Deirdre Budd’s Blog

Archive for August 2009

Infants and young toddlers with obstructive sleep apnea and sleep disordered breathing experience significant improvement following surgical treatment of the ailment, according to an invited article in the June 2009 issue of Otolaryngcology-Head and Neck Surgery

Sleep disordered breathing (SDB) in children, from infancy through puberty, while similar to adult sleep apnoea, actually has different causes, consequences, and treatments. A child with SDB does not necessarily have this condition when they become an adult. The consequences of pediatric obstructive sleep apnoea include snoring; sleep deprivation (which can cause moodiness and behavioural issues); abnormal urine production; slowed growth and development; and attention deficit and attention deficit hyperactivity disorders.

The study evaluated 73 cases in which children younger than two years old were treated for obstructive sleep apnoea through the removal of the adenoids, tonsils, or both (adenotonsillectomy). Those treated through surgery experienced significant improvement on the apnoea-o index (AHI), an index that measures the severity of sleep apnoea. Those treated medically, but not surgically, exhibited no improvement after treatment.

The study’s authors also concluded that the rate and types of post-surgical complications were within acceptable levels.


According to a study published in the American Academy of Sleep Medicine  a new study has found that alcohol consumption during pregnancy and small body size at birth predict poorer sleep and higher risk of sleep disturbances in 8 year old children born at term.

Those children who experience even low levels of foetal exposure to alcohol tend to have a short sleep duration and across all nights have a lower sleep efficiency.  Children born by Cesarean section are also more likely to have shorter sleep (7.7 hours or less) Most of the sleep disorder symptoms are bedtime resistance or sleep disordered breathing.

These results are in accordance with the foetal origins of health and disease hypothesis and the many studies that show that an adverse foetal environment may have life long influences on health and behaviour.

The authors of this study report that small body size at birth may function as a crude marker on disturbances in the foetal environment and reslts show that amoung children born healthy and at full term a linear relationship exists between smaller body size at birth and poorer sleep quality at 8 years of age.

Sleep deficit in Adults is recognised as a contributing factor in traffic accidents and accidents while operating machinery however recent research looking at the outcomes of sleep deficit in children shows a co relation between daytime sleepiness and accidental injury.

The NICHD study of Early Childhood Care, a study of 1,300 children were followed from birth to adolescence to identify if frequent night wakings resulted in increased risk of injury. This study followed on from two previous studies in 2000 and 2005 where a modest  but consistent link was identified. It is not surprising that tired children have poorer motor co-ordination, attention span and concentration, factors which may increase the risk of injury. (Fallone Owens and Deane 2002) It has long been recognised that tired children are more oppositional to rules, behave more impulsively, take more risks and have more mood disturbances. Again this increases the risks of accidental injuries.

Although this new study also raises many questions about the level of injuries sustained and the co relation of parental sleep deficit which may impact on parental awareness and  their reaction to aspects of child safety, the outcomes strongly suggest that children’s sleep dysfunction impacts on peer relationships, learning, immune functioning, as well as a range of physiological social and cognitive abilities (Loughin et al 2002)

From an applied perspective, these findings reinforce the need to aggressively treat sleep difficulty in young children, as a means to maintain not just cognitive and social development, but also physical health. From a theoretical perspective, the findings underscore the complexity of risk for pediatric injury, and the need to consider the multifaceted aspects of risk in the development of  appropriate intervention strategies.

Do not ignore your child’s sleep disorder.

If you need help to resolve night wakings or other sleep disturbance contact

Sleep disturbances in children with Autism and Autistic Disorders are often seen as part and parcel of the condition.  For this reason parents do not always seek appropriate help until the problem becomes severe.  Although sleep disturbance is in these children are often chronic they can be successfully treated with behavioural therapy and occasionally with a combination of medication and behavioural therapies. 

Nightwakings in these children are longer and more disruptive, sleep routines may be more problematic because of the sterotypical behaviours and difficulties in adapting to any alterations in these. Increased anxiety in these children may also play a part. Parents may also be more aware of their childs sleep difficulties, experience sleep deficit themselves and find the whole night time a period of upset and distress rather than quiet and restful.

Significant problems in getting to sleep and maintaining sleep have been reported in a range of neurological disorders. The prevelance of sleep disorders in children with such diagnosis as Aspergers syndrome, Angleman Syndrome, Retts and Williams syndromes have been estimated as being as high as 50-70%. Similar problems occur in blind children with difficulties in falling asleep, nightwakings and restless sleep being the most common.

Sleep disturbances in children with developmental delays are frequently effectively  altered by a variety of behavioural strategies. These need to be tailored to the developmental stage of the child and to the resources of the family. Choosing reasonable, attainable and mutually acceptable targets in terms of desirable behaviour at bed time, and in coping with nightwakings, are particularly important when assisting families to alter unwanted behaviours.

If you need help to alter your child’s night behaviour contact

Headbanging and body rocking come under the category of Rhythmic Movement Disorders. They are common in young children as self soothing behaviours.  They can occur at sleep onset and following normal night time arousals. Some studies state that about two thirds of 9 month old infants engage in some sort of rhythmic behaviour with less than half continuing these behaviours at 18 months and only 8% continuing to do so at 4 years of age.

Bodyrocking starts younger than headbanging and both are more common in boys than in girls (4:1 ratio) Usually these behaviours start before one year of age. The majority of children who engage in these behaviours are otherwise completely normal and healthy.  Where these behaviours continue during the day and are persistant they may be associated with pervasive developmental disorders such as Autism. Environmental stress, lack of environmental stimulation and self-stimulation are often associated factors.

Placing additional bumpers round the cot or bed in an attempt to protect the child is seldom effective. Even if the child is banging their head hard it is unlikely that injury will occur. Increasing nap times and diminishing sleep deficit will help, and it is useful to examine parents reaction to the rhythmic movements, as these can inadvertantly reinforce the child’s behaviours. 

Most children outgrow rhythmic behaviours by age 3 and 90% of children no longer use this method of self soothing after 4 years although some continue to engage in this until adolescence or adulthood. It is always worthwhile to rule out any concurrent medical problems such as ear infections or sleep disordered breathing. If there is an underlying medical issue then treating that will significantly decrease the frequency and duration of this behaviour.


August 2009
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