February Week 4 (by Dr Bidadi)
Snoopy is a two months old boy and the parents are concerned the baby sleeps too much. He sleeps about 12 hours a night and has 1-2 naps lasting 30 minutes to 2 hours during the day. The mother notes the patient only falls asleep in her arms and cries several times at night for long periods of time when he wakes up. When he awakes at night in the crib, he is only consoled when the mother comes and holds him so he can fall back asleep
1. What is the normal amount a newborn, and infant sleeps during the day and at night?
2. At what age are babies able to distinguish between day and night?
3. By what age is there no need for night time feeding?
4. What common sleep disorder in infancy does Snoopy have? What should you do in subsequent arousals to help the baby go back to sleep? What can be done in the first few months to help increase the chances a baby develops self soothing techniques to fall asleep?
Linus is a 3 year old boy who wakes up frequently at night recounting a bad Freddy Kreuger dream. He has a clear memory of the dream, and it’s usually later on in the night that it happens. He requires his parents for comfort. His sister Lucy has times at night where she screams in her sleep for periods at a time. During these episodes she appears awake, and when the parents try to console her, it doesn’t help and can prolong the episode. When Lucy wakes up, she does not remember what happened. These episodes usually happen in the first 1/3 of the night.
1. What sleep disorders do Linus and Lucy have? What stage of sleep is being effected with Linus and Lucy?
2. What kind of treatment does Linus need?
3. What kind of treatment does Lucy need? Are there medicines available to help Lucy if behavioral management is ineffective?
Peppermint Patty is brought into the office by her parents because of multiple episodes of snoring, witnessed apnea at night as well. She is not doing well in school and has increased daytime sleepiness. She has unusual sleeping positions and mouth breathing as well. Exam is significant for moderately increased tonsillar size.
1. what sleep disorder could Peppermint patty have? What percent of the pediatric population are affected by it?
2. who should you consider referring this patient to? What medicine could you try in this patient with large tonsils and sleeping disturbance to see if there is improvement?
3. What sequelae could this have that can affect growth and development?
4. what kinds of children are at risk for this sleep disorder?
Woodstock is a 14 year old adolescent who is having a lot of trouble in school. His parents bring him in to the office saying they are upset because he is being a “typical teenager” and refusing to fall asleep until 4 AM so has difficulty waking up. He is often late for school and his grades are dropping. He falls asleep frequently In school. on holidays and weekends, he is fine because he sleeps at 4 am but wakes up at 2 PM and feels well rested.
1. What common adolescent sleep disorder does Woodstock have and what is it characterized by?
2. What treatment could be done to help him regain a sleep schedule suitable for school?