Treating children with sleep disorders

doi:10.1136/bmj.320.7250.1667

BMJ 2000;320:1667 ( 17 June )

Letters

Treating children with sleep disorders

Children with breathing difficulties are being overlooked

Night waking is natural behaviour

Early intervention increases sleep times in young babies

Treatment of child sleeping problems and the quality of trials are important

Authors' reply

Children with breathing difficulties are being overlooked

The first 150 words of the full text of this article appear below.

EDITOR $---$ I was disappointed to see that once again children with sleep disorders are being lumped into a homogeneous group ofchildren with "behavioural" problems, then "studied" without usingpolysomnography. I think it's presumptuous and dangerous to thinkthat every child who has trouble sleeping has a behavioural problem.Few physicians are aware that breathing difficulty can cause nightwaking and bedtime resistance, and it is because of studies likethat of Ramchandani et al.¹

Doctors don't look for sleep disorders properly, don't know much about them, and are told repeatedly that behavioural treatmentsare the appropriate treatment. This is wrong unless we can guaranteethat the children have behavioural problems. A study looking atobese children using polysomnography diagnosed unsuspected obstructivesleep apnoea in 75% of the children studied $---$ meaning the physiciansexamining the children picked up only 1 in 4 cases. It thereforeseems a big leap of faith . . . [Full text of this article]

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A systematic review of treatments for settling problems and night waking in young children: Paul Ramchandani, Luci Wiggs, Vicky Webb, and Gregory Stores
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