Southampton
City Primary Care Trust hosts a children’s sleep disorder
service that accepts referrals for children from 12 months to
16 years with sleep problems.
The service was originally set up by Dr Leslie Bartlet, now
retired, a child psychiatrist who recognised the difficulties
experienced by families when their child cannot sleep. Indeed,
he conducted some of the earliest research in the 1980s identifying
sleep problems in children with learning difficulties.
The service sees approximately 150 children
a year, the majority being local children. Around 50% of these
children have special needs such as cerebral palsy, autistic
spectrum disorder, learning difficulties, epilepsy or sensory
impairment. The remainder present with a variety of discrete
primary sleep disorders such as rhythmic movement disorder,
circadian rhythm disorders or parasomnias.
The clinic staff comprises consultant paediatricians
(Dr Victoria McGrigor and Dr Cathy Hill), specialist nurses
(Jasia Beaumont and Angela Caulfield) and a consultant clinical
psychologist (Rene Westbrook) and offer care across primary,
secondary and tertiary levels. At the primary care level the
focus is on education of staff to promote independent management
of simple behavioural sleep problems. To this end we provide
local training courses and our specialist nurses provide outreach
support to practitioners in the field. Referrals at a secondary
and tertiary level will be received from GPs and paediatric
colleagues both locally and regionally. These latter children
will mostly be seen in an out-patient setting.
Sleep disorders in children are rarely purely
physiological. The very fact of sleep deprivation in the child
and family has a major impact on both the child’s daytime
functioning and that of the carers. Families are often so exhausted
they find it difficult to see a way around their difficulties.
At the first appointment, which usually lasts around 1 ½
hours, the focus is on a detailed assessment of the current
problems and culminates in a negotiated management plan. Sometimes
this involves adjustment of the child’s existing treatments
(for example where a child is gastrostomy fed; the timing of
these feeds may need to be adjusted to promote sleep). Some
children need further sleep diagnostics to study objectively
the timing of their sleep or their breathing in sleep. These
can be arranged wherever possible at home to disrupt the child’s
routine as little as possible. Almost all children and families
receive support in managing their child’s sleep behaviours,
for example what to do when a child continually gets up in the
night demanding their parent’s attention. Support for
this programme is given by regular telephone contact or home
visits as required.
The clinic is fortunate to have access to a
new children’s sleep research laboratory where Dr Cathy
Hill, who also holds an academic post in the University Of Southampton
School of Medicine, has recently been studying sleep quality
in children with cerebral palsy. More such work is anticipated
in the future.
Another important part of our work over the
past 6 years has been to support the innovative Sleep Scotland
initiative, providing education to sleep counsellors for children
with complex needs.
If you are interested in our work and would
like some more information please contact Anne Davies the service
manager – Anne.Davies@scpct.nhs.uk |
