances in the transition between phases of sleep. Parasomnias manifest themselves in various ways:
- Body and head rocking : this occurs mainly in young children from six months. The child moves his head in a repetitive motion, and hits his head against the front of the bed. It is most often benign, and it is not related to a neurological or psychological problem. This usually happens when falling asleep. This usually goes away on its own as the child gets older. It is important to distinguish between seizures, which are involuntary and repeated contractions of the body and limbs, in series, and which can be a sign of a serious illness that requires the advice of a neurologist.
- The child grinds his teeth (bruxism). Often there is a stressor causing it. If the child bites his tongue several times, it is necessary to think of an epileptic seizure.
- Night terrors : the child sits on his bed, he screams or speaks and shows signs of intense fear. Night terrors usually start an hour or two after falling asleep and last from a few minutes to 20 minutes. The child usually does not react when spoken to. The next morning, he remembers nothing. It is not necessary to give treatment or to wake the child during a seizure.
- Sleepwalking is a benign condition that occurs up to the age of 12. The walk lasts from a few minutes to half an hour. The sleepwalker must be brought back to bed.
- Somniloquy : it is the fact of speaking during sleep; it is common and does not require any treatment.
- Snoring, most often harmless. If it is associated with fatigue during the day, behavioral disturbances or learning disabilities, a thorough examination is necessary.
- Nightmares, associated with dreams. The child seems worried, as with night terrors, but usually remembers the dream. Wake the child up and reassure him.
- Restless legs syndrome can occur at the same time as other parasomnias; it is more common in children and adolescents than previously thought. The child has unpleasant sensations, especially in the legs, and cannot help but move them. The movement of the legs makes the symptoms disappear. The child cannot stand still and is constantly moving in his sleep. He is not always able to clearly describe the symptoms, which makes it difficult to recognize them. This syndrome is partially hereditary. So if one or both parents have this syndrome, the risk of the child suffering from it is also higher.
Sleep apnea
Apnea means ‘not to breathe’. The disease is characterized by short periods of stopping breathing, and then breathing spontaneously resumes. As, during apnea, the throat muscles contract, this occurs with loud snoring. Everyone has a brief apnea from time to time.
Be aware of the possibility of sleep apnea in overweight children and adolescents.
Obstructive sleep apnea is the most common form; it is a consequence not only of obesity, but also of the increase in the volume of the tonsils or adenoids. The main symptoms are fatigue during the day, insomnia, headaches in the morning, hyperactivity and learning problems.
Short-lived central apneas are normal in small infants. Central and obstructive apneas lasting more than 15 seconds require examinations because they can precede Sudden Infant Death Syndrome.
Insomnia
Insomnia is manifested by difficulty falling asleep, waking up repeatedly during the night, waking up early, or a combination of its signs. Insomnia is more common in adolescence. It is often associated with fatigue during the day and mental problems. It is also considered a risk factor for depression.
Excessive fatigue during the day
Infants usually get enough sleep; Excessive fatigue in children is rare because a child falls asleep when tired. The main cause of fatigue during the day is sleep apnea. From school age, narcolepsy can also be a cause. Narcolepsy is a rare disease in which the child falls asleep all the time. In older children, too short a night’s sleep is the leading cause of fatigue during the day.
How can the doctor recognize them?
The doctor will ask parents detailed questions about their child’s sleep problems. This allows him to assess whether it really is a disorder. He may ask parents to keep a sleep diary to assess the problem even better.
The doctor will also perform a physical examination. Recent sleep disturbances in children who slept well before may be due to an illness, such as ear infection. Sometimes the doctor will order blood and urine tests.
What can you do ?
Keep a sleep diary for 3 weeks. Record the time the child goes to bed, when you think he is falling asleep, when he wakes up and how long he is awake, what he eats at night, what he eats during the day and the number of naps he takes during the day.
- Make sure the child does not eat or drink too much in the last hours before bedtime.
- Keep the evening routine quiet, and have your child sleep at specific times.
- Avoid stressful activities such as computer games or action movies that are not suitable for children.
- Protect the area around the bed, and arrange the bedroom so that it is calming.
- Don’t make bedtime a big ritual. A simple hug can help.
- If the child sleeps too long in the parents’ bed, it will be more difficult for him to get used to his own room.
- If the sleep problem has been around for a long time, a gradual change in habits is desirable.
What can the doctor do?
The main task of the doctor is to make the correct diagnosis. Is this something benign, or is there a real sleep disorder? In the latter case, the doctor will refer you to a specialist for a thorough examination. This is certainly true if the child has apneas, suffers from narcolepsy, or has Restless Leg Syndrome. If the diagnosis is in doubt, a hospital sleep test can clarify the diagnosis. If you are overweight, losing weight may be enough to solve the problem. The problem can also be solved by the removal (ablation) of tonsils or polyps in the nose.
Want to know more?
- Better understand sleep – be born and grow
- The child who wakes up at night – Born and grow
- Sleep disorders – Being born and growing up
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