Children who are fidgety or hyperactive may have restless legs syndrome. Often misdiagnosed in kids, restless legs syndrome can interfere with sleep and affect childhood development.
A restless legs syndrome diagnosis isn’t exclusive to adults. In fact, the National Institutes of Health estimates one million school-age children have restless legs syndrome, or RLS. The symptoms of restless legs syndrome in children are often mistaken for growing pains or attention deficit hyperactivity disorder, making it difficult to get an accurate diagnosis.
The most common sign of RLS in children is, as with adults, an overwhelming need to move the legs, usually at night, says Binal Kancherla, MD, a pediatric pulmonologist at the Children’s Sleep Center at Texas Children’s Hospital in Houston and assistant professor of pediatrics at Baylor College of Medicine.
“Typically, restless legs symptoms are worse in the evening, when the child is at rest, lying down, or sitting,” says Dr. Kancherla. Children with RLS will complain of discomfort in their legs, but they may have trouble describing their symptoms. Children may say their legs feel itchy, like pins and needles, or “creepy crawly.” They may be able to tell you that the pain only goes away when they move.
More Signs of RLS in Children
The strange sensations in the legs and the irresistible need to move are not the only symptoms of restless legs syndrome in children. Other signs to look for in children include:
Struggling with sleep. Because of the urge to move their legs, children with RLS have trouble staying in bed and falling asleep. “Restless legs symptoms can lead to sleep deprivation and fragmentation of sleep,” says Kancherla. The leg discomfort can wake children up, and they may have trouble getting back to sleep.
Daytime drowsiness. Not getting proper sleep may result in daytime drowsiness. Children with restless legs syndrome will often have trouble getting up in the morning, and they may be tired during the day.
Behavior and academic problems. Sleep deprivation from restless legs syndrome has serious consequences. RLS may affect a child’s behavior at school and his or her academic performance. “Lack of adequate sleep in children can affect neurocognitive development, daytime focus, and attention,” says Kancherla. “It can lead to irritability or hyperactivity.”
The Causes of Restless Legs Syndrome in Children
Restless legs syndrome runs in families, says Kancherla. The exact cause is not known, but it is most likely inherited. It is considered to be both a neurological disease and a sleep disorder.“Up to 10 percent of the U.S. population is living with a restless legs diagnosis, with more women affected than men.” Some people have a mild form of the disorder; for others, RLS seriously affects their quality of life.
RLS can be caused by an iron deficiency. “Children with low levels of serum iron and ferritin, a substance that binds iron, have been related to restless legs syndrome,” says Kancherla.
Some medications can make RLS symptoms worse. Antihistamines block dopamine receptors, the brain chemicals that control movement. Anti-nausea medications and antidepressants can also aggravate the RLS symptoms.
Caffeine and caffeine products like chocolate can intensify symptoms and should also be avoided.
Getting a Diagnosis: Restless Legs Syndrome in Kids
Making a diagnosis of restless legs syndrome in children can be challenging. RLS is more common in adults, so a primary care physician may not look for RLS in children. Your doctor may not immediately associate symptoms such as aggression, inattention, and hyperactivity with RLS. “We make the diagnosis based on symptoms, but family history, the child’s medication use, and the presence of other medical conditions are also vital,” says Kancherla.
There is no specific test for restless legs syndrome, adds Kancherla, but when making a diagnosis, a doctor may measure the child’s serum iron and ferritin levels to see if an iron or vitamin deficiency could be the cause.
Is It RLS in Children or Something Else?
Evidence connecting restless legs syndrome and attention deficit hyperactivity disorder (ADHD) is growing, although the exact relationship is still unknown. RLS and ADHD have similar symptoms, and ADHD is common in people with RLS. When getting a diagnosis for restless legs syndrome, ask your doctor about ADHD.
Growing pains and restless legs syndrome have very similar symptoms with one important difference that could change the diagnosis. Both disorders cause children to feel leg discomfort, usually in the evening or at night, but with RLS, the uncomfortable sensations usually go away when the child moves. With growing pains, the discomfort is more constant and is not relieved by movement.
Treatment for RLS Children
Treatment should be individualized to the child. The first step is to reduce factors that make the symptoms worse. “If the child is iron deficient, iron supplementation may relieve symptoms,” says Kancherla. “Ferritin levels should be monitored by your health care provider during treatment.”
Other non-drug restless legs treatments for children include massage therapy, hot baths or ice packs applied to legs, and initiating good sleep habits. “In more severe cases of RLS, anticonvulsant medications such as gabapentin have been used in children,” says Kancherla. “These should only be prescribed under the guidance of an experienced pediatric sleep specialist.”
RLS is generally a lifelong condition and, currently, there is no cure, says Kancherla. However, a diagnosis of RLS does not indicate the onset of another neurological disease, such as Parkinson’s disease.
Under guidance of an experienced pediatric sleep specialist and with current therapies, restless legs symptoms in children can usually be controlled.
By Alice Martin
MAY