Working with pediatrics takes special skill and a lot of studying to keep up on the latest issues. To help providers, Home Health Products takes a look at the latest sleep disorders effecting children and offers some tips for addressing mobility needs, including choosing appropriate toys.
Three separate studies in the Sept. 1 issue of the journal SLEEP link sleep-related breathing and movement disorders in children to attention-deficit and behavioral problems as well as neurobehavioral deficits, that all affect a child’s memory, performance, functioning and ability to socialize.
Link between childhood sleep-disordered breathing and neurobehavioral deficit:
A study into sleep-disordered breathing (SDB), conducted by Dean W. Beebe, Ph.D., of the University of Cincinnati, evaluated and synthesized the findings of 61 studies of the relationship between childhood SDB and neurobehavioral functioning. Strong evidence indicates that childhood SDB is associated with deficits in behavior and emotion regulation, scholastic performance, sustained attention, selective attention and alertness. There is also evidence that SDB has minimal association with a child’s typical mood, expressive language skills, visual perception and working memory.
SDB is a group of disorders characterized by abnormalities of pauses in breathing or the quantity of ventilation during sleep. Obstructive sleep apnea (OSA) is the most common such disorder. OSA, although more common in men and women of any age, may be diagnosed in children with large tonsils.
Snoring, a symptom of increased upper airway resistance during sleep, is another form of sleep-disordered breathing. Studies have shown that 10 to 12 percent of children snore.
Periodic leg movements, which can impact a young person’s mental capabilities, occur more often during the daytime.
Periodic leg movements, experienced by persons of all ages, reach the level of a disorder, periodic limb movement disorder, which may be a factor in causing a person to have depression, bad memory, short attention span or fatigue.
Marie-Héléne Pennestri, B.Sc., and colleagues of the Sleep Disorders Center, Hôpital du Sacré-Cur, studied 67 healthy subjects between the ages of 5 and 76. They discovered that periodic limb movements during wakefulness was higher in subjects younger than the age of 40, including children, while periodic limb movements during sleep more often occurs in those older than 40.
Periodic limb movements occurs when a person experiences episodes of simple, repetitive muscle movements and is unable to control them. The movements do not involve a change in body position, stretching a muscle or a cramp, but instead tend to involve the tightening or flexing of a muscle. Movements occur most often in the lower legs and can occur while a person is asleep or awake. An episode will normally last from a few minutes to an hour. Within that time, movements tend to occur every 20 to 40 seconds.
Those whose sleep is severely disrupted by this condition can be very tired the following day, while those who experience it during waking hours are often disrupted in their daily life.
Children with bruxism experience more attention behavior problems:
Bruxism, a condition common among children, can affect a child’s ability to sleep and, consequently, have an adverse effect on his or her attention and behavior patterns.
A study on children with bruxism was conducted by Marcela Herrera, DMD, of Drexel University in Philadelphia. The study focused on 10 children, each of whom completed a dental evaluation, a nighttime polysomnogram and cognitive behavioral tests. The results showed that eight of 10 children had clinically significant bruxism and the two remaining patients had recent tooth damage. Sixty-six percent of the bruxism group experienced disturbed sleep, out of which 40 percent had significant attention and behavior problems.
A child should undergo early screening for bruxism by a pediatrician, noted Herrera.
“Although a polysomnographic evaluation may not be essential for the evaluation of most children with sleep bruxism, it is important to screen children for bruxism in the general pediatric office because these children appear to be at higher risk for having somatic complaints or problems, as well as behavior and attention problems,” the authors wrote.
Bruxism is the grinding or clenching of teeth during sleep. It is common for the jaw to contract during sleep. When these contractions are too strong, they produce the sound of teeth grinding, which can cause dental damage by wearing the teeth down. In most severe cases, hundreds of events can occur during the night. In milder cases, the grinding may vary from night to night.
The rate of bruxism seems to be highest in children. About 14 percent to 17 percent of children have it and the disorder can begin as soon as a child’s upper and lower teeth have come through the gums. Around one third of children with bruxism will still have it when they are adults. About 8 percent of young to middle-aged adults have bruxism; the rate continues to decrease with age.
Parents of children with a sleep disorder should consult with the child’s pediatrician, who will determine whether a visit to a sleep specialist is necessary.
SLEEP is the official journal of the Associated Professional Sleep Societies LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.
www.Sleepeducation.com, a Web site maintained by the AASM, provides information about the various sleep disorders that exist, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep centers.
Pediatric Mobility Tips:
Home Health Products went straight to the source and asked HME providers to provide some tips for meeting the mobility needs of pediatric clients. Here’s what they had to say:
- “When working with peds, you need to understand the diagnosis and the growth rate of the disease and especially the child. This determines how to construct the chair. It tells you how much growth or what kind of equipment or accessories you need to add to the chair.” —Joseph Nassef, RTS, Golden Valley Medical, San Bernardino, Calif.
- “My one source for the anatomy and how it responds … is from Missy Ball, a therapist and scientist, whom I met through Freedom Designs. The most help I have had with equipment over the years has also been Freedom Designs. They have been there for me under all circumstances.” —Joseph Nassef, RTS, Golden Valley Medical, San Bernardino, Calif.
- “I grow my business only with what allows me the time to service my clients the best. My increase in business has been through referrals. There is only so much time in the day to do things the best you can. Overextending yourself can only cause errors.” —Joseph Nassef, RTS, Golden Valley Medical, San Bernardino, Calif.
- “Pediatrics is not difficult, it just takes common sense, asking questions and being there for anyone in time of need. Increasing business comes with being supportive and not overdoing anything you try.” —Joseph Nassef, RTS, Golden Valley Medical, San Bernardino, Calif.
- “I think that one of the biggest things is having a basic knowledge of the disease states and the typical characteristics that that disease state is going to manifest, and then probably just addressing the growth factor.” —Randy Harrington, Price Rite Medical Equipment, Bozeman, MT
- “I try to take into account the caregivers, the parents as far as the ease of taking equipment apart and putting it back together for transportation, the ease of positioning the child. The more things you put on (the chair) and the more cumbersome it is, I think the less chances that the child will be positioned correctly. I like to definitely take into account the parents as far as transporting the chair and the growth factor so we?re not getting something new in another six months.” —Randy Harrington, Price Rite Medical Equipment, Bozeman, MT
- “Every time I get a diagnosis that I?m unfamiliar with, I immediately go to Internet and just try to find a whole page.” —Randy Harrington, Price Rite Medical Equipment, Bozeman, MT
- “I just try to give a little in-service and make sure everybody feels comfortable, and make sure they feel comfortable calling with questions.” —Randy Harrington, Price Rite Medical Equipment, Bozeman, MT
- “I think Medtrade and the International Seating Symposium are a must. I think you have to go to those things whether you like to or not because there?s so much stuff coming out that you?ve got to stay up on it. And also, you?ve got to stay up on the billing. I?d say one of the biggest things is billing.” —Randy Harrington, Price Rite Medical Equipment, Bozeman, MT
For more information on pediatrics and pediatric products, read “The Building Blocks of Pediatrics” in the October issue of Home Health Products.
Toys ‘R’ Us Offers Annual Guide of Toy Recommendations for Children with Special Needs:
WAYNE, N.J. — For more than a decade, Toys “R” Us has released its Toy Guide for Differently-Abled Kids, an easy-to-use toy selection guide for parents and friends of children with disabilities.
The 2006 edition is now available for free in all Toys “R” Us, U.S. retail locations and online at http://toysrus.com/differentlyabled.
Since its inception in 1994, thousands of parents, relatives, friends and professionals have relied on the guide to help them determine which toys are suitable for a child’s particular abilities.
“As the toy authority, Toys ‘R’ Us understands that parents and friends of differently-abled children have unique criteria when assessing their toy-buying needs,” said Jerry Storch, chairman and CEO, Toys “R” Us Inc. “Through the Toy Guide for Differently-Abled Kids, we’re determined to help our customers find everyday toys at affordable prices that will spark imagination and build critical skills for the child in their life.”
The guide was developed by Toys “R” Us in partnership with the National Lekotek Center, an independent, non-profit organization dedicated to making the world accessible to children of all ages and abilities. Over the past decade, the Toys “R” Us Children’s Fund has supported Lekotek with grants totaling more than $275,000. In addition, the United Parents Syndicate on Disabilities assists in distributing the guide to families across the country.
There are approximately 6 million special needs children in the United States today. “The right toy can have a dynamic impact for a differently-abled child,” explained Diana Nielander, executive director of Lekotek, “because play provides these kids with essential confidence-building and learning opportunities.”
Approximately 200 toys were evaluated using focus groups and other criteria. This year, more than 80 made the cut. Symbols are assigned to each toy so parents can easily find the right fit for their child, and all toys on the list are tagged with two or more symbols. The guide also offers Lekotek’s popular “Top 10 Tips for Buying Toys” for differently-abled kids.
Some picks this year include Baby Counting Pal™ by Leapfrog, which helps promote auditory skills; Candy Land® Deluxe by Milton Bradley, which helps promote language development; Classic Tinkertoy® Construction Set by Hasbro, which challenges kids to think; and Dora’s Talking Kitchen™ by Fisher-Price, which helps promote social skills.