Pediatric Sleep Disorders/Sleep in Children with Chronic Illness.

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WHAT IS RESTLESS LEGS SYNDROME?

Restless legs syndrome (RLS) is a neurological disorder in which a child or adolescent experi- ences a need or “urge” to move the legs. These feelings are typically worse in the evening and at bedtime. They can also occur during periods of inactivity such as sitting still for a long time. This urge to move is often accompanied by uncomfortable feelings in the legs. These sensations may be described by children as “creepy-crawly” or tingling. Some parents interpret their child’s complaints as “growing pains” or simply believe that their child is fidgety. These uncomfortable feelings are often partially or completely relieved by movement, such as stretching or jiggling the legs, getting up and walking or running around, or simply tossing and turning. For some children, rubbing the legs may make them feel better. Because of the leg discomfort and increased leg movements, it often takes a long time for a child or adolescent with RLS to fall asleep at bedtime. This results in not getting enough sleep.

In addition, children with RLS often kick their legs or twitch when they are asleep, which are called “periodic limb movements.” These movements may disrupt sleep, resulting in feeling tired the next day. Unlike restless legs symptoms, a child with periodic limb movements is typically not aware of the problem, although a parent may observe kicking and restless sleep.

WHAT CAUSES RESTLESS LEGS SYNDROME?

RLS appears to be genetic, as it often run in families. The majority of children with RLS have a parent or grandparent with similar symptoms. In addition, certain factors may make RLS worse. These include iron deficiency (with or without anemia), caffeine, and certain medications (anti- depressants such as Prozac). In addition, some children with a chronic illness, such as diabetes, cancer, and kidney disease, are at increased risk for RLS.

WHAT ARE THE SYMPTOMS OF RESTLESS LEGS SYNDROME?

The symptoms of RLS include the following.

n Leg discomfort: Children or adolescents often describe these uncomfortable leg sensations as creepy-crawly, itching, burning, popping, tingling, or sometimes as painful. They may also use more colorful descriptions, such as “ants crawling on my legs” or “soda bubbling through my veins.” These sensations usually occur only at bedtime or are much worse at bedtime. They can, though, also occur at other times of inactivity, such as while sitting still in school or on long car rides.

n Leg movements: Children and adolescents with RLS often have an irresistible “urge” or feel- ing that they “have” to move their legs. These movements can relieve the uncomfortable feel- ings. These movements can be shaking or kicking the legs, tossing and turning while lying in bed, or even walking or running about.

n Difficulty falling asleep: Children and adolescents with RLS often take a long time to fall asleep because of the leg discomfort and need to move. They not only have problems falling asleep, but may also have difficulty staying asleep.

Restless Legs Syndrome

© Mindell JA & Owens JA (2010). A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems, 2nd ed. Philadelphia: Lippincott Williams & Wilkins

2 ReStLeSS LegS SyndRome

© Mindell JA & Owens JA (2010). A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems, 2nd ed. Philadelphia: Lippincott Williams & Wilkins

n Bedtime behavior problems: Because of the difficulty falling asleep caused by RLS, some children may resist or struggle at bedtime.

n Daytime problems: The difficulties falling asleep and staying asleep can result in signifi- cant daytime sleepiness. In addition, problems with mood, behavior, and school are com- mon in children with RLS. They may also be hyperactive, impulsive, irritable, and have poor concentration.

HOW IS RESTLESS LEGS SYNDROME DIAGNOSED?

There is no definitive test for RLS. So the diagnosis is made based on the description of symp- toms. A medical history and physical examination will also be done to make sure there are no other problems. Your doctor may order a blood test for low iron called a “serum ferritin level.” Finally, an overnight sleep study may be recommended to evaluate for other sleep disorders, es- pecially periodic limb movements, which can only be definitively diagnosed with a sleep study.

HOW IS RESTLESS LEGS SYNDROME TREATED?

Treatment for RLS may involve any of the following.

n Good sleep hygiene: It is especially important that children and adolescents with RLS main- tain good sleep hygiene. This includes keeping a regular sleep schedule and having a consis- tent bedtime routine. An earlier bedtime may also help, especially if the symptoms are worse when your child is overtired.

n Change bedtime habits: Given that the leg discomfort gets worse the longer the child or adolescent lies in bed, it is usually better for your child to wait to get into bed until she is ready to turn out the light. Therefore, the bedtime routine, such as reading stories, should all occur before getting into bed.

n Exercise: Exercising at least a few hours before bedtime can be beneficial. n Reduce the discomfort: Massage, cold compresses, or a heating pad may provide temporary

relief. n Avoid caffeine: Caffeine can make RLS symptoms worse, so all caffeine should be avoided.

Caffeine can be found in many sodas, tea, and coffee. Some antihistamines and cold or sinus preparations can also make symptoms worse.

n Treat iron deficiency: If a blood test shows low iron (ferritin level <50), then iron supple- ments are usually recommended. The amount of iron in these supplements is typically more than that in a regular multivitamin, and several months of treatment are often needed to in- crease the ferritin level. Your doctor may recommend an iron supplement that also includes vitamin C. Vitamin C will increase the iron absorption. Some children develop constipation with iron supplements. Pay attention to your child’s diet, including increasing high fiber foods and increasing fluids. The addition of a stool softener is occasionally needed.

n Consider medication: For children and adolescents with RLS who have significant sleep disruption, medication may be recommended. There are a number of different types of medi- cations that can help. Your doctor can discuss these with you.