Medical causes for sleep disturbance
How much your baby sleeps generally depends on their predetermined sleep needs and their temperament (some babies require more co-regulation than others).
Waking overnight is developmentally normal and common in infants. There are times when sleep can be particularly challenging, such as during developmental leaps, periods of increased separation anxiety or when your little one is unwell with a viral illness.
Whilst they aren’t the most likely reason for night waking, it is important to consider and rule out medical conditions which could be contributing to sleep disruption in your little one. Common culprits are iron deficiency, sleep apnoea and uncontrolled eczema.
Iron deficiency
Iron deficiency is common in children between 9-24 months of age.
The leading cause is inadequate dietary intake of iron during a period of rapid growth and increased iron requirements.
Fussy eaters or children who drink more than 500mls of cow's milk per day are at increased risk.
Studies have found that low iron stores (serum ferritin < 50) are associated with restless legs syndrome (RSL) and periodic limb movement disorder (PLMD).
RLS is characterised by an unpleasant sensation in the legs that leads to an urge to move when at rest, especially at night, that can result in problems falling to sleep.
PLMD is a sleep disorder involving subtle twitching, jerking or flexing of the limbs which can affect sleep quality.
If there’s a clinical suspicion of low iron, blood tests aren’t necessarily needed. Short term supplemental iron whilst monitoring for improvents in sleep may be trialled.
Sleep Apnoea
Sleep apnoea is is a sleep related breathing disorder causing pauses in breathing.
Obstructive sleep apnoea occurs when there is a physical narrowing/blockage of the path from the nose to the upper airway. e.g due to a floppy larynx or large adenoids/tonsils.
Central sleep apnoea is due to a delay in the signal from the brain telling you to breathe. Children born prematurely are at increased risk of CSA.
Sleep apnoea can disturb sleep because when these pauses happen, the brain responds by waking the baby to initiate breathing.
Signs to look out for are pauses in breathing, gasping or choking sounds, persistent snoring, mouth breathing and/or sleeping with an extended neck. These will occur during both day and night sleep.
If you've noticed your baby makes unusual noises during sleep, it can be helpful to film these to show your doctor.
Eczema
Atopic dermatitis (eczema) is a very common skin condition in infants, occurring in up to 30% of under two year olds.
Research has shown that poorly controlled eczema resulting in dry, rough and itchy skin can lead to disturbed sleep (no surprises there!)
Eczema can be challenging to manage, requiring twice daily moisturising, knowing and avoiding your baby’s triggers and appropriate use of steroids for inflammed (red) eczema.
Conflicting advice from health professionals and fear about side effects often leads to the underuse of steroids.
If your baby's skin is dry, bumpy, red or inflamed, see your doctor for a thorough head to toe exam and tips on how to best care for their skin and keep them comfortable.
