The difficulty of children with some type of disorder in acquiring sleeping habits is directly related to learning, language and emotions. Helping a family to have healthy bedtime habits is to help with family harmony.

Sleep disorders are characterized by problems with sleeping and include difficulty falling asleep or staying asleep, falling asleep at inappropriate times, being too sleepy, or abnormal behaviors during sleep. In this article we will explain what are the main sleep disorders in childhood and what are the main recommendations to find a solution.

When we talk about sleep disorders it is because:

• Your child's sleep problems (mood disturbances, difficulty concentrating, drowsiness during the day, physical and mental fatigue, general state of tension and anxiety) significantly affect their daily life.
• The sleep problem is affecting the relationship between parents and children; the relationship of the entire family or their social and school relationships.

The most important thing is to recognize that there is a sleep disorder that is affecting your child so that you can begin to resolve it as soon as possible. For this reason, if in doubt you should notify the pediatrician. This article is not intended to replace a visit to your pediatrician.

There are many types of sleep disorders that can affect childhood and adolescence. To provide all the information available, we have divided them into three categories:

1. The child who has trouble falling asleep
2. The boy who does strange things at night
3. The child who falls asleep during the day

1. The child who has trouble falling asleep

Insomnia

Insomnia is characterized by difficulty starting and maintaining sleep, or the feeling of not having slept well and that this lasts for at least a month in a row. Insomnia disorder is one of the most common problems in children and normally, with the help of health professionals and their support, it can be treated and resolved.

• Behavioral insomnia: it is the child's inability to fall asleep if he or she is alone, presenting resistance and anxiety when going to bed. He wakes up very often.
• Insomnia due to inadequate sleep hygiene: it is associated with activities carried out during the day that prevent adequate quality of sleep at night (consumption of chocolate or caffeine; intense physical activity or use of computers, consoles or mobile phones) .

to. Restless legs syndrome:

This syndrome is characterized by the urgent need to move the legs in situations of rest , a fact that appears in many cases associated with an unpleasant sensation. It is a disorder that has a great impact on the child's quality of life and can cause insomnia and fatigue during the day . It is a disorder for which the causes are unknown, although it seems that there is a family predisposition. It is essential to offer these children support when they are at school, since many of them worsen in the morning due to the obligation to sit in class, without moving.

b. Phase delay syndrome:

This syndrome is an alteration in the sleep rhythm that begins to manifest, normally, from the age of 10; It is characterized by insomnia at bedtime and difficulty waking up in the morning at the right time, which leads to drowsiness during the day. The child may show daytime fatigue, poor school performance and/or decreased attention.

2. The child who does "strange things" at night

to. Obstructive sleep apnea-hypopnea syndrome:

This is a breathing disorder that occurs during sleep and is characterized by the presence of repeated episodes of complete or partial obstruction of the upper airways because the soft tissues of the throat collapse and close during the sleep period. Some anatomical alterations such as large tonsils or cranial malformation, neurological diseases and suffering from obesity or gastroesophageal reflux facilitate this syndrome.

Frequent hoarseness , problems breathing at night, drowsiness during the day or difficulty paying attention could make us doubt this syndrome. Treatment usually involves removing the child's tonsils or adenoids or sleeping with a mask so they can breathe comfortably.

b. Somnambulism

Sleepwalking is a very common sleep disorder in school-age children. It is usually benign and resolves with age without the need for treatment. The child does not respond to external stimuli and does not remember anything.

c. Night terrors

Night terrors are a type of sleep disorder that resembles a nightmare , although much more spectacular. The child, while sleeping, sits up abruptly in bed screaming and crying, upset and agitated. As in sleepwalking, the child does not respond to external stimuli and does not remember anything.

d. Nightmares

Nightmares are long, elaborate, complex sleep states, with a progressive increase in the feeling of fear or anxiety. The child wakes up very scared and totally alert. He describes in detail that the dream he had was very distressing and terrifying. Often the child believes that what he has dreamed has really happened. Parents cannot prevent nightmares but they can help them sleep more relaxed, and consequently this helps minimize nightmares.

and. Rhythmic movements related to sleep

They are repetitive movements that affect certain parts of the body such as the head, trunk, extremities or the entire body, which happen when the child is falling asleep. They begin when the child is not yet a year old and disappear as the child gets older.

3. The child who falls asleep during the day

to. Narcolepsy

Narcolepsy is a very rare disorder in childhood and usually establishes itself during adolescence and youth. It is characterized by daytime drowsiness, loss of muscle tone triggered by an emotion, maintaining lived experiences as real, and suffering a feeling of immobility.

This is a chronic disorder and requires treatment with which the child can lead a practically normal life. The role of parents at this stage is especially important in establishing sleep hygiene habits.

General recommendations to try to avoid any type of sleep disorder

The main tips to follow to facilitate correct sleep development in children are detailed below, by age group. For more general advice , watch this video by Dr. Òscar Sans, coordinator of the Pediatric Sleep Unit at the Sant Joan de Déu Hospital , the first pediatric unit accredited by the Spanish Sleep Society.

to. Children under 2 months

• It is very important that the baby is awake when he eats, so he will begin to associate food with the day before.
• After each feeding, keep the baby awake in your arms for a while to eliminate gas, very important!
• After changing diapers, leave the baby awake in the crib so he can learn to fall asleep on his own.
• Try to develop a routine before bed: bath – massage – dinner – lullaby or story – sleep. There are aromatherapy tricks to set the rhythms of the day, a cologne in the morning and other

b. Between 2 and 5 months

• Always do the same thing at bedtime.
• Do not wake the baby at night to feed him.

Between 5 and 12 months

• During this period the baby no longer has to eat at night but each child is unique. If he wakes up, you should calm him down with caresses and affectionate phrases and try beforehand to get him to sleep without eating.
• You can give him a transitional object: a doll, a stuffed animal... something to keep him company.
• You should continue with the bedtime routine and let him fall asleep on his own. Leave him in the crib just before he is going to fall asleep.

From 12 months

• The environment should be calm, dark and the temperature pleasant.
• Going to bed should be approximately the same as waking up time.
• Excess fluids cause you to wake up at night.
• Avoid intense physical activity 1-2 hours before bedtime.
• Avoid giving chocolate and/or caffeinated soft drinks.
• Don't let him take too long naps.

From 2 years old

• If the child protests or cries during the night, we reflect on what happened during the day but above all do not shout, reassure him and continue with the routine.
• Prevent him from going to sleep hungry but don't let him drink too much fluids that will make him wake up to pee.

Between 2 and 5 years

• They only have to take a nap as a complement to night sleep and on many occasions sleeping calls for more sleep. A daily rest at an early hour in the afternoon is highly recommended to reach the night with serenity and face the night with peace of mind.
• Be very careful, at these ages, not to enhance anguish or fears.
• Avoid giving exciting foods and drinks.
• Limit intense physical activity 1 – 2 hours before bedtime.
• Never associate food or sleep with a punishment or threat.

adolescent stage

• It is important to have information about the changes in adolescence: you will need to learn to recognize the signs of lack of sleep: irritability, difficulty waking up, catching up on sleep on weekends.
• Avoid using cell phones, computers, tablets... before going to sleep.
• The dialogue about sleep and its influence on health is essential.
• Parents need to set examples with good sleep habits.

Remember that if you have any questions you should visit the pediatrician. Most sleep disorders are common and have treatment. Access to reference sources:

Sleep disorders in childhood . Spanish Pediatric Association. [Consultation date: 03/18/2015]

Child and youth mental health issues. The son of the children . Orienta Foundation. [Consultation date: 03/16/2015]

Learning to know and manage sleep problems in childhood and adolescence. Health Guide. [Consultation date: 03/16/2015]

Cristina Oroz Bajo