Restless Legs Syndrome (RLS) in Children and Adolescents
What is restless legs syndrome (RLS)?
Restless legs syndrome (RLS), also called Willis-Ekbom disease, is a sleep 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.
How many children have restless legs syndrome (RLS)?
In the United States, approximately 1.5 million children and adolescents are estimated to have restless legs syndrome (RLS). About 35% of patients who report having RLS say it started before 20 years of age.
Symptoms and Causes
What causes restless legs syndrome (RLS)?
The exact cause of restless legs syndrome varies from child to child. In some cases, the cause is not known. In other children, RLS can be related to a low iron level or sometimes is 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 different types of drugs including those used to treat depression, allergies, and psychiatric disorders may cause RLS as a side effect.
What are the symptoms of restless legs syndrome (RLS)?
Symptoms of restless legs syndrome include:
- Leg discomfort or "heebie-jeebies:" Uncomfortable leg sensations often described by adults as creeping, itching, pulling, crawling, tugging, throbbing, burning, or gnawing. Feeling of "cola running through the veins" has been described. Children may describe these sensations as “got to move, wiggle or kick.” 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, especially when resting, such as when sitting or lying down.
- 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 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).
Diagnosis and Tests
How is restless legs syndrome (RLS) diagnosed?
Young people who have RLS or who show the symptoms of RLS are usually dismissed as having "growing pains" or are considered to be overexerting themselves during physical activity. However, RLS is a real condition that requires appropriate evaluation, diagnosis and treatment.
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. A blood test may be ordered to check iron levels. 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 older than 12 years of age:
- 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 or inactivity such as when sitting or lying down. 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 or night than during the day or occur only in the evening or night.
- Symptoms are not due to another medical or behavioral condition.
Modified criteria are in place for children younger than 12 years of age 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.
Management and Treatment
How is restless legs syndrome (RLS) treated?
Treatment options for RLS can include any of the following:
- Get regular exercise: Gentle exercises, such as walking or riding a bike can be tried. Avoid heavy/intense exercise within a few hours of bedtime.
- 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 (coffees, teas, colas, chocolates, and some medications).
- Use 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, light stretching, or other relaxation techniques.
- Check iron levels: Have your physician check your child’s iron levels and if necessary, folic acid levels. Low levels of these substances can contribute to restless legs syndrome symptoms. Your doctor may recommend iron or folate supplements.
- Consider medication options: Your child’s doctor may discuss several different types of drugs as options. Most medications used to treat RLS in adults have not been approved by the Food and Drug Administration to treat RLS in the pediatric population as they have not been extensively studied in children.
- 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.
The non-drug treatments listed above are usually tried first.