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Childhood Sleep Disorders


Does your child snore more than three (3) times per week? Is he/she sleepy during the day? Has a difficulty staying focused in school? Does he/she have ADHD/ADD? If so, a sleep test may be needed for a diagnosis.

Frequently Asked Questions for Parents

What is Infant Sleep Apnea?
Infant Sleep Apnea is characterized by having episodes of either Central Apnea or Obstructive Sleep Apnea (OSA) during sleep. An apnea is the stoppage of airflow at the nostrils and mouth lasting at least ten (10) seconds. A Central Apnea occurs when respiratory efforts stop for more than ten (10) seconds (20 seconds in infancy) due to a malfunction in the part of the brainstem that controls and regulates one's breathing. An OSA occurs when the upper respiratory airway becomes blocked.

Up to what age is considered an Infant Apnea?
The diagnosis of Infant Apnea is reserved for infants who are older than 37 weeks (approximately nine [9] months) at the onset of the apnea and for those with no specific causes of Apparent Life-Threatening Event (ALTE) or apnea can be identified.

Apnea of Prematurity is restricted to apneas in infants younger than 37 weeks (approximately [9] months) and due to a respiratory immaturity (with no other identifiable causes).

What are the symptoms of Sleep Apnea in children?
• Skin color/tone change (pale or bluish in infants)
• Body limpness
• Noisy breathing during sleep.

What is Urinary Incontinence (Enuresis)?
Urinary Incontinence (Enuresis) is a medical terminology for bedwetting or the accidental urination in children who should be otherwise be able to control their bladders. Girls usually develop the bladder control before boys do. The diagnosis of Enuresis is for girls over the age of five (5) and for boys over the age of six (6). There are different types of bedwetting that can occur including the following:

Diurnal Enuresis - wetting during the day
Nocturnal Enuresis - wetting during the night
Primary Enuresis - occurs when a child has never fully mastered the toilet training
Secondary Enuresis - occurs when a child did have a period of dryness but returned to having periods of incontinence.

What causes Urinary Incontinence?
There can be numerous factors for why children wet. A few possible reasons for the problem include poor toilet training, a delay in the ability to hold urine (this may be a factor up to about the age of five (5), small bladder, poor sleep habits, a presence of a sleep disorder, and problems with hormones that regulate urination.

How is Urinary Incontinence diagnosed?
Urinary Incontinence is usually diagnosed based on a complete medical history and physical examination of the child. In addition, the child's physician may perform the following procedures to help rule-out other causes for wetting:

• Urine test (to rule-out an infection or conditions such as diabetes)
• Blood pressure measurement
• Blood tests.

What types of treatments are available for urinary incontinence?
A specific treatment will be determined by the child's physician based on the child's age, overall health, and the medical history. Other factors include analysis of the extent of the condition, the child's tolerance for specific medications, procedures or therapies.

What do I need to know about sleep cycles?
When people sleep, they cycle between rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. In REM sleep, eyes move around fast, the body doesn't move much, and people often dream. REM sleep is when an infant or child is most likely to wake up. In normal sleep, a child cycles between REM and NREM sleep stages.

What do I need to know about how babies sleep?
Infants go through a complete sleep cycle about every 50-60 minutes, and therefore, they can wake-up many times during the night. Newborn's sleep is equally divided between day and night. By age of four (4) months, the baby will probably sleep in a 6-8 hour blocks at night, and by age of six (6) months, in a 10-12 hour blocks, but that's not to say that they won't wake up during that time period. Most babies still wake-up at least once at night even at age of nine (9) months. Some babies can get back to sleep by themselves, and some babies need help of others to fall back asleep.

What do I need to know about school-age children and sleep?
School-aged children still need 9-12 hours of sleep at night. At this age, they usually start a trend toward becoming more sleep-deprived. Parents need to figure out how much sleep the child needs. The child is getting the right amount of sleep if they:

• Can fall asleep within 15 to 30 minutes
• Can wake up easily at the time they need to get up and don't need others to keep bugging them to get up
• Are awake and alert all day and don't need a nap during the day. It is a good idea to check with the child's teacher to make sure the child is able to stay awake and be alert during school time.

How can I tell if my child is sleep-deprived? How much sleep do children need?
The following chart shows some averages. It gives an idea of the ballpark figure, depending on the child's age. Some children need more or less sleep and differ in how they nap.

Age Nighttime Sleep (hrs) Daytime Sleep (hrs) Total Sleep (hrs)
1 month
3 months
6 months
9 months
12 months
18 months
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12-13 years
14 years
15 years
16 years
8.5 (many naps)
6-10
10-12
11
11
11
11
10.5
11.5
11
10.5-11
10.5
10-10.5
10
9.5-10
9.5
9-9.5
9
8.5-9
8.5
7.5 (many naps)
5-9
3-4.5
3 (2 naps)
2.5 (2 naps)
2.5 (1-2 naps)
2 (1 nap)
1.5 (1 nap)
0
0
0
0
0
0
0
0
0
0
0
0
16
15
14.5
14
13.5
13.5
13
12
11.5
11
10.5-11
10.5
10-10.5
10
9.5-10
9.5
9-9.5
9
8.5-9
8.5

How are night terrors different than nightmares?
Night Terrors are distinguished from nightmares because they usually occur during times of stress or fatigue. Night Terrors usually occur with males between the ages of three (3) to eight (8) years. They are characterized by a child bolting upright and screaming, with parents usually unable to console the child for up to 30 minutes.

What can I do if my child sleep-walks?
Common symptoms of Somnambulism (sleep-walking) and Somniloquy (sleep-talking) include a child sitting-up in bed with eyes open but "unseeing." Activities may range from a purposeless restlessness in bed to actual walking through the house. Speech is mumbled and slurred and is rarely intelligible. It is important for parents to take steps to ensure the child's safety by placing the sleep-walker on the first floor of the home to avoid the possibility of his/her falling-down stairs and making sure that all windows and doors are securely closed. When confronting a child who is sleep-walking, parents should keep the intervention to a minimum and refrain from shaking, slapping or shouting at the child. Children usually outgrow these sleep behaviors by the adolescent age.

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