兒科英語診斷:睡眠sleeping

Sleeping

睡眠

Sleep behaviors are culturally determined, and problems tend to be defined as behaviors that vary from accepted customs or norms. In cultures where children sleep separately from their parents in the same house, sleep problems are among the most common that parents and children face. Infants generally adapt to a day-night sleep schedule between 4 and 6 mo. Sleep problems beyond these ages take many forms, including difficulty falling asleep at night, frequent nighttime awakening, atypical daytime napping, and dependence on feeding or being held for sleep. These problems are related to parental expectations, the child's temperament and biologic rhythms, and child-parent interactions. Inborn biologic patterns are central to an infant's sleep patterns, whereas emotional factors and established habits become more important in the toddler and older child. In addition, sleep disturbances become common at 9 mo and again around 18 mo, when separation anxiety, increasing ability of the child to move independently and control his environment, long late-afternoon naps, overstimulating play before bedtime, and nightmares tend to become more common.

睡眠行為靠培養(yǎng)，睡眠問題是指違背公認(rèn)習(xí)慣或標(biāo)準(zhǔn)的行為。在兒童與父母同屋單獨睡的文化環(huán)境中，睡眠問題是父母兒童所面臨的最常見問題之一。4－6個月大時的嬰兒一般已適應(yīng)了晝夜睡眠表。大于這個年齡的睡眠問題各不相同，如，夜間難以入睡、夜間頻繁醒來、晝間瞌睡無規(guī)律，喂著或抱著才能入睡等。這些問題都與父母的期望、兒童性情和生物節(jié)律及父母與子女溝通有關(guān)。天生的生物形態(tài)是嬰兒睡眠形態(tài)的主軸，情感因素和既成習(xí)慣對幼兒和兒童更重要。此外，睡眠紊亂在9個月時較普遍，18個月前后又是如此，此時，分離的焦慮、小兒獨立活動與對環(huán)境控制能力的增強(qiáng)、長時間午睡、睡前玩耍興奮過度及夢魘等更為常見。

Evaluation

評估

History: History focuses on the child's sleeping environment, consistency of bedtime, bedtime routines, and parental expectations. A detailed description of the child's average day can be useful. The history should probe for stressors in the child's life, such as difficulties in school, as well as exposure to unsettling television programs and caffeinated beverages (eg, sodas). Reports of inconsistent bedtimes, a noisy or chaotic environment, or frequent attempts by the child to manipulate parents by using sleep behaviors suggest the need for lifestyle changes. Extreme parental frustration suggests tension within the family or parents who are having difficulty being consistent and firm.

病史：病史詢問重點是兒童的睡眠環(huán)境、固定就寢時間、就寢常規(guī)和父母期望。兒童日常情況詳細(xì)描述很有用。病史應(yīng)調(diào)查兒童生活中的壓力因素，如學(xué)習(xí)困難、及接觸一些攪人心神的電視節(jié)目與含咖啡飲料（如碳酸鈉)等。如反映就寢時間不定、環(huán)境噪雜、或兒童經(jīng)常想利用睡眠行為操縱父母等，都提示有對生活方式改變的必要。父母極度失望提示家庭關(guān)系緊張或父母難以始終如一，無法堅持。

A sleep diary compiled over several nights may help identify unusual sleep patterns and sleep disorders (eg, sleepwalking, night terrors). Careful questioning of older children and adolescents about school, friends, anxieties, depressive symptoms, and overall state of mind often reveals a source for a sleep problem.醫(yī)學(xué) 全在.線提供bhskgw.cn

幾個晚上的睡眠日記可以幫助確認(rèn)異常睡眠形態(tài)和睡眠障礙（夢游、夜驚等)。仔細(xì)詢問兒童少年有關(guān)上學(xué)、交友、焦慮、抑郁癥狀及總體心理狀態(tài)常常可以提示睡眠問題的原因。

Physical examination and testing: Examination and diagnostic testing generally yield little useful information.

體檢與化驗：檢查與診斷化驗一般不會提供有用信息。

Treatment

治療

The clinician's role in treatment is to present explanations and options to parents, who must implement changes to get the child on an acceptable sleep schedule. Approaches vary with age and circumstances. Infants are often comforted by swaddling, ambient noise, and movement. However, always rocking the infant to sleep does not allow the infant to learn how to fall asleep on his own, which is an important developmental task. As a substitute for rocking, the parent can sit quietly by the crib until the infant falls asleep, and the infant eventually learns to be comforted and to fall asleep without being held. All children awaken during the night, but children who have been taught to fall asleep by themselves will usually settle themselves back to sleep. When a child is unable to get back to sleep, parents can check on the child to reassure themselves of the child's safety and to reassure the child, but the child should then be allowed to settle himself back to sleep.

In older children, a period of “winding down” with quiet activities such as reading at bedtime facilitates sleep. A consistent bedtime is important, and a fixed ritual is helpful for young children. Asking a fully verbal child to recount the events of the day often eliminates nightmares and waking. Encouraging exercise in the daytime, avoiding scary television programs and movies, and refusing to allow bedtime to become an element of manipulation also help prevent sleep problems. Stressful events (eg, moving, illness) may cause acute sleep problems in older children; reassurance and encouragement are always ultimately effective. Allowing the child to sleep in the parents' bed in such instances almost always prolongs rather than resolves the problem.

臨床醫(yī)師在治療中的作用是向家長作出說明，提供解決方案，家長必須作出改變，說服小孩接受睡眠計劃。具體方法則依小孩年齡與情況而定。嬰兒常常可以從襁褓、周圍聲音和運(yùn)動中得到安撫。不過，始終搖嬰兒睡覺不會使其學(xué)會自行入睡。自行入睡恰恰是一項重要的成長任務(wù)。父母可以安靜地坐在搖籃邊直到嬰兒入睡，慢慢地嬰兒就會學(xué)會感到安撫，不用抱就可以入睡，這是替代搖睡的一個辦法。兒童都會在夜間醒來，已學(xué)會自行入睡的兒童會自己睡著。如果小孩無法再次入睡，父母可以查看，確信小孩的安全，安撫小孩，然后讓小孩自行入睡。大一點的小孩，通過一些安靜的活動，如就寢時看看書，使他有一段時間“慢慢放松”，這有助于他入睡。讓會說話的小孩講講白天的一些事情常�？梢韵�除夢魘和夢游。鼓勵白天運(yùn)動、避免嚇人的電視節(jié)目和電影、拒絕使就寢時間成為人為操縱的一個因素，這也有助于預(yù)防睡眠問題。一些讓人感到壓力的事情（如搬家、生病)可能引起較大兒童的急性睡眠問題。安慰和鼓勵總是最有效的。讓小孩睡在父母床上只會延長而不是解決問題。