sleep, restless movements in

Restless movements in a child's sleep are often of great concern to parents, but only rarely signify a significant problem.

Infants in the first 6 months of life may exhibit jerking movements in sleep, which involve the entire body, trunk or limbs. They occur only in sleep - awakening the child stops the movements. This is termed benign sleep myoclonus of infancy. There is no treatment, and the movements fade away after the first few months of life. Rocking may initiate the movements, which certainly startles the mother. An important note: because jerking movements in infancy, especially of the trunk, could be a very serious type of epilepsy, parents should always discuss such movements with their child's physician immediately.

Rhythmic movements associated with sleep are common in young children; we leave it at that unless they are associated with disturbance of sleep or possible injury. Repetitive movements that disturb sleep or cause real or potential injury are termed rhythmic movement disorder. It involves rhythmic head banging, leg banging, or rocking back and forth during wakefulness or sleep in children before about age 6. Children with this condition usually can stop the behavior on request. Treatment is rarely necessary, but is possible with benzodiazepines or tricyclic antidepressants. The condition is almost always outgrown in the early years of childhood.

Most adults have experienced sleep starts (also called hypnic jerks). These are sudden brief jerks, mainly of the legs or arms, as one falls asleep. These jerks are classically associated with a feeling of falling, a sensory flash, or a hypnagogic dream (a very brief, vivid dream that occurs between wakefulness and sleep).

A fairly rare condition characterized by uncomfortable sensations described as "creeping" or "crawling" in the legs at sleep onset is termed restless legs syndrome. It involves repetitive movements of a group of leg muscles (the anterior tibialis). These sensations are relieved by moving the legs, hence the name. The majority of children with RLS also have kicking movements during sleep, termed periodic limb movement disorder. Both conditions interfere with normal sleep cycling, to the extent that the sleep disruption can lead to daytime sleepiness and attention deficit problems. Children suspected of having these conditions should be referred to a sleep study center for a sleep study (polysomnography) and definitive diagnosis.