How to help a child with restless leg syndrome

Mayo Clinic Q and A: Restless legs syndrome in children

• By

  Cynthia Weiss

  January 27, 2022

DEAR MAYO CLINIC: My child moves around a lot at bedtime and has trouble falling asleep. She describes "bugs" on her legs. As someone who was diagnosed with restless legs syndrome, I am wondering if children can develop restless legs syndrome, too?

ANSWER: Yes, children can have restless legs syndrome. You also may hear it called Willis Ekbom disease, based on the names of the physicians who first described this condition.

Just like adults, children can have sensations in their legs that makes it hard for them to fall or stay asleep. If the sensation happens regularly, they may have restless legs syndrome, which is considered a sleep disorder.

Restless legs syndrome can occur in about 2% of school-aged children. It also can run in families. Children with symptoms may have a parent who has restless legs syndrome.

Similar to adults, restless legs syndrome can make it difficult for children to get a good night's sleep. It does not lead to other health problems in children. Treatments are available that often can reduce or eliminate restless legs syndrome.

At first, it can be challenging to diagnose children with restless legs syndrome, which is characterized by an unpleasant or uncomfortable urge to move their legs. Some people describe it as a crawling, pulling or burning sensation in the thighs, calves or feet. Children may describe "bugs" or use other such descriptors.

The sensation is temporarily relieved when they get up and move around, or when they shift or stretch their legs. Children also can have "growing pains," which typically wax and wane, and are not associated with the need for movement.

Symptoms of restless legs syndrome typically begin at night after a person has been sitting or lying down for some time. These symptoms can occur during the day, too, when a person is sitting, but they typically are worse at night. Children may sometimes have these feelings while sitting in a car or classroom.

Many people have mild leg twitches as they drift off to sleep. These movements, called "hypnic starts," are a normal part of falling asleep. They are not associated with restless legs syndrome. Restless legs syndrome is much more uncomfortable, and it often makes it hard to fall sleep and stay asleep.

Sometimes muscle and ligament strain can be misinterpreted as restless legs syndrome, too. Usually, however, a strain is relieved by rest; whereas, the symptoms of restless legs syndrome worsen when limbs are kept still.

Health care providers usually can diagnose restless legs syndrome based on symptoms. In children, symptoms can start as early as 5 to 6 years of age. Attention deficit hyperactivity disorder can coexist in about 30% of children who experience restless legs syndrome.

Sleep studies are not necessary unless children cannot accurately describe their symptoms. Based on how old children are developmentally, it can be difficult for them to describe the unusual feelings in their legs, so it is important to speak with a health care provider about options.

Treatment for restless legs syndrome focuses on relieving its symptoms. Taking a warm bath, massaging the legs, or applying warm or cool packs can calm symptoms of restless legs syndrome. Stretching, followed by exercise at a moderate level regularly and establishing good sleep habits also can make a difference. Caffeine, alcohol or tobacco consumption can trigger or worsen symptoms.

Research shows that too little iron in a person's diet can contribute to restless legs syndrome. Some young children or toddlers have a high consumption of cow's milk, which can lead to low iron. You may want to speak to your pediatrician about checking their blood iron level.

If the blood iron level is low, eating more iron-rich foods can help. Examples include red meat; dark green leafy vegetables; beans; and iron-fortified breads, cereals and pastas. Your health care provider also might recommend an iron supplement, which is usually the first choice to treat children.

No medications have been approved by the Food and Drug Administration for children with restless legs syndrome. Certain medications may be considered by a sleep medicine physician if children have not responded to other measures to manage symptoms.

For adults, if lifestyle changes are not enough, medications are available to reduce symptoms related to restless legs syndrome. Medications that have been shown to help include several that affect a chemical in your brain called dopamine. Dopamine's job is to send messages from your brain to your body that control muscle movement. Researchers suspect that restless legs syndrome may be linked to insufficient activity of dopamine in the nervous system.

Be aware that certain medications can worsen symptoms of restless leg syndrome, including over-the-counter sleep aids that contain diphenhydramine, selective serotonin reuptake inhibitors and anti-nausea drugs. Review current medications with your health care provider. He or she may recommend substitutes, as needed, to manage restless legs syndrome. — Dr. Julie Baughn, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota

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Restless Leg Syndrome | Children's Hospital Colorado

What are restless leg syndrome (RLS) and periodic limb movement disorder (PLMD)?

Restless leg syndrome (RLS) is a condition that causes a strong urge to move the legs. This urge to move may be accompanied by other uncomfortable sensations felt inside the legs that are difficult for children to describe. The uncomfortable sensation and urge to move are made worse by rest or lying down and are temporarily relieved by walking or moving the legs.

Periodic limb movement disorder (PLMD) is periodic episodes of repetitive limb movements that occur during sleep. Periodic limb movements in sleep (PLMS) are brief jerks of the foot or leg, typically every 20 to 40 seconds. They can be identified during a sleep study known as polysomnography. PLMD is often associated with RLS but can occur by itself.

What causes RLS and PLMD?

In some cases, a gene causes this problem. So, it's common for another family member to have RLS.

An important chemical in the brain that helps control motion called dopamine may be low in children with both RLS and PLMD. Children with early-onset RLS may show evidence of an iron deficiency in the brain. Iron is required for proper dopamine activity in the nervous system.

Who gets RLS and PLMD?

RLS symptoms often begin during childhood or adolescence. About 35% of patients report RLS before age 20, and 10% tell doctors that their symptoms appeared by age 10.

What are the signs and symptoms of RLS and PLMD?

Children and adults with RLS or PLMD commonly have disturbed sleep because of the condition. In children, sleep disturbance may occur before they complain of leg discomfort. The quality and quantity of a child’s sleep are often decreased, resulting in moodiness, irritability, inattentiveness, fatigue or hyperactivity.

Children with RLS tend to seek relief from their discomfort by moving their legs often by fidgeting, stretching, walking, running, rocking or changing position in bed. Parents or healthcare providers may mistakenly attribute the child's discomfort to "growing pains." At school, a child’s attempts to relieve the uncomfortable feelings of RLS may be perceived by teachers as inattentiveness, hyperactivity or disruptive behavior. Because of this, children with RLS may mistakenly be diagnosed with attention deficit hyperactivity disorder.

Restless legs syndrome is a real medical condition that calls for proper evaluation, diagnosis and treatment. Some children with RLS complain of the sensations more during the day than at night.

What tests are used to diagnose RLS and PLMD?

Doctors often order a blood test to measure iron (serum ferritin) levels for patients who may have RLS. Studies have found associations between low stores of iron in the body and increased RLS symptoms, probably because of iron's important role in brain dopamine function.

Similarly, iron deficiency can cause or worsen RLS in children and adolescents, even when the deficiency is not severe enough to cause anemia. A ferritin level of less than 50 mcg/L, which may even be in the low-normal range, indicates a potential problem.

A diagnosis of PLMD is based on three criteria:

• Periodic limb movements during sleep exceeding norms for age (more than 5 per hour for children)
• Clinical sleep disturbance and
• The absence of another primary sleep disorder or underlying cause (including RLS)

In a child with RLS, the physical exam is usually normal. Family history is important because there is a 50% chance of passing the RLS trait on to children if a parent has RLS.

How do providers at Children's Hospital Colorado make a diagnosis?

Medical professionals have developed criteria for diagnosing RLS in children ages 2 through 12 years with definite, probable or possible RLS:

• Definite RLS: A child feels an urge to move the legs that begins or worsens with sitting or lying down and is partially or totally relieved by movement. The urge is worse in the evening or night than during the day, or occurs exclusively in the evening or nighttime hours. Children describe the discomfort using their own words, such as "owies, tickle, tingle, static, bugs, spiders, ants, boo-boos, want to run, a lot of energy in my legs," etc. There is a clinical sleep disturbance for age. A biological parent or sibling has RLS. A sleep study has documented a periodic limb movement index of 5 or more per hour of sleep.
• Probable RLS: There is an urge to move the legs and the move begins or worsens with sitting or lying down. The urge to move is partially or totally relieved by movement, and the child has a biological parent or sibling with definite RLS.
• Possible RLS: The child has PLMD and a biological parent or sibling has definite RLS, but the child does not meet the criteria for definite or probable childhood RLS.

Adolescents (13 years and older) are evaluated with the adult criteria.

How are RLS and PLMD treated?

Patients with RLS or PLMD are treated with a combination of learning new behavioral skills, vitamin supplements and other medication.

• Good sleep habits: It is important for children and adolescents to get enough sleep and have a regular sleep schedule. Sleep psychologists can help families establish better sleep routines.
• Iron supplementation: If a child’s ferritin level is below 50 mcg/L, your child's doctor will recommend additional iron intake through foods high in iron or medication. Multivitamins have enough iron to maintain proper iron stores, but do not have sufficient iron to replace low iron stores for children with RLS or PLMD.
• Medications: RLS and PLMD have been treated with clonidine (Catapres), clonazepam (Klonopin), gabapentin (Neurontin) and zolpidem (Ambien). Dopaminergics are the medications of choice for RLS in adults, but are not used as frequently in children.
• Monitoring and safety: Any medication treatment for RLS or PLMD requires close monitoring for safety and efficacy. As part of routine care, remember to maintain the safe storage of all medications (including Tylenol) in childproof containers.
• Attention-deficit/hyperactivity disorder (ADHD): There is evidence that suggests that treating RLS or PLMD can reduce or eliminate symptoms of ADHD in some children or adolescents. Stimulant medications used for ADHD do not worsen RLS or PLMD.

Why choose Children's Colorado for your child's RLS and PLMD?

At Children's Colorado, our Pediatric Sleep Center is made up of experts in treating children with restless leg syndrome (RLS) and periodic limb movement disorder (PLMD). Our clinicians have years of experience diagnosing and treating these movement disorders. Our sleep psychologist can help families learn good sleep habits to support any medical treatments recommended by our sleep doctors.

The Sleep Team often coordinates care with other specialists and primary care physicians involved in each family's treatment. Most "go the extra mile" to improve sleep and optimize development.

• The National Sleep Foundation provides information on healthy sleep, as well as sleep disorders like RLS and PLMD.
• American Academy of Sleep Medicine (AASM) is the only professional society dedicated exclusively to the medical subspecialty of sleep medicine.
• The Restless Legs Syndrome Foundation is a non-profit foundation dedicated to RLS that seeks to increase awareness, improve treatments and use research to find a cure to RLS.
• Healthychildren.org, powered by The American Academy of Pediatrics, provides information on recommendations for healthy sleep, as well as sleep disorders.

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Restless legs syndrome in children: what is it and why does it occur?

Restless Leg Syndrome (RLS ) - is a condition that causes an uncontrollable urge to move the legs, usually due to discomfort . It usually occurs in the afternoon or evening when the person is sitting or lying down. Often movement temporarily relieves discomfort.

People often describe the symptoms of this condition as abnormal discomfort in the legs or feet which usually occurs on both sides of the body. Less commonly, these sensations occur in the hands. Sometimes the sensations which usually occur inside the limb rather than on the skin are difficult to explain.

People with restless leg syndrome do not usually describe the condition as muscle spasm or numbness. However, this is often described as a strong desire to move the legs.

Feet can't be calm, and neither can the owner. But restless legs syndrome affects not only adults, but also children and young people. “Like adults, children have sensations in their legs that make it difficult to fall or sleep. When the sensation occurs regularly, it may be restless legs syndrome, which is considered a sleep disorder,” says Dr. Julie Bohn, Pediatric Pulmonologist Mayo Clinic in Rochester, Minnesota.

According to the specialist, « this occurs in approximately 2% of school-age children. It can be inherited , so the father or mother of children with these symptoms may also have restless leg syndrome .”

As with adults, restless leg syndrome can make it difficult for a child to sleep well at night, but it does not lead to other health problems for the child. At first, diagnosing restless legs syndrome in a child can be difficult. Children also have what are called "growing pains", which usually go away and are not associated with the need to move.

“Many people feel slight cramps in their legs when they fall asleep. These movements are known as "horse jerking" and are a normal part of falling asleep; that is, they are not associated with restless legs syndrome, because in this case 9The 0004 feeling is much more uncomfortable and often makes it difficult to fall and sleep. Sometimes a muscle or ligament strain can also be misinterpreted as restless leg syndrome. However, sprains are usually relieved by rest, while restless leg syndrome is exacerbated when the limbs remain motionless,” - says Bohn.

« When they go to bed at night, children have vague and diffuse changes in sensitivity, is usually in the depths of the legs, which they describe, among other things, as burning, itching, ringing, or “like a carbonated drink in the legs ”, explains pediatrician Ulrich. Fegeler of of the German Professional Association of Pediatricians and Adolescent Physicians.

and when moving the legs, this unpleasant sensation that the victim experiences decreases. Restless legs may hide various reasons . First, genes seem to play a prominent role. But low levels of iron or medications for depression or allergies can also cause this syndrome.

According to Fegeler , this is considered a sleep disorder . Therefore, families should work with their pediatrician to find ways to improve sleep. However, there are practically no medicines that can help children with restless legs. But a regular sleep pattern, sufficient movement throughout the day, and cold compresses or massages before bed can relieve discomfort.

Doctors usually diagnose restless leg syndrome based on symptoms. “In children ,” adds Bon , “, symptoms may appear early, around the age of 5-6 years. Attention deficit hyperactivity disorder (ADHD) may coexist in approximately 30% of children with restless leg syndrome.