Editor's note: The 2017 AAP National Conference & Exhibition will take place from Sept. 16-19 in Chicago.
For years, Judith Owens, MD, FAAP, has been giving a popular talk on how to approach common sleep problems in children. This year, she decided to change it up.
“This is going to be a little bit different than a review of the basics,” said Dr. Owens, director of sleep medicine at Boston Children’s Hospital.
During the session titled “Pediatric Sleep Problems,” Dr. Owens plans to address three areas pediatricians ask about after they hear her speak: sleep-disordered breathing, the sleepy teen and insomnia.
“I do think that all of these issues are of considerable interest to a primary care pediatrician,” she said.
Attendees will have two opportunities to attend the session. It will be presented from 2:00-2:45 pm Sunday (F2120) in McCormick Place West, W190 A, and again from 8:30-9:15 am Monday (F3030) in McCormick Place West, W178 B.
Dr. Owens will discuss how to screen children at high risk for sleep-disordered breathing, including those with Down syndrome and obesity, with an emphasis on asking the right questions during well-child visits.
In addition, she will explain how to interpret a sleep study report since it’s often up to pediatricians to make treatment decisions.
“You have to understand what the test is showing you, or not showing for that matter, in order to make recommendations,” she said.
While tonsillectomy may be indicated, it’s not the only treatment available for children with sleep apnea. Dr. Owens said she plans “to emphasize that there are other options in terms of our therapeutic armamentarium,” including pharmacologic treatment, positive airway pressure, oral appliances, and myofunctional therapy, which is a noninvasive behavioral treatment for mild obstructive sleep apnea.
She also will outline a systematic approach to the teen who presents with daytime sleepiness and may be falling asleep in school or while driving.
“This is a very common presenting complaint in pediatric practice,” said Dr. Owens, professor of neurology at Harvard Medical School.
On the other end of the spectrum are young children who have trouble falling asleep and staying asleep. Dr. Owens said she is going to assume that most attendees are familiar with the basics of sleep training in children 5 and under.
“I’m going to talk about what are common pitfalls and what are things that can derail your best efforts in working with families on implementing these well-evidenced behavioral strategies,” Dr. Owens said.
She also will provide a primer on the use of cognitive behavioral therapy for insomnia in older children and adolescents, adding she is concerned when pediatricians recommend melatonin without implementing behavioral strategies.
“I’m not easily shocked at this point in my career, but I am just blown away by how much melatonin is being used out there,” she said. “It is literally rare now for me to see a patient in our sleep clinic for insomnia who either isn’t on melatonin or hasn’t been on melatonin at some point.”
Research on the safety and efficacy of melatonin is scarce, she said, and the quality of products varies widely.
“I just want to paint a cautionary tale here … be thoughtful about it and understand what the potential risks are,” she said.
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