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Children's insomnia becomes a source of problems for all family members. A child experiencing a shortage of sleep and rest is not able to fully develop. Its nervous system is exposed to high loads, the emotional background is broken, permanent whims and sleepless nights do not allow to relax homemade. Most often, negative manifestations become the result of non-compliance with the toddler's day, developing certain bad habits. With the right approach to sleep disorders, such origin in children can be quickly getting rid of serious consequences and without the help of doctors. In rare cases, insomnia becomes a manifestation of congenital or acquired pathology, for example, brain disease.

In case of disabilities, the child is not able to fully develop.

Types and causes of sleep disorders

Neurologists and pediatricians distinguish at least hundreds of insomnia development scenarios in childhood. Basic status classification shares all these options into four main groups. Pathology is manifested by problems with falling asleep or awakening, a collection of biorhythms, the emergence of Parassian (Enurrez, nightmares, Lunatism and the other).

A separate group includes a night apnea - a sudden stop of breathing.

Frequent causes of sleep breakdown in childhood:

• emotional bursts - insomnia are able to provoke not only negative, but also positive emotions;
• increased sensitivity is not the pathology of the nervous system, and its peculiarity, which should be taken into account when organizing the conditions of children's stay;
• violation of the day or its absence - night sleep is acquired, and not congenital need, so it must be properly worked out;
• non-compliance with power rules - overeating during dinner or departure to bed with empty stomach;
• physiological discomfort - cutting teeth, problems with digestion, general inconvenience against the background of rapid growth;
• physical discomfort - sleep disorder arises against the background of heat, cold, increased dry dryness, uncomfortable bedding or sleeping clothes;
• neurological pathologies, somatic diseases.

You can not go to sleep on an empty stomach.

Treating any sleep disorders in children begins with identifying and eliminating the cause of the problem. Takes of traditional medicine and techniques of physiotherapy act as auxiliary means. Medicase products are started in the most extreme cases.

Manifestations of sleep disorders in children

Wake-up at night is not the only sign of sleep breaking in a child.

Depending on the severity of the problem and features of the situation, the clinical picture can take a different look.

Common symptoms of sleep disorders at childhood:

• night awakening - in the period from 4 months to year are considered the norm, most often arise against the background of parents attempts to abandon long-term lulling;
• fears are characteristic of sensitive and capricious boys under 6 years. Awakening does not occur, the baby is in the dawn, crying, can sit on the bed. It is impossible to wake it up, it is difficult to calm down, he does not remember anything in the morning. The manifestation occurs against the background of overexcitation of the nervous system, usually passes with age alone;
• lunaticism is walking and performing targeted actions with open eyes, but with a disconnected consciousness;
• conversations in a dream - usually these are individual words or short unintelligent proposals that sleep in the morning can not even associate with what he has dreamed;
• anxious dreams and nightmares - in contrast to fears, after waking, the patient can recall the content of dreams. If the phenomenon is repeated more often than once a week, a consultation of a psychotherapist is necessary, otherwise the child is afraid of the child will arise with falling asleep;
• bruxism - grincling with teeth is usually noted in adolescents, its reasons are not clarified;
• shuddered - more often registered in infants, indicate the instability of the mental sphere, violations in the work of the nervous system;
• enurrez - the problem of children from 6 to 12 years old, which may indicate a delay in mental development, problems in the work of the allocation bodies, stress;
• apnea - with a rare occurrence is considered an option for the norm, but the basic breathing of the sleeping must be clean and measured. Frequent respiratory stops require an estimate of the neurologist, a Laura or pediatrician.

The problem can provoke apnea.

All listed moments reduce the quality of night sleep, therefore represent a potential hazard to children's health. Separately allocate a number of moments that may indicate a high risk of developing serious pathologies in the future.

What you need to pay special attention

Minor sleep disturbances or rare flood problems are found in 90% of children. In most cases, there is enough correction of the regime, relaxation sessions, changes in the principles of nutrition. It is necessary to immediately turn to the doctor if the clinical picture is exacerbated by differentials or a sharp change in the patient's mood, retained longer than 3 weeks, is complemented by enuresum or apnea.

It is better to obtain a doctor's advice, when violations have the form of nightmares, Lunatism, speaking in a dream. Such phenomena may indicate epilepsy, mental pathologies, diseases of internal organs, brain damage. According to statistics, such people at a later age, Alzheimer's disease develops more often than the rest.

Diagnosis and treatment

In situations, when not to visit the doctor, it is advised, first it is recommended to go to the pediatrician. It will establish the reason for the night awakens of the baby and other forms of sleep violation or send to the profile doctor. In the case of physiological origin, the problem is carried out by the necessary therapy. This may be the admission of soft sedatives, the treatment of adenoids or the curvature of the nasal partition, the fight against melting invasions or digestions of the gastrointestinal tract. Often the basic approach is complemented by vitaminotherapy, sessions of therapeutic physical education. Sometimes there is a need to visit a children's psychologist or psychotherapist.

Sleep disorders in childhood should not be ignored. If the problem appeared, then it will not disappear in itself. Even with transient symptoms, a small patient needs help and a special approach.

I.V. Bagramyan, Moscow

The path of grieving is quite a thorny. For the child, the first school of life is his family that represents the whole world. In the family, the child learns to love, tolerate, rejoice, sympathize with many other important feelings. In the conditions of the family, the emotional-moral experience inherent only to it: beliefs and ideals, evaluations and value orientations, attitude towards people and activities. Priority in the child's education, belongs to the family (M.I. Rosenova, 2011, 2015).

Sleep

It says a lot about how important it is to be able to let go, completing the old-senior. Otherwise, they say, the new will not come (the place is occupied), and there will be no energy. Why do we climb, reading such motivating articles on cleaning, but still everything remains in their places? We find thousands of reasons to postpone postponed to emissions. Or do not start the dissemination of the bumps and storage rooms. And already habitually scold himself: "stumbled at all, you need to take yourself in hand."
To be able to easily and confidently throw away unnecessary things - becomes a mandatory program "Good Mistress". And often - the source of another neurosis for those who for some reason cannot do this. After all, the less we do "as needed" - and the better you can hear themselves, the happier we live. And the more correct it is for us. So let's figure it out if you need to be broken personally.

Art of communication with parents

Parents often love to teach their children, even when they become already quite adults. They interfere with their personal life advise, condemn ... It comes to the point that children do not want to see their parents, because they are tired of their morals.

What to do?

Making disadvantages. Children should understand that parents can not be transported, they will not change, no matter how you wanted it. When you reconcile with their shortcomings, you will be easier to communicate with them. You just stop waiting for a different relationship than it was before.

How to prevent

When people create a family, no one, with a rare exception, and does not think about raising relationships on the side. And yet, according to statistics, the family most often disintegrate precisely because of the change. Approximately half of men and women change their partners as part of a legal relationship. In a word, the number of faithful and incorrect people is distributed 50 to 50.

Before talking, how to protect your marriage from change, it is important to understand

Catad_TEMA Sleep Disorders - Articles

Sleep disorders at childhood: causes and modern therapy

Sleep problems, unfortunately, are observed not only in adults, but also in children. Meanwhile, sleep condition is particularly important for a developing children's body. At this time, energy recovery processes, growth, important hormones are produced, immune protection factors are generated. The article presents the most common forms of sleep disorders, the principles of their diagnosis and treatment.

Sleep disorders are distributed in a children's population at least in adult - according to one of the surveys, 25% of children aged 1 to 5 years have problems with sleep. However, pediatrician doctors, children's neurologists and psychiatrists are much worse than doctors working with adults, familiar with sleep disorders in children and less often put appropriate diagnoses. Moreover, this problem is relevant for both domestic and foreign medicine. So, according to R.D. Chervin et al. (2001), out of 103 cases of confirmed sleep disorders, a complaint against a bad dream appeared in the history of the disease in 16% of cases and only in 10% of cases the correct diagnosis was made.

Sleep functions are diverse, the most famous of them are related to the restoration of the physical condition of the body, growth processes, cognitive processes, mental protection functions. Insufficient provision of these fundamental needs in childhood is fraught with lagging in development, raising the risk of developing behavior in the future, family problems for adults.

In pediatric practice there are sleep disorders from all six categories mentioned in the international classification of sleep disorders 2005: Insomney, respiratory disorders in a dream, hypersimene, parassion, movement disorders in a dream and cycle disorders "Sleep - wake."

Insnya
The most common and relevant problem is insomnia. Insomney, according to the international classification, is a clinical syndrome characterized by the presence of the difficulties of initiating, maintaining sleeping or early morning awakening, a feeling of non-establishment or poor-quality sleep. At the same time, the condition of the presence of sufficient time and conditions for sleep (i.e., a voluntary chronic restriction of sleep time is not included in this category), as well as to induce one or more manifestations during wakefulness: a feeling of fatigue or faintness; violation of attention, concentration or memory; Social or household dysfunction or school failure; mood disorder or irritability; Day drowsiness; Reducing motivation, initiative or energetic; the tendency to make mistakes at work or during the management of the vehicle; Sensation of tension, headaches, gastrointestinal disorders; Concerns about his sleep. In children, the most frequent symptoms accompanying sleep disorders are day-first hyperactivity, violation of attention and emotional lability, which can be regarded as a manifestation of somatic pathology (in younger children) or attention deficit syndrome with hyperactivity from older.

In pediatric practice, two forms of insomnia are most common: behavioral inxia of children's age and insomnia, due to impaired hygiene of sleep.

One of the drugs, the effectiveness of which in relation to the influence of sleep during the behavioral insomnia of children's age was properly proved, is Alimhazin (Teraulizhen).

Behavioral inxia of children's age is defined as sleep disorders associated with a certain form of behavior of children and parents in the period preceding sleep or allotted for sleep. Depending on the mechanism, once the development is allocated two forms of behavioral insomnia.

Behavioral insomnia According to the type of violation of fallback associations is characterized by the dependence of falling asleep on the presence of certain conditions - the indication of the hands, feeding, the presence of parents in close proximity. The most characteristic manifestation of this type of behavioral insomnia is frequent night awakening with the requirement of the approach of parents and ensure the conditions in which the child is used to fall asleep. Parents account for, for example, 5-10 times overnight approach the child, remove it from the bed and rock on the hands or offer a bottle with drink. When providing the usual fallup association, the child quickly calms down and falls asleep. Most often, the violation of fallback associations are found in children of the 2nd half of the life (at 25-30% of the population of the chest). The probability of developing this type of behavioral insomnia is largely determined by socioeconomic and cultural factors. Recognized risk factors include: joint sleep, breastfeeding, age period from 9 to 12 months; Passage of certain stages of development, both motor (crawling, stacking) and mental (separation alarm). Events temporarily breaking sleep, such as colic, infectious diseases, post-specific responses, change modes, can also provoke the establishment of harmful fallup associations as a reflection of parents attempts to help the child. The formation of sleep habits is also influenced by the child's temperament, parental anxiety and maternal depression. The consequences of behavioral insomnia by the type of violation of fallback associations for children is to increase the night wakeful time, reduced the total number of sleep. For parents, a child's sleep disorder is poured into an increase in the frequency of intra-family conflicts and depression in mothers. Behavioral insomnia According to the type of incorrect sleep installations is characterized by the presence of unreasonable conditions for laying, determined by parents, the result of which is the protest behavior of the child and an increase in the fallback time. The most frequent problem is the attempts of the child to stop parting with their parents with the help of the skills of manipulation of the needs ("I want to drink", "to the toilet") or the feelings of the parents ("I'm scared, sit with me"). In other cases, the child refuses to go to bed in a certain place (in his room), and wishes to sleep only in bed with parents. This state is distributed in children of the second and third year of life, reaching 10-30% of the population. Risk factors are considered: "free" style of education, with minimal limitations; conflicting styouts of parental education; Insufficient awareness of the parents about sleep hygiene rules; The aforementioned age period; "Hard" type of child temperament; the presence of opposition behavior during the daytime; Problems of sleep surroundings, for example, the difficulties of separating a separate room for sleeping a child; Chronotype of the child - the children of the "owls" are not inclined to humble with early lingering. The consequence of such behavior for children is to reduce the total sleep time, especially when required in the morning to get up on the set schedule, for example, to kindergarten. For parents, it becomes the reason for reducing the time of the evening rest, the participation of the alarming manifestations.

In the treatment of both types of behavioral insomnia of children's age, the main role is played by irritable techniques. First of all, you should pay attention to sleep hygiene. This applies to the time of laying, conditions for sleep and ritual of laying. It is recommended to stick to the same time of laying and lifting for the child, adjusting it as it grows. At the same time, first of all, the needs of the family should be taken into account, and not seemingly the tendency of the child to fall asleep at a particular time. Practice shows that children easily fit into any time of laying if parents show enough perseverance. The ritual of laying should be as possible, unchanged and contain a repeating, predictable sequence of actions. It must be short enough and positively configure the child with regard to laying. The last part of the ritual is recommended to be carried out in bed, in the presence of a parent. It is important to teach a child to the possibility of further care or parental waste with the formation of the ability of "complacency". By age, 1 year, usually 70% of children acquire such an ability and no longer require the presence of parents when falling asleep or at every night awakening.

To change the wrong associations of falling asleep and sleep installations, special forms of behavioral therapy are used. The most common technique for the first case is "Checking and Exposure", for the second - "gradual repayment". When using the "Check and Exposure" technique, the parent instructs the parent with a child during the laying of a certain time, laying sleeping in the bed, then leave the room or go to bed and within a certain time (more often 15-20 minutes) not approach Him and do not respond to the call. After this time, it should be approached, correct the bed and again return to yourself. During the night awakens, the child is not taken out of the bed, do not feed (if it is not required by age or medical testimony), they are also suitable for it only for a short time, and then show 15-20-minute "exposure". The "gradual repayment" method involves leaving the child in the bedroom to fall asleep one at a certain time, ignoring his protest and attempts to manipulate it. After a certain time, the parent returns, soothes the child, then leaves again, gradually the intervals of his absence are becoming more and more. Thus, it is gradually possible to reach agreement with the child in relation to the time of laying and teach to an independent population.

Medicinal preparations for behavioral inxias of children's age are used only for the time of changing sleep mode in order to reduce the severity of the child's protest behavior. For this purpose, homeopathic preparations, preparations of medicinal herbs (Valerian root, dyeing, peony), nootropic agents (aminophenyl-oil acid), non-selective histamine receptor blockers (diphenylhydramine, chloropiramine, promethazine) are used.

One of the drugs, the effectiveness of which in relation to the influence of sleep during the behavioral insomnia of children's age was properly proved, is an alimhazine (in Russia is produced under the trademark of Terauljngen). In 3 placebo-controlled studies of children aged 7 to 36 months, the use of alimemazine in doses of 30 to 90 mg per day was accompanied by reliable (P< 0,05) уменьшением выраженности нарушений сна по соответствующей шкале и уменьшением числа ночных пробуждений по сравнению с плацебо . Алимемазин является производным фенотиазина, близким к хлорпромазину. Основным свойством препарата является блокада D 2 -дофаминовых рецепторов, также он оказывает антигистаминное, серотонино- и адреналинолитическое действие. В малых и средних дозах обладает отчетливым противотревожным, успокаивающим эффектом, снижает возбудимость, раздражительность, аффективную напряженность. В России применение препарата у детей разрешено с возраста 7 лет.

Another form of insomnia, characteristic only for childhood, is an insomnia due to a breakdown of sleep hygiene. The prevalence of this violation in the children's population is 1-2%. Most often teenagers suffer. The most characteristic complaint is the difficulties of falling asleep in the evening. In addition, problems are noted with sleeping sleep (frequent awakening with subsequent fallback difficulties) and the difficulties of morning awakening on time (for example, to school). The reason for the development of sleep disorders in this case is a malfunction of sleep hygiene, including certain requirements for regime and conditions for ensuring a full sleep. Compliance with sleep mode involves laying and lifting at a certain time, providing sufficient sleep for this age (for adolescents it is 9 hours). An important aspect of sleep hygiene is to ensure sleep environment, comprising a comfortable temperature in the bedroom (from 18 to 25 ° C), low noise and light, comfortable bed and linen. The most common cause of sleep hygiene violations in adolescents is stimulating mental or physical activity before bedtime (cooking lessons, television programs, a game on a computer). Another factor that prevents SNA is the use of products with a stimulating effect (tea, cola, chocolate) and smoking. The key to the normalization of sleep in this form of insomnia is the establishment of a hard routine and control of the parents of compliance with the mentioned sleep hygiene rules. Use of drugs is usually not required.

Alimemazin is a derivative of phenothiazine close to chlorpromazine. The main property of the drug is the blockade D 2 refamine receptors, it also has antihistamine, serotonino and adrenalinolithic effect.

Children of senior school age appears another form of insomnia - psychophysiological insomnia. This disorder is characterized by the acquisition of disturbing the sleep of associations leading to the increase in the level of somatized voltage and prevent falling asleep. The child is tired in the evening, feeling drowsiness, however, as soon as he falls into bed, the dream "as a hand takes off." Having leaving so some time, the teenager goes to the toilet, goes to eat or drink or go to parents with complaints about that he could not sleep. Returning to bed, he discovers that there is no drowsiness, continues to worry about the fact that the next day, not to sleep, you will have to go to school, and in such a state there are still a few more dozen minutes or a few hours. This kind of insomnia is characteristic of children with increased anxiety, responsible attitude towards studying (more often it is girls).

In the treatment of psychophysiological insomnia, measures are used to normalize child sleep hygiene (it is primarily important to limit classes that increase the level of brain-activation and anxiety - computer games, watching movies, cooking lessons immediately before bedtime). The methods of behavioral therapy used in this case include a decrease in stimulation (not to use bed for classes, watching television, reading; go to bed when you feel drowsiness, but not before the set time, if you do not sleep - get up to work out any calmly Sleepiness will not appear, then go to bed), various forms of autoraxation: autotraining, positive visualization, deep slow breathing. Drugs are prescribed during the correction of sleep mode and the application of behavioral therapy techniques to facilitate the adaptation to the new regime. Short (2-3 weeks) Courses of tranquilizers (amino-phenylma acid, hydroxyzine), mixtures of sedative herbs (valerians, dyeing, chamomiles, hops) are prescribed. In the treatment of insomnia in children use the sedative and sleeping pills of "small neuroleptics". So, Alimemazin (Teraulidgen) is recommended to be used at a dose of 2.5-5 mg per night.

Paramyania
Paramyania is defined as unusual forms of behavior or perception arising due to sleep (PARA- (Greek) - about; Somnus (lat.) - Sleep). The most frequent paraceans in childhood are sitting, night fears and night enuresis.

Single (Somnambulism) is a series of episodes of comprehensive behavior arising during the phase of slow sleep and leading to the walk during sleep without aware of this. The severity of clinical manifestations varies from simple attachment in bed to the production of complex manipulations of the type of door locks or window constipation. Often, walking in a dream is combined with negotiation, while it is a non-communal, the responses of the nefple, however, quite coherent and relevant reports are possible (reporting Self-speaking). Children during singing episodes can make usual actions related to day games. A characteristic feature of the episode of the interchange is the lack of memories of the next. There is also no connection with the presence or content of dreams and such an episode.

The attack occurs usually during the first period of slow sleep, more often in one hour after falling asleep. On the polysomnogram there is an episode of EEG activation or a complete awakening, which occurs at the end of the 3rd or 4th stage of slow sleep. Sometimes activation is preceded by a flash of high-amplitude delta activity. EEG recording During the episode of interchange, children demonstrate signs of sleep patterns on the background of EEG-wake: diffuse rhythmic delta activity, diffuse actu-activity, mixed delta, theta, alpha and beta-activity. There may be an attack of sitting and in the 2nd stage of slow sleep. A sitting may happen several times during the night, but only one episode is usually. The beginning of the interception is usually accounted for by age 4-6 years. Peak falls from 8 to 12 years old, when up to 17% of children have such episodes. Then there is a rapid decrease in the frequency of the interchange, in adults, the maximum prevalence of this form of parassian is 4%. A significant family predisposition is noted. Research in Gemini has shown that at least 50% of cases of this form of parassion have a genetic nature. The probability of establishment in the child, if he was not in childhood, no one of his parents is 22%, one of the parents - 45%, in both parents - 60%. The factors contributing to the manifestation of such a preposition in children are considered: an insufficient amount of sleep; irregular mode; The presence of breathing disorders in the dream and periodic movements of the limbs in a dream; fever; reception of drugs that increase the amount of slow sleep (lithium), or the abolition of drugs that reduce its number (benzodiazepines, tricyclic antidepressants); consumption before sleeping caffean-containing products; Sleep with a complete bladder; noise and light; Stress and anxiety.

With rare attacks of interchange, active treatment is not carried out. Attention should be paid to compliance with the rules of sleep hygiene (sleep mode, sleep environment, remove provoking factors) and ensure a safe environment in the bedroom in order to if the child is walking in a dream, he could not fall or hurt. If an attack occurs, it is not recommended to wake a child, it is enough to control his behavior, gently take it back and put in bed. It is not recommended to discuss what happened in the morning, as it is in the ignorance of a relatively happening attack. The form of behavioral therapy of the interchange includes the tactics of "scheduled awakening". At the same time, the child will be for a short time 15-30 minutes before the alleged start of the episode for 2-4 weeks. With frequent and / or intense attacks of interchange, use coursework (1-2 weeks) by benzodiazepine sleeping drugs, which reduce the amount of deep slow sleep (clonazepams or nitrazempam). With the ineffectiveness of these drugs, the use of tricyclic antidepressants (amitriptyline, imipramine) is possible.

Night fears are sudden awakening from a slow sleep with a piercing screaming or crying, accompanied by vegetative and behavioral manifestations of strong fear. As in the case of interchange, the episodes of night fears occur more often at the end of the first episode of slow sleep, about an hour after falling asleep. During an attack, the child usually sits down in bed, shouts loudly, trembled or strains muscles, looks frightened and excited, does not respond to the attempts of parents to calm and often resist them. The duration of the attack ranges from 5 to 15 minutes, after which the child calms down and falls asleep. The next morning, as well as during the interchange, the memories of the occurred at night are absent. At the EEG during an attack, a pattern of wakefulness with multiple artifacts of movements is recorded. The beginning of night fears is celebrated from the age of 4, after 12 years the frequency is significantly reduced. The prevalence of this form of paramy is from 1 to 6% of the children's population. As with the situation, a genetic preposition is a major role in the development of night fears. Factors provoking attacks are the same as for sitting.

In the treatment of night fears, the same approaches are used as in the treatment of the situation: the organization of the sleep mode and the safe surroundings of sleep, the exclusion of provoking attacks of factors, behavioral therapy "planned awakening". In terms of frequent episodes, benzodiazepine scenery or tricyclic antidepressants are used.

It should be emphasized the fundamental differences between nightmares and nightmares (nightmarish dreams). In the episodes of night fears, an incomplete awakening occurs, which is not realized by the child, respectively, he cannot tell about the incident next morning, in addition, there is no connection between the attack with any dreams. Nightmares are unpleasant dreams, often threatening character, which arise from fast sleep, are often well remembered, and the next morning you can get a fairly complete report. An important is the differential diagnosis of interchange and night fears with comprehensive psychomotor seizures in epilepsy. To do this, the EEG is recommended, best during night sleep, in the framework of polysomnography or night video monitoring EEG.

Night Enuresis is frequent (at least 2 times a week) episodes of involuntary urination, which happens during the child's sleep from the age of 5 years. Initially called night enuresis, having a place constantly, without "dry periods", secondary - enuresis, resumed after the "dry period" duration of at least 6 months. Recently, it is customary to divide the enuresis on monosimptomic, including the episodes of night incontinence of urine without associated gastrointestinal or urogenital problems, and not monosimptomic, associated with such daily symptoms as imperative urge, day incontinence, change the frequency of urination, chronic constipation or enchnoze. Despite the fact that the night enuresis does not bear a significant danger to the health of the child and first is ignored by them, in the future the presence of Enurraw can lead to serious problems of socialization and education. Unlike the previously discovered opinion on the connection of the episodes of Enurraw with an excessive deep sleep, polysomnographic studies revealed that the episodes of involuntary urination may occur in any stage of sleep and even during night awakening.

The prevalence of night enuresis in the children's population is 10% aged 6 years, 7% of the age of 7 and 5% - in ten-year. Each year, 15% of children are explicitly cured. The prevalence of secondary enuresis is estimated at 25% of all cases of night enuresis.

The reasons for the development of primary enures are seen in violation of the reaction of the awakening of the child on the sensation of a filled bladder or in the impossibility of preventing the detrussion cuts during sleep. This skill is formed with age, so under 5 years the diagnosis of night enuresis as a form of pathology is not put. Violate the formation of this skill The following factors: Psychomotor Development Delay; an increase in the wake-up threshold; heredity (it is shown that the probability of the presence of night enuresis is 44%, if in childhood one of the parents was made such a diagnosis, if both of the value increases to 74%); the presence of mental or neurodegenerative diseases (attention deficit syndrome with hyperactivity); reducing the functional volume of the bladder; Reducing antidiuretic hormone products during sleep.

Among the factors contributing to the development of secondary night enuresis, there are violation of the ability to concentrate urine in diabetes, sickle-cell anemia; Increased urine products when taking caffeine or diuretics; the pathology of the urinary tract - infection, neurogenic bladder, developmental abnormalities; constipation and enchnozer; neurological pathology, including night epileptic seizures; sleep disorders, such as obstructive sleep apnea, sitting; Psychosocial stresses, such as parents divorce.

Treatment of night enures usually do not begin until the age of 6-7 years. An important task of treatment is the active involvement of the child in this process. This is achieved by encouraging "dry days", participation in changing the wet bed. The methods of behavioral therapy are used, including the normalization of the fluid intake mode (not to drink before bedtime), the urine hold training in the afternoon, awakening to the beginning of the episode of Enurraw ("Looking"), including using auxiliary devices. These fixtures include a signaling system that is triggered during nursing panties (Enuresis Alarm). The efficiency of the use of the signal device reaches 40% (healing frequency) when applied for a sufficiently long period of time (up to 16 weeks). Imipramine in doses from 12.5 to 75 mg and desmopressin (synthetic analog of vasopressin) are actively used in the primary night enuresis.

In small and medium doses, Teraulidgen has a distinct antitle, soothing effect, reduces excitability, irritability, affective tension.

With secondary enuresis associated with a hyperactive bladder, effective cholinolics (cable chloride).

Breath disorders in a dream
Respiratory disorders in a dream in children are a serious problem both due to their prevalence (about 2% of the children's population) and in connection with the serious influence on the development of the child.

The primary apnea of \u200b\u200bbaby sleep apnea is characterized by the presence of multiple apnea and hypopoda of various nature (central, obstructive or mixed), accompanied by violation of physiological functions (hypoxhemia, bradycardia, the need for intensive care measures). The emergence of this form of respiratory disorders in a dream is connected either with the problems of development (ripening) stem, having fun (apnea premature), or with the presence of various kinds of medical problems that can influence the regulation of respiration (anemia, infection, metabolic disorders, gastroesophageal reflux, Use of drugs).

The prevalence of primary sleeping apnea is largely determined by post-oppression age. So, 25% of the prematurity weight of less than 2500 g had symptomatic apnea in the neonatal period. At the age of 37 weeks, the representation of this syndrome was estimated at 8%, and at the age of 40 weeks - only 2%. The course of primary sleep sleep apnea is usually benign - respiratory indicators in a dream reaches normal values \u200b\u200busually by 43 weeks of post-chase age. It is believed that children with primary sleep apnea have significantly increased the risk of developing obvious life-degrading events, when there is a need for intensive care. Previously, the primary sleep apnea was viewed as an independent factor in the development of the syndrome of the sudden death of infants, but the latest research was not confirmed by this association.

The diagnosis of primary sleep apnea syndrome is raised based on the results of an objective study (polysomnography or cardiorespiratory monitoring during sleep), which detects the presence of 1 and more episode per hour of prolonged respiratory pauses in the form of an apnea or hypopneus duration of 20 seconds and more. Depending on the post-conventional age, two types of syndrome are distinguished: the apnea is prevenged (for children under 37 weeks) and apnea of \u200b\u200binfants (for children aged 37 weeks and older).

With a quantitative predominance of apnea and hypopne of a central character of the preparations of selection in the treatment of babies sleep apnea are methylxantins.

Theophylline is used in a loading dose of 5-6 mg / kg and a supporting dose of 2.0-6.0 mg / kg, divided into 2-3 receptions. Caffeine citrate is prescribed in a loading dose of 20 mg / kg orally or intravenously with a transition to a supporting dose of 5 mg / kg once daily. In the presence of pronounced hypoxia during sleep with central apnea, oxygen therapy is used. If there is mainly obstructive apnea and hypoploa, respiratory support is used by ventilation using a nasal mask by constant positive air pressure (sipap-therapy) or ventilation by intermittent positive air pressure (bypass-therapy). Periodically monitor the effectiveness of treatment with polysomnography or cardiorespiratory monitoring, the possibility of discontinuing treatment with drugs or devices is usually discussed after age 6 months, when the risk of developing the syndrome of the sudden death of babies is significantly reduced.

The obstructive apnea of \u200b\u200bchildren's sleep apnea (coas of children) is characterized by the emergence of multiple obstruction episodes at the level of the upper respiratory tract during sleep, often accompanied by episodes of desaturations. Among the clinical manifestations of the syndrome, snoring predominate and the surrounding respiratory stops in a dream. An analogue of excess daytime drowsiness, especially in preschool children, is hyper-speaking, uncontrollable behavior. Often in this case is a diagnosis of attention deficit with hyperactivity. During sleep with obstruction periods in children, unusual phenomena are visually noted - the rear hypertex of the neck to relieve respiration and the paradoxical retraction of the chest during episodes of inefficient respiratory efforts. Owl breathing during sleep is a practically bonded phenomenon. Characteristic clinical symptoms of CHAS children are also excessive sweating during sleep and frequent cases of night enuresis.

The clinical picture of SAAS children has its own characteristics, depending on the age of the child. So, for children up to year, weak sucking, episodes of obvious life-degrading events are characterized, the poor organization of the "Sleep - wake-up" cycle, streakorous breathing. At an early age (up to 3 years), such children are often marked by paramy in the type of interchange, night fears, restless sleep. In preschool age, night enuresis, the difficulties of awakening in the morning, morning headaches are joined. Schoolchildren - bite disorders, difficulties in studies, slowdown in puberty, emotional disorders, possibly the development of arterial hypertension.

In the diagnosis of coasters of children, the main role is assigned to a polysomnographic study, which allows determining the number of episodes of obstructive apnea and hypopne. The diagnosis is confirmed if they are 1 and more episodes per hour and there are any of the above clinical symptoms.

Among the causes of the development of obstructive sleep apnea, children are primarily called adenotonzillary hypertrophy. The growth of the lymphoid tissue of the pharyngeal ring observed in frequently ill-treatment leads to a significant narrowing of the lumen of the upper respiratory tract at the level of the nasomic and oralogot. Mostly the oral type of breathing contributes to the growth of the upper jaw, which, in turn, leads to a relative narrowing of the lumen of the upper respiratory tract in such children. More rare than adults, the cause of SAICs in childhood is obesity.

Congenital developmental abnormalities affecting the facial skeleton also contribute to the development of associates of children. In case of Daun's disease, the main reason for the development of obstructive sleep apnea is the macrogloss, with a croisson syndrome - a small upper jaw, trother syndrome -kollyza - mandibular hypoplasia. From the first days of the life of SAAS detects in children with Pierre's syndrome Robin due to mandibular hypoplasia and glossoptosis. Neurological pathology may cause the development of respiratory disorders in a dream in children: obstructive apnea is described at the Miopathy of Duzhenna, children's cerebral paralysis, kiaari anomalies combined with hydrocephalus and spina bifida.

In the treatment of coasters of children, the main role is played by timely, to the development of complications in the cardiovascular system and in the form of deformation of the facial skeleton (adenoidal face, high soft sky), adenotonzilctomy. Its effectiveness is estimated at 50-80%. At the same time, it is emphasized by the need for simultaneous removal and sizzling, and skydly almonds. Clinical symptoms of COAS After such operations, often regresses dramatically: the night enuresis, sweating, the child becomes calmer and cheerful.

With insufficient effectiveness of this operation, it is resorted to a rapid expansion of the upper jaw using a special plate, which is inserted under the soft heaven between the indigenous teeth and contributes to the expansion of the solid sky, and the base of the nasal passages, in the transverse direction.

In the treatment of insomnia in children use the sedative and sleeping pills of "small neuroleptics". So, Alimemazin (Teraulidgen) is recommended to be used at a dose of 2.5-5 mg per night.

In children with congenital maxillofacial anomalies, the method of distraction osteotomy is effective, which allows to increase in the amount of the upper or lower jaw, which leads to the normalization of the number of obstructive apnea in a dream.

If it is impossible or ineffective, the use of the above techniques during sleep is used by ventilation by constant pressure through the nasal mask (sipap-therapy). With the right selection of air pressure, the effectiveness of this method of treatment is extremely high-breeds begins to sleep calmer, snoring, sweating, unusual sleep poses disappear. The healing pressure of the air is selected under the conditions of the sleep laboratory. The criterion for the correct selection of pressure is to reduce to normal values \u200b\u200bof the number of episodes of respiratory disorders in a dream in all stages of sleep and in any position of the body. The child should sleep with the device 5-7 nights per week at least 4 hours per night. In the future, in the interval in one year, polysomnographic studies are repeated in order to assess the dynamics of obstructive sleep apnea syndrome, until it decides to terminate the use of the device or the possibility of using surgical techniques. In this review we only touched on some of the most common in the practice of children's doctors or clinically significant sleep disorders in children. Other sufficiently important disorders included in various categories of the international classification of sleep disorders, such as psycho-physiological insomnia, narcopsy, return hypersignia, a dust-wake cycle violation by the type of sleeping phase, bruxism, rhythmic motor disorder and nightmares. The clinical picture and maintaining patients with these childhood disorders may differ significantly from those in adults.

Literature
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Healthy sleep is not only a guarantee of good mood, but also strong immunity. But sometimes in the body fails, because of which a sleep disorder occurs in children. Or recently the kid experienced a strong psychological stress that influenced his opportunity to calmly fall asleep.

Causes of sleep disorders in children

During sleep, the child is resting, charges with energy. The newborn sleeps around 16 hours a day, a six-month-old child sleeps around 14 hours, and already starting from the two-year-old age, the baby begins to be 13 hours a day.

But each child is individual, some parents are sleeping longer or less. It is necessary to worry only when the baby shouts in a dream, it will hardly fall asleep or completely refuses to sleep.

The reasons for sleep disorders include:

• Individual features of sleep baby.
• Emotional disorders, nervous overload.
• Personal problems.
• Problems associated with the nervous system.

A change in sleep can cause a power change, for example, if the child has recently been away from breasts, conflicts between parents, changing the usual situation. Restless sleep in babies is developing due to colic and other tummy problems, cutting teeth, due to hunger, cold or overheating. In this case, a short-term sleep disorder may be observed. If restless sleep is associated with mental disorders, in this case only a specialist can help.

Sleep symptoms include:

• Cream in a dream.
• Cramps.
• Fear of sleep.
• Urinary incontinence.
• Change of breathing during sleep.

Facial movements during the Drema are manifested not only in children, but also in adults, since this factor relates to the physiological feature of a person. If you have noticed that the kid often flies at night, consult a doctor to eliminate the risk of epilepsy.

Some children aged 10-13 years during sleep gripe with teeth. The danger of this physiological habit is to destroy the enamel of the teeth and the impaired respiration, changes in blood pressure. This situation requires consultation of a neurologist and a dentist.

Night fears may arise in a child of any age. Sometimes they arise after watching the horror movie, reading a book with a fantastic plot, various horror stories who tell children to each other.

In some cases, the parents themselves are to blame, when they tell the child if he won't sleep, a bad person will come to his room and steal him. Most often, this type of fears is observed in boys aged 2-8 years. Usually this fear disappears when the child reaches adolescent age.

The most dangerous views of sleep disorders are Lunatism, a conversation in a dream and nightmares. Lunatism is dangerous in that the child does not give the report to his actions, he can go outside when he sleeps, and in the morning will not remember this. Children of all ages talk in a dream, as a rule, this feature as it grows undergoes by itself.

Nightmares attend kids from 3 to 7 years, and from 10 to 12. Such dreams are a response reaction of the nervous system to external stimuli. A distinctive feature of nightmares from night fear is that after waking up the child remembers his sleep.

Treatment of sleep disorders in children

Sleep impairment in children can be cured only if you sort out the factors of its formation. With pathological sleep disorders, the only salvation is to appeal to a specialist who will prescribe a course of treatment. In all other cases, you can try to cope with this ailment.

If the baby has night fears, it is strictly forbidden to view any transmission and movies before bedtime. Try so that the nervous system of the baby is not overwritten, only in this case it will be guaranteed a calm dream.

If your baby is active, then before the release of KNA, you can take a walk on the street. In the morning it is advisable to make gymnastics, which will allow the baby faster to come to himself and awaken.
If a child is over 3 years old, it is undesirable to feed it before bedtime, especially fatty food.

Prepare for the baby bath with prefabricated herbs that calm the baby. Take such water procedures no longer than 10 minutes, and so 10 days in a row. The water temperature should not be above 37 degrees.

If the problems with a dream in a child are related to the fact that in the family it is not uncomfortable conflicts between parents, in this case only adults will help. Mom and dad should understand that small children are sensitive to external stimuli, especially loud voices.

Do not think that the baby does not understand the quarrel between adults. The child passes through itself all the negative energy, which occurs between adults, because of this, he then screams in a dream or sleeps badly. If the parents can not minimize their conflicts, they should not quarrel in front of the baby.

In cases where the kid is poorly falling asleep because of the teething teeth, the output one is to wait when they seek, and the baby's sleep stabilizes. To facilitate the pain of the child, you should take advantage of special gels that are sold in any pharmacy.

Sleeping in children - Komarovsky

Restless kid affects the performance of all family members. At night, the body is restored, and problems with sleep negatively reflected on immunity.

If the sleep disturbance in children is repeatedly happening, it speaks of pathology. We must consult a doctor. It is important to determine sleep disorder is a whim or illness.

Falling asleep at night and continuous sleep is not determined genetically, but are laid during life: there is no change in the day and night in the womb.

Therefore, the babies of the 1st year of life are always waking up at night and sleep during the day.

Causes of sleep disorders are varied:

• disease internal organs;
• hereditary predisposition;
• emotional loads, stress (hike in kindergarten, mother's yield to work);
• incorrect behavior in relation to sleep and wakefulness;
• physical discomfort (cutting teeth, colic, wet bed, crumbs on sheet, inappropriate room temperature);
• hunger;
• late dinner, redemption from the chest.

Sleep disorders in children under a year can be caused by rickets, groove and umbilical hernia, diseases of the spine, stomach and intestines, rheumatism.

20% of kids are poorly falling asleep in the evening, wake up and cry at night.

Different types of disorders have different manifestations.

For the treatment and measures for the prevention of nervous tick in adults, see.

The main manifestations of sleep disorder in children

The wrong model of sleep and wakefulness is expressed in the fact that the baby repeatedly falls asleep during the day and wakes up at night.

In addition, the following deviations are common:

Fears. A sleep disturbance in a child of this nature is commonly occupied between the ages of 2-6 years, more often in the flexible boys. The child in the midwerome sits down, shouts and crying in bed; Soothing the efforts of the parents.

During the attack, Chado cannot be wake up, by morning he cannot remember his behavior and retell the dreams.

These are manifestations of strong nervous system. By 10-12 years, the disorder passes.

Awakening among the night. They are found in Croh from 4 months to a year. There is nothing serious and the reason lies in the wrong behavior of the parents who rush to subsoine Chado. The baby has a conditional reflex, in which parents attention acts as reinforcement. The body "is configured" to awaken to get food and parental care.

The cause can also serve as heart disease, vessels, respiratory organs.

Sleepwalking. Being sleeping, a child (usually a boy is 5-10 years old) actively behaves, walks and makes targeted actions. His eyes are open, the movements are clumsy, but it does not stumble and does not bump into furniture; In the morning I do not remember anything.

Disorder may occur in connection with epilepsy, enuresis, diseases of the central nervous system and the urogenital system.

Speaking in a dream. Children, being in a state of sleep, pronounce words or suggestions, really fuzzy; After awakening, nothing remembers.

Nightmarescharacteristic for any age, but more often such a sleep disorder can be seen from a child for 3-7 years, as well as 10-12 years. Man wakes up among the night and remembers the dreaming - this is the difference from fears.If terrible dreams last often once a week, it's time for a doctor.

Bruxism. The child (more often 12-13 years old) stifies his teeth, his breath and heartbeat change. The reason for this behavior is not clarified, but the worms are not here.

It can talk about incorrect bite. Because of the erasure of Enamel Choo, you need to show a dentist-orthodontist. Bruxism is a consequence of nerve violations, when the stress of the facial muscles does not pass even at night. It requires the help of a neurologist.

Shuddertoddes manifest themselves before the year, born with hypoxy or defects, and adolescents. Shudders indicate epilepsy,unhealthy nervous system and mental sphere.

Urinary incontinence (enuresum) Persons 6-12 years old are subject to mental delay or genetically predisposed.

The cause is the immaturity of the nervous system (the reflexes of awakening are not developed), as well as urological diseases, stress.

In this case, a neurologist will help.

Stop breathingmeets all. Man breathes through his mouth, snoring, his breathing is intermittent; Sleep impairment in infants can be expressed in difficulty feeding, older guys are poorly trained in view of dayly drowsiness. The disease is associated with an increase in adenoids and almonds, sometimes with diseases of nerves and muscles, congenital pathologies, overweight.

Here is the consultation of Laura.

Sleep initiation disorder. A hard fall asleep in the evening in preschoolers is common in the difficulties of adaptation in the team, the increased excitability of the nervous system, psychological discomfort.

Syndrome of the detaine phase of sleep. Teens lead an active life at night, and in the morning it is difficult for them to awaken, all day they are sluggish. The problem has psychological roots associated with the entry into adulthood, and with increased school loads.

Stop breathing suffer 3% of children, bruxism - 20%.

Sleeping in children treatment

To the pediatrician it is worth going in cases if sleep disorder:

• accompanied by a serious change in mood;
• combined with enuresis and breathing interruptions;
• lasts more than 3 weeks;
• it comes in children up to 1 year.

Correction of fears, night awakening, walking and speaking in a dream is that the child must be worse in 10-15 minutes before the symptom occurs (terrible dreams see 1-2 hours after falling asleep).

Then the awakened baby will fall again and no longer disturb the parents in the "urgent time."

With a bruxism for the protection of the jaws, kapaps are worn; If its cause is neurological, reassuring the reassuring drugs. With enuresis, "moisture signals" - alarm clocks, triggered as soon as the baby is purified. It is important to wake a child, so that he does not perform it unconsciously, and always go to the toilet before bedtime.

Falling asleep at a certain time suffering from a breakdown of sleep initiation will help. The kid intuitively starts pre-prepared to sleep. The syndrome of the detaine phase of sleep is adjusted to the shift of the night rest at earlier time.

Often, pediatricians discharge the "Bai-Bai" drops for mobile, excitable kids from 5 years, the "citched" bromine medicine, and the drugs "Notta", "Domirkind", depressive teenagers are prescribed "EPAM" drops.

You can not drink drugs longer than the doctor appointed, otherwise Apathia will arise.

Prevention

To the campaign to the doctor is necessary:

• Keep a dream diary. During the week, recording the time of the child's awakening, the duration of anxiety, the time of re-falling, etc.
• Go to bed and wake up, take food at the same time. At least 2 hours a day to walk in the air, in the morning to carry charging and wet wipes.
• Limit emotional load (even pleasant). Viewing a large number of cartoons overloads the nervous system. Watch TV needs 2 hours to sleep. You can not play the moving games with a child in the evening, to persuade him there is something through strength. It is better to load Chado physically in the first half of the day, and at night read a fairy tale. Do not give sweets before bed.
• To regularly air the kid's room, follow the physical parameters. The optimal temperature is 22 ° C, the humidity is 70%. You can achieve this by putting a wet rag on the battery.
• Monitor bed linen. It should be clean, from natural fabrics, Mattress with a half-man.
• Provide a cozy psychological climate. Between family members should be trusting relationships. Parents need to find out whether their child feels comfortable in school, whether he has a relationship with teachers.

To correct sleep, you may need to not give a child to sleep. A calm fallback will provide a soft toy - protection symbol.

When a child falling asleep only in his arms, wakes up in bed, he is capricious. It is possible to stop this by the following admission. Mom is sitting near the bed and is engaged in his business. A child in rage scatters all the toys, moves the pillow. Mom fits, returns everything in place, then leaves.

In no case deny the child in a dream when he asks, under the pretext of employment by various cases.

It is impossible not to react to the crying of the child: in adulthood it will develop in neurosis, complexes.

Snu is favored by twilight, reading at night, the planning of tomorrow, monotonous noise of the washing machine, TV from the next room.

Children's sleep - the key to the health of the child and a full-fledged marital life. In disabilities, the actions of parents who do not limit annoying factors are to blame. In the absence of visible reasons for disorders, you need to go to the doctor.

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