Restless Legs Syndrome

Restless legs syndrome is a movement disorder in which a child or adolescent experiences uncomfortable sensations in the legs during periods of rest or sitting still. The sensations are usually described as creepy, crawly, tingling or painful. Some parents interpret their child’s complaints as “growing pains.”

Rubbing the legs may make them feel better. Because of the leg discomfort and increased leg movements, it often takes a long time for a child with restless legs syndrome to fall asleep at bedtime.

A second sleep disorder that often goes along with restless legs syndrome is periodic limb movement disorder (PLMD). This is also a movement disorder in which the legs kick or twitch during sleep. Unlike restless legs syndrome disorder, a child with PLMD is usually not aware of the symptoms, although a parent may observe kicking and restless sleep. The only symptom may be daytime fatigue that is a result of the disturbed sleep.

Restless legs syndrome can run in families, and thus there is likely a genetic basis to some cases. It can also be related to low iron stores in the brain, even in the absence of anemia. In addition, some children with chronic diseases, such as diabetes and kidney disease, are at increased risk for developing restless legs syndrome. Some medicines can also worsen restless legs syndrome.

The symptoms of restless legs syndrome include:

• Leg discomfort. Children or adolescents often describe these uncomfortable leg sensations as creepy, crawly, painful or tingling. These sensations usually occur at bedtime but can also occur at other times of inactivity, such as during long car rides or while watching a movie.
• Leg movements. To relieve the leg discomfort, children and adolescents with restless legs syndrome often have an irresistible urge to move their legs, whether by tossing and turning while lying in bed, or by walking or running about at bedtime.
• Sleep disruption. Children and adolescents with restless legs syndrome often take a long time to fall asleep because of the leg discomfort and need to move. They not only have problems falling asleep but may also have difficulty staying asleep.
• Bedtime behavior problems. Because of the difficulty with falling asleep, parents may report that their child is a problem at bedtime due to not staying in bed.
• Daytime sleepiness. The difficulties with falling asleep and staying asleep can result in significant daytime sleepiness.
• Behavior and academic problems. Children and adolescents with restless legs syndrome may have daytime behavior and academic problems, such as hyperactivity, impulsivity and irritability, which is the result of the sleep disruption

There is no definitive test for restless legs syndrome, so diagnosis is made based on the description of symptoms. A medical history and physical examination will also be done to exclude other problems. Finally, an overnight sleep study may be recommended to evaluate for other sleep disorders, especially PLMD.

Treatment for restless legs syndrome may involve any of the following:

• Change bedtime habits. Given that the leg discomfort gets worse the longer the child or adolescent lies in bed, it is usually better for the child to wait to get into bed until she is ready to turn out the light. Therefore, the bedtime routine, such as reading stories, should all occur out of bed.
• Avoid caffeine. Caffeine can make restless legs syndrome worse; so all caffeine should be avoided. Caffeine can be found in many sodas, tea and coffee, but also in chocolate and medicines (e.g., Midol, Excedrin).
• Reduce the discomfort. Massage, cold compresses or a heating pad may provide temporary relief.
• Rule out iron deficiency. Low levels of iron can contribute to restless legs syndrome symptoms, so an iron supplement may be prescribed.
• Consider medication. For children and adolescents with restless legs syndrome who have significant sleep disruption, medication may be recommended. There are a number of different types of medications that can help.

© Mindell JA & Owens JA (2003) A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Philadelphia: Lippencott Williams & Wilkins. Used with permission.