Health
Thursday, August 09, 2018
 
Doctor’s Perspective
Sleep disturbance in children


By Dr. Anthony Policastro One of the most common complaints I get from parents is sleep disturbance. For adults there are many kinds of medications to aid with sleep. Parents have the perception - an incorrect assumption - that the same is true for children. The biggest reason for that assumption is the feeling that disordered sleep must be a physiological problem. In reality, most sleep issues are behavioral in nature. The most common issue is unrealistic expectations. Parents think that their children should sleep between certain hours of the night. That notion is based upon the thought that all children are the same. We all know that is clearly not the case. Children have a biological clock that is set for a certain number of hours of sleep between certain times of the night. This clock - a circadian rhythm - is different for every child. We know that some infants eat and sleep almost like clockwork while others are very unpredictable. It is no different with sleep in older children. The first thing parents should do with a child who is experiencing sleep problems is keep a sleep diary for two weeks. The diary usually shows the child is getting enough hours of sleep. It is just not happening when the parents want it to. The child may fall asleep later than expected and awake later than expected. This happens on weekends and it causes issues on school days because these children are not ready to get up. The child may fall asleep early and then get up at the crack of dawn. Again the number of hours might be correct, however, the timing is wrong for the parents who do not want to be up that early. A second common behavioral cause of poor sleep is related to night waking. When children are put to bed at night, there is a certain pattern to the bedtime routine. When they wake in the middle of the night, the routine might be different. Their body then sends the message that it is not bedtime so they stay awake. This is called sleep association. The bedtime pattern needs to be repeated as closely as possible. Allowing the child to climb in bed with the parent will insure that they wake every night expecting that to happen. There are only three medications that can help children with sleep. None of them are as predictable as adult medication. Melatonin is an over the counter chemical. There is no prescription for it. For that reason, one never knows the purity of the preparation that is purchased. Our body makes melatonin of its own. It releases it about two hours prior to bedtime. Some parents give melatonin at bedtime. Then the child falls asleep two hours later. This is expected. It needs to be given earlier. We still do not know that much about melatonin use in children. We are not really sure of the dose. We do not know long term side effects so there are still unknowns. Benadryl (diphenhydramine) makes children sleepy, however, the dose needs to be higher than the usual prescribed dose for daytime use. It is still safe since it is only a once a day high dose. The problem is that Benadryl gives children something like a hangover the next day which will interfere with school. Clonidine is an old blood pressure medication. Adults who used to take it would fall asleep. We no longer use it for blood pressure but it does help with sleep. The problem is that using it means giving children a blood pressure medication that they do not need. Stopping it cold without tapering the medication can cause a blood pressure rise that is dangerous. The bottom line is that there is no acceptable sleep medication for children. About 25 percent of children have sleep problems. Most of them are behavioral and they do not need medication. Medications are few and each one of them has problems associated with it.

Stroke Support Group Nanticoke Rehabilitation Services will host a stroke support group on Tuesday, Aug. 21 from 1:30 to 3 p.m. at the Seaford Library & Cultural Center. This support group is designed for individuals who have survived a stroke as well as their families, friends, and caregivers. Modeled from the American Stroke Association, this free support group provides education, community resources, and emotional support to those who have been affected by this life-altering event. Meetings consist of guest speakers and breakaway sessions for caregivers and stroke survivors to discuss concerns, providing support and networking.

Pre-registration is not required. For more information, call Nanticoke Rehabilitation Services at 302-629-6224.

Dementia products trade show Wendy's Warriors, a Walk to End Alzheimer's Team, will present a trade show on Thursday, Aug. 23 from 11 a.m. to 3 p.m. at 23767 Samuel Adams Circle in Independence, A Schell Brothers 55+ Community, Millsboro. The show will highlight 17 local services with vendors available to discuss the products and share the literature they offer that is helpful to adults in early to moderate stages of Alzheimer's disease and other dementias. Free parking is available. For more information, contact Wendy Biggs at 443-350-7182 or email rb97183@gmail.com. The Walk to End Alzheimer's will be held on Saturday, Sept. 29, at Grove Park in Rehoboth Beach with registration starting at 8:30 a.m. For more information, call 800-272-3900 or go online to register at www.alz.org/delval.

Evans named director at Nanticoke Nanticoke Memorial Hospital is proud to announce that Jodi Evans, BSN, RN, has been named nursing director of the Specialty Surgical Unit (SSU) at Nanticoke Memorial Hospital. In this position, Evans will be responsible for the delivery of medical surgical care in collaboration with physicians and other health care providers. Evans received her bachelor of science in nursing from Salisbury University in June 1993, and then started her career at Nanticoke Health Services a month later as a nurse on the Progressive Care Unit (PCU). She has worked as a nurse for over 25 years and has held several leadership roles in various departments throughout the hospital. In 2015, she transitioned into a full-time orthopedic coordinator, where she was responsible for managing the orthopedic program while collaborating with surgeons, office schedulers, the SSU director, admissions, and several other departments and staff within the hospital. Evans is actively involved with the organization and her community. At Nanticoke, she serves on Nanticoke's bariatric and orthopedic committees and regularly participates in community outreach events including Riverfest, Apple Scrapple and Nanticoke's Health Fair in Laurel. Outside of work, she volunteers her time with the women's ministry and nursery at her church, Atlanta Road Alliance Church (ARAC) in Seaford. She also coaches a co-ed volleyball team at ARAC.

Lymphedema Support Group Nanticoke Rehabilitation Services hosts lymphedema support groups on the third Thursday of each month from 1:30 to 3 p.m. at the Seaford Library and Cultural Center. This month's meeting is Thursday, Aug. 16. This free support group is open to anyone affected by lymphedema including patients, caregivers, and relatives. Meetings will consist of a lecture by health care professionals and medical equipment providers followed by refreshments and an open question and answer session or discussion among participants. Registration is not required. For more information about this support group or to learn more about services provided by Nanticoke Rehabilitation Services, call 302-629-6224 or visit www.nanticoke.org/rehabilitation.

Parkinson's Support Group Nanticoke Health Services, in conjunction with CHEER and Care DE and the Manor House, will hold a Parkinson's education and support group on Thursday, Aug. 16 from 9:30 to 11 a.m. at the Manor House in Seaford. This support group is free and open to the public. This support group is not only helpful for the individual diagnosed with PD, but also for caregivers, friends and family. Group members welcome guest speakers on a variety of subjects related to PD and provide support to each other through other small group discussions. Studies show that the information, training, and counseling that participants receive at support groups enhances the quality of life, help to alleviate stress, and may even boost the immune system. Tara Trout, LPN at Nanticoke Memorial Hospital, co-facilitates the group with Kathy Landis, caregiver resource coordinator at CHEER in Sussex County, Delaware. For more information, contact Tara at 302-629-6611, ext. 3838.