Diagnosis and Management of Common Sleep Problems in Children

Sumit Bhargava

doi:10.1542/pir.32-3-91

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Sumit Bhargava, MD*

^*Assistant Professor of Pediatrics, Section of Pediatric Respiratory Medicine, Yale School of Medicine, New Haven, CT.

Author Disclosure
Dr Bhargava has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Objectives

After completing this article, readers should be able to:

Discuss the wide prevalence of sleep problems in children.
Recognize and manage common sleep problems in children.
Know the American Academy of Pediatrics guidelines for diagnosis and management of obstructive sleep apnea in children.

Introduction

Sleep plays a vital and often underestimated role in the growth and development of children. Community surveys have discovered that sleep problems have a high prevalence throughout childhood and adolescence, with 25% to 50% of preschoolers and up to 40% of adolescents experiencing sleep-related problems. (1) Disruption of sleep due to a variety of sleep disorders may affect cognitive development and growth, and the child's sleep problems may become a significant family stressor. Studies have shown that sleep issues are usually not addressed adequately in pediatric practice. (2) This article describes the features of common sleep disorders that present to the pediatrician and provides strategies for effective management.

Sleep in Infancy, Childhood, and Adolescence

Sleep architecture, sleep behaviors, and sleep problems change as children progress from infancy to adolescence. The ability to sleep through the night usually does not develop until at least 3 to 6 months of age. Sleep duration also varies by age (Table 1). Insufficient sleep and poor sleep quality may manifest as changes in mood, behavior, memory, and attention. Parents are usually quick to recognize any changes in their child's behavior and mood, and these observations should be ascertained during history taking. Younger children may develop symptoms of hyperactivity, poor impulse control, and neurocognitive dysfunction that includes attentional problems and impaired vigilance. Adolescents who are not getting sufficient sleep may have symptoms of excessive daytime sleepiness, such as falling asleep on …