August brings more returning travellers, this time with dengue fever. Also adolescent sleep problems, adverse childhood experiences (ACEs), an update on rhinitis and the neurological effects of rotavirus. Do leave comments below.
New leaflet available for downloading to give to parents struggling with getting their child to sleep. Written by a paediatric registrar, Dr Sophie Niall, with input from the Redbridge child development and Early Years team. I find it a useful summary of some of what I say in a general paediatric consultation when the conversation turns to the parents’ sleepless nights.
Lots of things to talk about this month. Reminder of what Koplik spots look like, good e-learning on human trafficking, a link to the new primary care guidelines page, night terrors v. nightmares, some good allergy websites and Jess Spedding again on scaphoid injuries. Do leave comments below.
Parasomnias – with thanks to Dr Sophia Datsopoulos
A group of sleep disorders that are paroxysmal, predictable in timing in the sleep cycle and characterized by retrograde amnesia. Polysomnography (type of sleep study in which various parameters are measured in order to rule in or out various sleep disorders), if performed, is abnormal. Diagnosis is based on a thorough history; extensive work-up seldom necessary.
Focus on: ‘Pavor Nocturnus’ or Night Terrors
Children aged three to eight years, M>F. Often family history of night terrors or sleepwalking. Occur approximately 90 minutes into sleep,
during non-REM sleep.
Presentation: Child suddenly sits bolt upright, screams, and is inconsolable for up to 15 minutes, before relaxing and falling back to sleep
with no memory of the event the next morning. Tachycardia, tachypnoea and other signs of autonomic arousal are apparent.
– Reassure families that they have a benign course and are self-limiting
– Advise them not to attempt to wake the child during an episode and that comforting during the episode may delay its recovery
– Explore and alleviate any stress in the child’s environment. Encourage a relaxing bedtime routine
– If frequent and occurring at a specific times every night, behavioural interventions such as scheduled awakenings (see http://www.epic.edu.au/sites/default/files/Sleep/PDFed/Night%20terrors.pdf) may be beneficial
– More severe forms may benefit from treatment with benzodiazepines (e.g., clonazepam) under direction of specialist services.
Main differential: nightmares – these can occur at any age, during the lighter stage of sleep when dreaming, and so tend to be later in the night. Seizures due to temporal lobe epilepsy can appear similar to night terrors but the seizures are usually brief (30 seconds to a few minutes) and are more common in older children and adults.
Comparison: Night Terrors and Nightmares
|Age||3 – 8 years||Any age|
|Occurrence in sleep cycle||NREM||REM|
|Memory for event||No||Yes|
|Exacerbated by stress||Yes||Yes|
REM = rapid eye movement; NREM = non-rapid eye movement.
Next month: Focus on: Somnambulism (sleep waking) and Somniloquy (sleep talking)
Delayed sleep phase this month and chronotherapy which sounds like quite an undertaking. Also a link to a new parent’s guide to picking up and talking about sexual abuse, links to handy recent uploads to the site, the BSACI guideline on allergic rhinitis and more banging on about vitamin D supplementation – please.