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Keeping kids with grown-up diagnoses from falling through the cracks

SleepingKidOnce in a while, kids suffer grown-up medical problems such as multiple sclerosis, sleep apnea or stroke. None of these conditions are rare, but the fact that they hardly ever occur in children causes special frustrations and challenges for young patients, as a story in the current issue of Neurology Now describes. Doctors don't always think to look for these diagnoses in children, so they may mistake kids' symptoms for other childhood medical problems and treat them incorrectly.

That's especially true of children with sleep apnea, says Rafael Pelayo, MD, a sleep specialist with Lucile Packard Children's Hospital Stanford who is quoted in the story. Sleep apnea patients repeatedly stop breathing during sleep, making it hard for their brains to get enough oxygen. Kids with this condition are chronically overtired -- and they act that way, as he explains:

Diagnosis of sleep apnea in children is tricky because symptoms such as hyperactivity and inattentiveness can resemble those of attention deficit disorder (ADD), says Dr. Pelayo. Sleep apnea in children generally first appears between the ages of 3 and 6, the same ages when many ADD diagnoses are made. "It's estimated that as many as 25 percent of children diagnosed with ADD actually have sleep apnea," he says. "Sleep disruption should be considered before any kid gets labeled [with ADD]." In many cases, once the sleep apnea is treated, the behavioral problems disappear, he says.

The good news is that with the correct diagnosis, pediatric sleep apnea is usually not difficult to treat. Some children need surgery to remove large adenoids and tonsils, which can block breathing. Patients may also need to wear headgear at night to help their jaw grow correctly, and some children require continuous positive airway pressure while they sleep, a treatment often used for adults. But it's important for parents who notice loud snoring or frequent gaps in their child's sleep breathing to get the issue investigated so that kids don't miss out on needed treatments. "The misperception is that the problem will go away on its own," Pelayo says.

For children with other neurologic conditions seen in adults, it can be more difficult to get the right treatment, since drugs and other therapies may never have been tested in kids, and it can be hard to find doctors with the right combination of expertise. As Deborah Hertz of the National Multiple Sclerosis Society puts it in the story, "Pediatric neurologists don't always know how to treat MS, and adult neurologists don't always know how to treat children."

Previously: Memory of everyday events may be compromised by sleep apnea, Exploring the mystery of multiple sclerosis in the Pacific Northwest and Sleep, baby, sleep: Infants' sleep difficulties could signal future problems
Photo by Cathy Stanley-Erickson

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