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Restless Legs Syndrome in Children and Adolescents

What is restless legs syndrome?

Restless legs syndrome (RLS) is a movement disorder in which the child or adolescent reports an uncomfortable and irresistible urge to move his or her legs. This urge usually happens at bedtime but can occur at other times when the legs have been inactive, such as when sitting still for a long period of time (eg, during long car rides or while watching a movie).

To relieve the discomfort, the child or adolescent moves his or her legs, stretches his or her legs, tosses and turns, or gets up and walks or runs around. The relief experienced is usually immediate.

What causes restless legs syndrome?

The exact cause of this disorder is not known. RLS can be related to a low iron level or sometimes associated with diabetes, kidney or some neurological diseases. RLS sometimes runs in families and there is thought to be a genetic link in these cases. Many types of drugs used in the treatment of other disorders may cause RLS as a side effect.

What are the signs and symptoms of restless legs syndrome?

Symptoms of restless legs syndrome include:

  • Leg discomfort or "heebie-jeebies" — uncomfortable leg sensations described as creeping, itching, pulling, crawling, cramping, tugging, tingling, burning, gnawing, or pain. Feeling of "Coca Cola in the veins" has been described. These sensations usually occur at bedtime but can occur at other times of leg inactivity.
  • Urge to move legs — to relieve leg discomfort, children and adolescents have an uncontrollable urge to move their legs.
  • Sleep disruption — additional time is often needed to fall asleep because of the urge to move the legs to relieve the discomfort. Sometimes staying asleep may also be difficult.
  • Bedtime behavior problems — because children have a hard time falling asleep, they may not always stay in bed and sometimes need to get out of bed to stretch their legs to relieve discomfort.
  • Daytime sleepiness — problems with falling asleep and staying asleep may result in problems with daytime sleepiness.
  • Behavior and school performance problems — again, due to sleep disruption, problems may emerge in the child’s academic performance or in daytime behavior (irritability, moodiness, difficulty concentrating, hyperactivity, etc)

How is restless legs syndrome diagnosed?

Unfortunately, there is no specific test for restless legs syndrome. Diagnosis is made based on symptoms. A medical history and complete physical exam is conducted to rule out any other possible health problems. An overnight sleep study may be recommended to evaluate for other sleep disorders, especially periodic limb movement disorder (a movement disorder in which legs kick or twitch during sleep but the child is usually not aware of the symptoms).

According to the Restless Legs Syndrome Foundation, to be officially diagnosed with restless legs syndrome, the following criteria must be met in a child > 12 years old:

  • The individual must have nearly an irresistible urge to move his or her legs. The urge is often accompanied by uncomfortable sensations described above.
  • The symptoms start or become worse at rest. The longer the rest period, the greater the chance that symptoms will occur and the more severe they are likely to be.
  • Symptoms are temporarily relieved when legs are moved. Relief can be complete or partial but only persists as long as legs continue to be moved.
  • The restless legs symptoms are worse in the evening and especially when lying down.

Modified criteria are in place for children younger than 12 year where the diagnosis may be more uncertain. Your sleep doctor will be able to discuss this further with you and may even suggest a sleep study to help with the diagnosis.

How is restless legs syndrome treated?

Treatment options for RLS can include any of the following:

  • Adopt appropriate bedtime habits. The child or adolescent is only to get into bed and lay in bed when it is time to go to bed. Do not get into bed and spend time reading, watching television, or playing any games.
  • Say "No" to caffeine. Caffeine can make RLS worse, so avoid caffeinated products (eg, coffees, teas, colas, chocolates, and some medications).
  • Using local comfort aids for legs. Apply a heating pad, cold compress, or consider rubbing your legs to provide temporary relief to the discomfort in your legs. Also consider massage, acupressure, walking, stretching, or other relaxation techniques.
  • Supplement micronutrients. Have your physician check your child’s iron stores and if necessary, folic acid levels. Low levels of these substances can contribute to restless legs syndrome symptoms.
  • Consider medication options. Your child’s doctor may discuss several different types of drugs as options. The simplest is iron or folate supplementation as mentioned above. Other categories of drugs include dopaminergic agents (eg, carbidopa-levodopa), dopamine agonists (eg, ropinirole, pramipexole), benzodiazepines (eg, clonazepam), anticonvulsants (eg, gabapentin), and others including clonidine.
  • Eliminate unnecessary medications. Talk with your doctor about other medications (both prescription and over-the-counter) and herbal products your child may be taking. They may be making RLS worse. Some of the types of products to discuss with your doctor include drugs to treat nausea, colds, allergies, and depression.
  • Conduct a dietary review. Make sure your child is eating a healthy and well-balanced diet. You may wish to review this with the doctor.

Additional Sleep Information and Suggested Readings

Mindell, JA and Owens, JA. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Philadelphia, PA: Lippincott Williams and Wilkins, 2003.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/9/2013…#14309