Medical disorders resulting in problem sleeplessness in children
- Stephen H Sheldon, DO, FAAP
Stephen H Sheldon, DO, FAAP
- Professor of Pediatrics
- Northwestern University, Feinberg School of Medicine
Problems with sleep onset and maintenance are common complaints presenting to the child health care practitioner. A sleepless child affects the entire family, and symptoms of problem sleeplessness are often identified in several members of the same family. Sleeplessness may cause a child to have problems with daytime performance, behavior, or mood, regardless of the underlying cause of the sleeplessness.
Problem sleeplessness in children (pediatric insomnia) is a symptom of a heterogeneous group of disorders that include but are not limited to conditioned, behavioral, social/environmental, circadian rhythm, and medical causes. The causes and clinical presentation of sleeplessness in children are quite different from those in adults, and the approach to diagnosis and management is correspondingly different.
Little substantive literature exists exploring the association between medical conditions and sleeplessness in childhood. This topic review describes medical conditions that may be associated with sleeplessness in children. The general assessment of sleep disorders in children, and the diagnosis and management of behavioral sleep problems are discussed in separate topic reviews. (See "Assessment of sleep disorders in children" and "Behavioral sleep problems in children".)
Otitis media is common in children. Acute otitis media is typically characterized by ear pain, with or without associated fever, and rarely goes unrecognized. However, chronic middle ear disease may go unnoticed; serous or secretory otitis media associated with persistent middle ear effusions can present with disrupted nocturnal sleep, with few other symptoms.
Acute otitis — Children with acute suppurative otitis media typically present with fever, otalgia, changes in appetite, and vomiting, and may appear acutely ill. Prolonged or repeated arousals and wakings often occur, and may be associated with daytime sleepiness and a decrease in daytime activity levels. Physical examination reveals loss of normal tympanic membrane landmarks, erythema, or bulging of the tympanic membrane. (See "Acute otitis media in children: Epidemiology, microbiology, clinical manifestations, and complications", section on 'Clinical manifestations'.)
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- OTITIS MEDIA
- Acute otitis
- Chronic otitis
- ALLERGIC RHINITIS
- ATOPIC DERMATITIS
- NEUROLOGIC AND NEURODEVELOPMENTAL DISORDERS
- Clinical presentation and diagnosis
- - Behavioral management
- - Pharmacotherapy
- Zolpidem and eszopiclone
- Other drugs
- ATTENTION DEFICIT HYPERACTIVITY DISORDER
- MEDICATION-INDUCED SLEEP DISTURBANCE
- Clinical presentation and diagnosis
- CHRONIC ILLNESS
- Clinical presentation and diagnosis