1. Sleep in the Pediatric Practice M. Mohammadi MD Professor of Pediatrics & Neurology Children’s 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 it’s 60% vs. 40% Sleep is the primary activity of the brain during early development

4. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.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!

6. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.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

8. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.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

10. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.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”

12. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.A public health issue

13. 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

14. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.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 5 th leading concern of the parents, following illness, feeding problems, behavioral problems, & physical abnormalities

16. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.A public health issue

17. Sleep is necessary for children’s 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

18. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.A public health issue

19. 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

20. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.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

22. Top Ten Reasons for Pediatricians to Care More 1.So common 2.Chronic 3.Treatable 4.Preventable 5.Major impact on family 6.One of the most common parental complaints 7.Necessary for children’s optimal functioning 8.Effective on development 9.Coexistence with other medical problems 10.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

24. Some Common Scenarios

25. 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.