CURRENT ESSENTIALS PEDIATRICS - part 8

Đêm khủng khiếp xảy ra ở 3% trẻ em thường Trong thời hạn 2 giờ ngủ (sâu không chuyển động mắt nhanh chóng [REM] ngủ) Đêm cuối cùng khủng khiếp ~ 30 phút với la hét, trận đòn, thở nhanh, tim đập nhanh, đổ mồ hôi, ngủ, không dính nhau đi bộ. Không có trẻ em đã nhớ lại sự kiện trong giấc ngủ ngưng thở tắc nghẽn buổi sáng-to ngáy, | Chapter 22 Developmental and Behavioral Disorders 367 Sleep Disorders Essentials of Diagnosis Night terrors occur in 3 of children usually within 2 hours of falling asleep deep non-rapid eye movement REM sleep Night terrors last 30 minutes with screaming thrashing tachypnea tachycardia sweating incoherence sleep walking. Child has no recall of event in the morning Obstructive sleep apnea loud snoring chest retraction morning headache dry mouth. Peak age 2-6 years. Associated with adenoid and tonsillar hypertrophy obesity jaw and other facial anomalies hypotonia Dyssomnia frequent night-time wakening or difficulty falling asleep with frequent demands for parental attention. Usually a learned behavior. Starts at 9 months of age Careful physical examination medical and psychosocial history clarifies diagnosis and establishes parental confidence Differential Diagnosis Nightmares frightening dreams during REM sleep. Child is fearful but oriented seeks parental reassurance and usually remembers the event the next morning Exaggerated periodic breathing may resemble obstructive sleep apnea Psychiatric problems GE reflux sometimes causes night-time wakening because of pain or choking Hunger inadequate daytime food fluid intake associated with night-time demands for food or bottle Treatment Night terrors parent education protection of child during spell regular sleep schedule avoidance of sleep deprivation. Scheduled waking of child before spells if night terrors occur predictably Nightmares reassurance night light establish a routine response to nightmares so child can calm himself herself when they occur Dyssomnia set developmentally appropriate limits on parental visits to the bedroom after child is put in bed establish regular bedtime rituals with age-appropriate bedtimes ensure adequate daytime calorie intake avoid exhaustion Polysomnography may help clarify diagnosis of obstructive sleep apnea Treat physical causes of sleep apnea adenoidectomy weight reduction Pearl .