Restless Legs Syndrome

What is restless legs syndrome (RLS)?

Restless legs syndrome, often referred to as 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.” To relieve the discomfort, children or adolescents with restless legs syndrome will likely have an overwhelming urge to move their legs, whether stretching them, getting up and walking or running around, or simply tossing and turning. In addition, 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 or adolescent 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, a child with periodic limb movement disorder 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.

What causes restless legs syndrome?

The cause of restless legs syndrome is unknown. It can run in families, and thus there is likely a genetic basis to some cases. Restless legs syndrome can also be related to low iron (anemia). Additionally, some children with chronic diseases, such as diabetes and kidney disease, are at increased risk for developing restless legs syndrome.

What are the symptoms of restless legs syndrome?

The symptoms of restless legs syndrome include:

1. 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 long car rides or watching a movie.
2. Leg movements. To relieve the leg discomfort, children and adolescents with restless legs syndrome often have an irresistible urge to move their legs, whether it is tossing and turning while lying in bed or walking or running about at bedtime.
3. 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.
4. Bedtime behavior problems. Because of the difficulty falling asleep, parents may report that their child is a problem at bedtime, as she will not stay in bed.
5. Daytime sleepiness. The difficulties falling asleep and staying asleep can result in significant daytime sleepiness related to inadequate sleep.
6. 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.

How is restless legs syndrome diagnosed?

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 periodic limb movement disorder.

How is restless legs syndrome treated?

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

1. Change in 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.
2. Avoid caffeine. Caffeine can make restless legs syndrome symptoms worse; so all caffeine should be avoided. Caffeine can be found in many sodas, tea, and coffee, but also in chocolate and medications (e.g., Midol, Excedrin).
3. Reduce the discomfort. Massage, cold compresses, or a heating pad may provide temporary relief.
4. Iron deficiency. Low levels of iron or folic acid can contribute to restless legs syndrome symptoms, so an iron or folic acid supplement may be prescribed.
5. 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.