Obstructive Sleep Apnea:

What Is Sleep Apnea?

Brief pauses in breathing during sleep are normal. But when breathing stops often or for longer periods, it’s called sleep apnea. When someone has sleep apnea, oxygen levels in the body may fall and sleep can be disrupted.

It’s more common in older people, but kids and teens can have sleep apnea too.

What Happens During Sleep Apnea?

Sleep apnea happens when a person stops breathing during sleep. It is usually caused by something obstructing, or blocking, the upper airway. This is known as obstructive sleep apnea (OSA).

OSA is a common, serious condition that can make kids miss out on healthy, restful sleep. If it’s not treated, OSA can lead to learning, behavior, growth, and heart problems. In very rare cases, it can even be life-threatening.

Child-sleeping

What Causes Obstructive Sleep Apnea?

When we sleep, our muscles relax. This includes the muscles in the back of the throat that help keep the airway open. In obstructive sleep apnea, these muscles can relax too much and collapse the airway, making it hard to breathe.

This is especially true if someone has enlarged tonsils or adenoids(germ-fighting tissues at the back of the nasal cavity), which can block the airway during sleep. In fact, enlarged tonsils and adenoids are the most common cause of OSA in kids.

Risk factors for the development of OSA include:

  • a family history of obstructive sleep apnea
  • being overweight
  • medical conditions such as Down syndrome or cerebral palsy
  • defects in the structures of the mouth, jaw, or throat that can narrow the airway
  • a large neck (17 inches or more in circumference for men; 16 inches for women)
  • a large tongue, which can fall back and block the airway during sleep

Less commonly, sleep apnea can happen when someone doesn’t get enough oxygen during sleep because the brain doesn’t send signals to the muscles that control breathing. This is called central sleep apnea. Head injuries and other conditions that affect the brain increase the risk for this type of apnea, which mostly affects older adults.

What Are the Signs & Symptoms of Sleep Apnea?

When breathing stops, oxygen levels in the body drop. This usually triggers the brain to briefly wake us up so that the airway reopens. Most of the time, this happens quickly and we go right back to sleep without knowing we woke up.

ut with sleep apnea, this pattern repeats itself all night. So people who have it don’t reach a deeper, more restful level of sleep.

Signs of OSA in kids include:

  • snoring, often associated with pauses, snorts, or gasps
  • heavy breathing while sleeping
  • very restless sleep and sleeping in unusual positions
  • bedwetting (especially if a child previously stayed dry at night)
  • daytime sleepiness or behavioral problems

Because OSA makes it hard to get a good night’s sleep, kids might:

  • have a hard time waking in the morning
  • be tired throughout the day
  • have attention or other behavior problems

As a result, sleep apnea can hurt school performance. Teachers and others may think a child has attention deficit hyperactivity disorder (ADHD) or learning problems.

How Is Sleep Apnea Diagnosed?

If your child snores regularly, is a restless sleeper, is very sleepy during the day, or has other signs of sleep apnea, talk to your doctor. Your doctor might refer you to a sleep specialist or recommend a sleep study.

A sleep study (also called a polysomnogram) lets doctors check for OSA and record a variety of body functions while a child sleeps. Sleep studies also can help doctors diagnose central sleep apnea and other sleep disorders.

In a sleep study, sensors are placed at a few spots on the child’s body with a mild adhesive or tape. The sensors are wired to a computer to provide information while the child sleeps. Sleep studies are painless and risk-free, but patients usually need to spend the night in a hospital or sleep center.

During a sleep study, doctors monitor:

  • eye movements
  • heart rate
  • breathing pattern
  • brain waves
  • blood oxygen level
  • snoring and other noises
  • body movements and sleep positions

How Is Sleep Apnea Treated?

If enlarged tonsils or adenoids are thought to be causing the apnea, the doctor will refer your child to an ear, nose, and throat doctor (ENT). The ENT might decide that an operation called an adenotonsillectomy is needed to remove the tonsils and adenoids. This often is an effective treatment for OSA.

If tonsils and adenoids are not the cause of OSA or if symptoms of OSA remain after adenotonsillectomy, a doctor may recommend continuous positive airway pressure (CPAP) therapy. In CPAP therapy, a person wears a mask that covers the nose and mouth during sleep. The mask is connected to a machine that continuously pumps air into it to open the airways.

When excess weight is a factor in OSA, it’s important to work with a doctor on diet changes, exercise, and other safe weight-loss methods. In mild cases of OSA, doctors may monitor a child for a while to see if symptoms improve before deciding on treatment.

http://kidshealth.org/en/parents/apnea.html?WT.ac=ctg

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What Are Night Terrors?

Most parents have comforted their child after the occasional nightmare. But if your child has ever had what’s known as a night terror (or sleep terror), his or her fear was likely inconsolable, no matter what you tried.

A night terror is a sleep disruption that seems similar to a nightmare, but is far more dramatic. Though night terrors can be alarming for parents who witness them, they’re not usually cause for concern or a sign of a deeper medical issue.

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What Are the Signs and Symptoms of Night Terrors?

During a night terror, a child might:

  • suddenly sit upright in bed
  • shout out or scream in distress
  • have faster breathing and a quicker heartbeat
  • be sweating
  • thrash around
  • act upset and scared

After a few minutes, or sometimes longer, the child simply calms down and returns to sleep.

Unlike nightmares, which kids often remember, kids won’t have any memory of a night terror the next day because they were in deep sleep when it happened — and there are no mental images to recall.

What Causes Night Terrors?

Night terrors are caused by over-arousal of the central nervous system (CNS) during sleep.

Sleep happens in several stages. We have dreams — including nightmares — during the rapid eye movement (REM) stage. Night terrors happen during deep non-REM sleep. A night terror is not technically a dream, but more like a sudden reaction of fear that happens during the transition from one sleep stage to another.

Night terrors usually happen about 2 or 3 hours after a child falls asleep, when sleep moves from the deepest stage of non-REM sleep to lighter REM sleep. Usually this transition is a smooth one. But sometimes, a child becomes upset and frightened — and that fear reaction is a night terror.

Who Gets Night Terrors?

Night terrors have been noted in kids who are:

  • overtired, ill, or stressed
  • taking a new medicine
  • sleeping in a new environment or away from home
  • not getting enough sleep
  • having too much caffeine

Night terrors are relatively rare — they happen in only 3%–6% of kids, while almost every child will have a nightmare occasionally. Night terrors usually happen in kids between 4 and 12 years old, but have been reported in babies as young as 18 months. They seem to be a little more common among boys.

Some kids may inherit a tendency for night terrors — about 80% who have them have a family member who also had them or sleepwalking(a similar type of sleep disturbance).

A child might have a single night terror or several before they stop. Most of the time, night terrors simply disappear on their own as the nervous system matures.

How Can I Help My Child?

Night terrors can be very upsetting for parents, who might feel helpless when they can’t comfort their child. The best way to handle a night terror is to wait it out patiently and make sure your child doesn’t get hurt if thrashing around. Kids usually will settle down and return to sleep on their own in a few minutes.

It’s best not to try to wake kids during a night terror. This usually doesn’t work, and kids who do wake are likely to be disoriented and confused, and may take longer to settle down and go back to sleep.

There’s no treatment for night terrors, but you can help prevent them. Try to:

  • reduce your child’s stress
  • create a bedtime routine that’s simple and relaxing
  • make sure your child gets enough rest
  • help your child from becoming overtired
  • don’t let your child stay up too late

If your child has a night terror around the same time every night, you can try waking him or her up about 15–30 minutes before then to see if that helps prevent it.

Understanding night terrors can ease your worry — and help you get a good night’s sleep yourself. But if night terrors happen repeatedly, talk to your doctor about whether a referral to a sleep specialist is needed.

http://kidshealth.org/en/parents/terrors.html?WT.ac=ctg

Broken Bones:

The harder kids play, the harder they fall. The fact is, broken bones, or fractures, are common in childhood and often happen when kids are playing or participating in sports.

Most fractures affect the upper extremities: the wrist, the forearm, and above the elbow. Why? When kids fall, it’s a natural reflex for them to throw their hands out in an attempt to stop the fall.

Many kids will have a broken bone at some point. Most aren’t too big of a deal, but fractures can be scary for kids and parents alike. Here’s what to expect.

Broken hand 2

How Do I Know if It’s Broken?

Falls are a common part of childhood, but not every fall results in a broken bone. The classic signs of a fracture are pain, swelling, and deformity (which looks like a bump or change in shape of the bone). However, if a break is non-displaced (when the pieces on either side are straight in line with one another), it may be harder to tell.

Some telltale signs that a bone is broken are:

  • You or your child heard a snap or a grinding noise during the injury.
  • There’s swelling, bruising, or tenderness around the injured part.
  • It’s painful for your child to move it, touch it, or press on it; if the leg is injured, it’s painful to bear weight on it.
  • The injured part looks deformed. In severe breaks, the broken bone might poke through the skin.

What Do I Do?

If you suspect that your child has a fracture, you should seek medical care immediately.

If your child has either of the following, do not move your child and call 911 for emergency care:

  • your child may have seriously injured the head, neck, or back
  • the broken bone comes through the skin. Apply constant pressure with a clean gauze pad or thick cloth, and keep your child lying down until help arrives. Don’t wash the wound or push in any part of the bone that’s sticking out.

For less serious injuries, try to stabilize the injury as soon as it happens by taking these quick steps:

  1. Remove clothing from around the injured part. Don’t force a limb out of the clothing, though. You may need to cut clothing off with scissors to prevent your child from having unnecessary added pain.
  2. Apply a cold compress or ice pack wrapped in cloth. Do not put ice directly on the skin.
  3. Place a makeshift splint on the injured part by:
    • keeping the injured limb in the position you find it
    • placing soft padding around the injured part
    • placing something firm (like a board or rolled-up newspapers) next to the injured part, making sure it’s long enough to go past the joints above and below the injury
    • keeping the splint loosely in place with first-aid tape or a wraparound bandage
  4. Get medical care right away, and don’t allow the child to eat, in case surgery is needed.

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Constipation

Constipation is a very common problem in kids. A child is considered constipated when he or she has fewer than three bowel movements in a week; has trouble having a bowel movement; or when the stool (poop) is hard, dry, and unusually large.

Constipation usually isn’t a cause for concern, and easy to avoid by adopting healthy eating and exercise habits.

potty-training_boy_eahv4n

Causes of Constipation

Constipation usually is due to a diet that doesn’t include enough water and fiber, which help the bowels move properly. Kids who eat lots of processed foods, cheeses, white bread and bagels, and meats may become constipated fairly often. Eating a healthier diet with high-fiber foods like fruits, vegetables, and whole grains can keep stool from getting hard and dry.

Sometimes, medicines like antidepressants and those used to treat iron deficiencies can cause constipation. Constipation can happen in babies as they move from breast milk to baby formula, or from baby food to solid food. Toddlers who are toilet training sometimes can become constipated, especially if they’re pushed to toilet train before they’re ready.

Some kids avoid going to the bathroom, even when they really have the urge to go. They might ignore internal urges because they don’t want to use a restroom away from home, stop playing a fun game, or have to ask an adult to be excused to go to the bathroom. Ignoring the urge to go makes it harder to go later.

Stress also can lead to constipation. Kids can get constipated when they’re anxious about something, like starting at a new school or problems at home. Research has shown that emotional upsets can affect how well the gut functions and can cause constipation and other conditions, like diarrhea.

Some kids get constipated because of irritable bowel syndrome (IBS), which can happen when they’re stressed or eat certain trigger foods, which often are fatty or spicy. A child with IBS may have either constipation or diarrhea, as well as stomach pain and gas.

In rare cases, constipation is a sign of other medical illnesses. So talk to your doctor if your child continues to have problems or if the constipation lasts for 2 to 3 weeks.

Symptoms of Constipation

Keep in mind that different kids have different bathroom habits. A child who doesn’t have a bowel movement every day isn’t necessarily constipated. One child might go three times a day, while another might go once every 3 days.

Generally, signs of constipation in kids include:

  • going less than usual
  • having trouble or pain when going to the bathroom
  • feeling full or bloated
  • straining to poop
  • seeing a little blood on the toilet paper

It’s also common for kids with constipation to sometimes stain their underwear with bits of stool.

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Concussions

A concussion is a brain injury that causes temporary changes in the way the brain works. You might think they happen when someone is knocked unconscious while playing sports. But concussions can happen with any head injury, often without a loss of consciousness.

We often hear about head injuries in athletes, but most concussions happen off the playing field — in car and bicycle accidents, in fights, and even minor falls.

crying-little-girl

About Concussions

A concussion is a type of traumatic brain injury. The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. The brain can move around inside the skull and even bang against it. If the brain bangs against the skull — for example, in a fall on a playground or a whiplash-type of injury — blood vessels can tear and the nerves inside the brain can be injured. These injuries can cause a concussion.

Anyone who has a head injury should be watched closely for signs of a concussion, even if the person feels OK. An undiagnosed concussion can put someone at risk for brain damage and even disability. So anyone who has any symptom of a concussion should be seen right away by a doctor.

Sports-related concussions get a lot of attention. Doctors now recommend these steps after a suspected sports concussion:

  1. The player should immediately stop playing or practicing.
  2. The player should get checked out by a doctor before returning to practice or play.

All injured body parts take time to heal, even brains. By resting and taking certain important precautions, kids with concussions usually recover within a week or two without lasting health problems.

Signs and Symptoms

Someone with a concussion may be knocked unconscious, but this doesn’t happen in every case. In fact, a brief loss of consciousness or “blacking out” doesn’t mean a concussion is any more or less serious than one where a person didn’t black out.

If your child might have had a concussion, go to the emergency roomif you see any of these symptoms:

  • loss of consciousness
  • severe headache, including a headache that gets worse
  • blurred vision
  • trouble walking
  • confusion and saying things that don’t make sense
  • slurred speech
  • unresponsiveness (you can’t wake your child)

Call your doctor right away to report other problems, such as vomiting, dizziness, headache, or trouble concentrating. Then you can get advice on what to do next. For milder symptoms, the doctor may recommend rest and ask you to watch your child closely for changes, such as a headache that gets worse.

Symptoms of a concussion don’t always show up right away, and can develop within 24 to 72 hours after an injury. Young children usually have the same physical symptoms as older kids and adults, but cognitive and emotional symptoms (such as irritability and frustration) can appear later, be harder to notice, and last longer. Sleep-related issues are more common in teens.

Though most kids recover quickly from concussions, some symptoms — including memory loss, headaches, and problems with concentration— may linger for several weeks or months. It’s important to watch for these symptoms and call your doctor if they last. Often, in these cases, children need further evaluation and treatment.

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About ANSD

Hearing loss is a common problem in newborns. Some cases are due to auditory neuropathy spectrum disorder (ANSD), a problem in the transmission of sound from the ear’s innermost part (the inner ear) to the brain.

The causes of ANSD are unknown, but children who are born prematurely or have a family history of the condition are at higher risk for it. Symptoms can develop at any age, but most kids with ANSD are born with it and diagnosed in the first months of life.

As ANSD becomes better understood, it is diagnosed more frequently and now accounts for about 10% to 15% of cases of hearing loss.

Fortunately, kids with ANSD can develop strong language and communication skills with the help of medical devices, therapy, and visual communication techniques. Proper diagnosis and early intervention are essential, so if you suspect that your child has any difficulty hearing, talk with your doctor as soon as possible.

How Hearing Works

To understand ANSD, it’s helpful to review how the ear hears. Hearing begins when sound waves that travel through the air reach the outer ear, or pinna, the part of the ear that’s visible. The sound waves go through the ear canal into the middle ear, which includes the eardrum(a thin layer of tissue) and three tiny bones called ossicles. The sound causes the eardrum to vibrate. The ossicles amplify these vibrations and carry them to the inner ear.

The inner ear is made up of a snail-shaped chamber called the cochlea, which is filled with fluid and lined with four rows of tiny hair cells. When the vibrations move through this fluid, the outer hair cells contract back and forth and amplify the sound. When the vibrations are big enough, the inner hair cells translate them into electrical nerve impulses in the auditory nerve, which connects the inner ear to the brain. When the nerve impulses reach the brain, they are interpreted as sound.

Normal Ear diagram

How ANSD Affects Hearing

When someone has ANSD, sound enters the ear normally, but because of damage to the inner row of hair cells or synapses between the inner hair cells and the auditory nerve, or damage to the auditory nerve itself, sound isn’t properly transmitted from the inner ear to the brain.

As a result, the sound that arrives at the brain isn’t organized in a way that the brain can understand. It is disorganized and in some cases the sound never even makes it to the brain. In other cases, ANSD is due to a problem with the auditory nerve.

ANSD has only been understood and diagnosed in recent years. As a result, many questions remain about it. Not all newborn hearing screening programs can identify ANSD, so many kids and adults might have it but not know it.

The symptoms of ANSD can range from mild to severe. Some kids with ANSD hear sounds but have trouble determining what those sounds are. For others, all sounds seem the same, like static or white noise. For example, a voice might sound the same as water running, a dog barking might sound the same as a car horn, or a bird chirping might sound the same as a pan banging.

For some people, ANSD improves over time. For others, it remains the same or gets worse.

Causes

The causes of ANSD aren’t known. But some factors do put a child at risk, including:

Symptoms

Even if a child passes a newborn hearing screening, symptoms of hearing problems might only be noticed over time. Talk with your doctor if you think that your child is having trouble hearing or if you notice any of these symptoms:

  • your infant doesn’t startle when there are loud or sudden noises or doesn’t turn toward sound
  • your baby isn’t cooing, babbling, or laughing by 8 months
  • your child is not trying to imitate sounds and actions by 12 months or isn’t responding to simple commands

If hearing problems seem likely, your doctor might refer you to an audiologist (someone who specializes in diagnosing and treating hearing loss and balance problems). Your doctor also might have your child see an otolaryngologist (also called an ears, nose, and throat [ENT] doctor).

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Bedwetting:

What Is Bedwetting?

Bedwetting is when kids who are old enough to control their bladder pee at night during sleep. It’s a common problem in kids, especially those under 6 years old.

Why Does Bedwetting Happen?

Doctors don’t know for sure what causes bedwetting or why it stops. But it’s often a natural part of development, and kids usually grow out of it. It’s most common in young kids, but can last into the teen years. Most of the time, bedwetting is not a sign of any deeper medical or emotional issues.

Bedwetting often runs in families: many kids who wet the bed have a relative who did too. If both parents wet the bed when they were young, it’s very likely that their child will.

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How Can We Cope With Bedwetting?

Bedwetting is an issue that millions of families face every night, and can be very stressful. Kids can feel embarrassed and guilty about wetting the bed and anxious about spending the night at a friend’s house or at camp. Parents often feel helpless to stop it.

Bedwetting usually goes away on its own, but may last for a while. It can be embarrassing and uncomfortable for your child, so it’s important to provide emotional support until it stops.

Reassure your child that bedwetting is a normal part of growing up and that it’s not going to last forever. It may comfort your child to hear about any other family members who struggled with it when they were young.

Try to have your child drink more fluids during the daytime hours and less at night (and avoid caffeine-containing drinks). Then remind your child to go to the bathroom one final time before bedtime. Many parents find that using a motivational system, such as stickers for dry nights with a small reward (such as a book) after a certain number of stickers, can work well. Bedwetting alarms also can be helpful.

When your child wakes with wet sheets, don’t yell or punish. Have your child help you change the sheets. Explain that this isn’t punishment, but it is part of the process. It may even help your child feel better knowing that he or she helped out. Offer praise when your child has a dry night.

When Should I Call the Doctor?

Bedwetting that begins suddenly or happens with other symptoms can be a sign of another medical condition, so talk with your doctor.

The doctor may check for signs of a urinary tract infection (UTI)constipation, bladder problems, diabetes, or severe stress.

Call the doctor if your child:

  • suddenly starts wetting the bed after being consistently dry for at least 6 months
  • begins to wet his or her pants during the day
  • snores at night
  • complains of a burning sensation or pain when urinating
  • has to pee often
  • is drinking or eating much more than usual
  • has swelling of the feet or ankles
  • is 7 years of age or older and still wetting the bed

http://kidshealth.org/en/parents/enuresis.html?WT.ac=ctg