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A Clinical Guide to Pediatric Sleep

Diagnosis and Management of Sleep Problems, Third Edition

Emrick, Beth Bloom MD

Journal of Developmental & Behavioral Pediatrics: June 2016 - Volume 37 - Issue 5 - p 431
doi: 10.1097/DBP.0000000000000271
Book Review

Department of Pediatrics, West Virginia University Charleston Division Charleston, WV

Disclosure: The author declares no conflict of interest.

In the preface to the third edition, the authors of A Clinical Guide to Pediatric Sleep immediately acknowledge not only the high prevalence of sleep disorders, but also the impact these disorders can have on a child's physical and mental health. Poor sleep can lead to mood disturbances, poor school performance, and safety issues, and can cause family stress. Given that sleep issues are both preventable and treatable, the authors seek to arm primary care physicians with the tools to address pediatric sleep problems. The result is an important manual for every pediatric care provider.

The new edition includes the most updated diagnostic criteria (International Classification of Sleep Disorders, third edition, 2014; and DSM-5, 2013) as well as practice guidelines from the American Academy of Pediatrics and the American Academy of Sleep Medicine. ICD-10 codes are given to aid in billing. The book is divided into 4 sections, plus online appendices. Text boxes highlight definitions, diagnostic criteria, and key points. Readers also get access to the complete e-book with an online code (included in front cover). The online materials are easy to access and search.

The first section offers an introduction to pediatric sleep, focusing mostly on normal sleep. The authors explain the sleep architecture and expected changes across different age groups. Common sleep issues for each age are mentioned here, but are explored more fully in the next section. Chapter 3 outlines the key features of a sleep history and evaluation. Chapter 4 discusses polysomnography; an annotated polysomnography report will be especially useful for providers to understand the key features of the sleep study reports.

Section 2 focuses on pediatric sleep disorders. It opens with symptom-based algorithms for 3 common sleep complaints: bedtime resistance, nightwakings, and daytime sleepiness in adolescents. Subsequent chapters concentrate on specific sleep disorders. Etiology and risk factors, evaluation, and differential diagnosis are discussed. The management section of each chapter includes treatment and, importantly, when to refer. Each chapter ends with tips for talking to parents, which can be used for quick reference.

Section 3 discusses medications, though the authors emphasize that medication is not considered a first-line treatment, and there are no sedative or hypnotic medications approved by the U.S. FDA for treatment of sleep disorders in children. The authors point out many aspects that should be considered before recommending or prescribing a sleep medication and urge providers to think carefully about the rationale for medication as well as concerns about safety, efficacy, and potential for tolerance. An extensive list of common over-the-counter and prescription medications is included in a chart, and many are discussed in more detail in the following pages.

The final section addresses sleep in special populations, including neurodevelopmental disorders (autism spectrum disorder, Angelman, Prader–Willi, Down syndrome), medical disorders (asthma, diabetes, sickle cell disease), and psychiatric disorders (ADHD, mood disorders). Because these children can often have a lot going on, the authors urge providers to remember to address sleep problems as part of their patients' overall well-being.

The online appendices are invaluable. The e-book includes numerous printable resources for families. Screening questionnaires for obstructive sleep apnea and restless leg syndrome are included, as is a sleep diary template. Anticipatory guidance handouts for parents of children from birth to adolescence guide parents on what to expect and how to help their child sleep at each stage of development. Other printable aides address common sleep and bedtime problems, such as delayed sleep phase, nightwakings, nightmares, sleep terrors, teeth grinding, and bedwetting. Handouts are appropriately detailed for families, and the bullet point format is easy to follow.

Overall, this is a user-friendly, easy-to-read book that can serve as a comprehensive resource for practicing clinicians. It is an essential text for every pediatric provider to evaluate and treat sleep disorders in primary care and mental health settings.

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