Restless Legs Syndrome in Children

Aka: Restless Legs Syndrome in Children, Pediatric Restless Leg Syndrome

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II. Epidemiology

  1. Prevalence: 2 to 4% in children (more common in teens)

III. Pathophysiology

  1. Multifactorial (including Iron Deficiency, heredity)
  2. CNS Dopamine regulation appears to play a role

IV. Risk Factors

  1. Family History of first degree relative with Restless Legs Syndrome
  2. Iron Deficiency Anemia
  3. Chronic Kidney Disease
  4. Attention Deficit Disorder

V. Symptoms

  1. See Restless Leg Syndrome
  2. Urge to move legs and leg discomfort (may be difficult for a child to express)

VI. Associated Conditions

  1. Attention Deficit Hyperactivity Disorder (25% of RLS cases)

VII. Diagnosis: Clinical

  1. Obtain history in words of child if possible
  2. Characteristics
    1. Urge to move legs due to unpleasant or uncomfortable Sensation
    2. Examples: "want to kick", "bugs crawling", "tingly"
  3. Provocative
    1. Sensation worsens or begins with rest (e.g. inactivity, lying down, sitting)
  4. Palliative
    1. Improves or resolves with activity (e.g. Stretching, walking)
  5. Timing
    1. Onset primarily at night
  6. Associated
    1. Impaired sleep or daytime functioning (e.g. affected school work)
  7. References
    1. Allen (2014) Sleep Med 15(8): 860-73 [PubMed]

VIII. Labs

  1. Serum Ferritin
    1. Single, reasonable test screening for Iron Deficiency Anemia
    2. May be falsely elevated due to function as an acute phase reactant

IX. Diagnostics

  1. Polysomnogram (Sleep Study)
    1. Not required for diagnosis (clinical criteria as below are sufficient)
    2. May be needed in unclear cases (especially is too young to communicate a history)
    3. Periodic Limb Movements 5 or more per hour during Polysomnogram

X. Differential Diagnosis

  1. Sleep Problems in Children
  2. Growing Pains
  3. Akathisia
  4. Myalgias or Arthralgias
  5. Venous Stasis or Leg Edema
  6. Tic Disorder (e.g. habitual foot tapping)

XI. Management

  1. Avoid Caffeine
  2. Avoid Tobacco (Nicotine)
  3. Avoid Alcohol
  4. Avoid prolonged inactivity during the daytime
    1. Encourage activity and Exercise
  5. Treat Iron Deficiency Anemia
    1. Iron Replacement indicated for Serum Ferritin <50 mcg/L
    2. Recheck Serum Ferritin again in 3 months
    3. Kryger (2002) Sleep Med 3(2): 127-32 [PubMed]
  6. Avoid medications that provoke Restless Legs Syndrome
    1. See Restless Legs Syndrome
    2. Antihistamines (e.g. Diphenhydramine)
    3. Selective Serotonin Reuptake Inhibitors
    4. Tricyclic Antidepressants
    5. Metoclopramide (Reglan)
  7. Medications
    1. No medications are approved in children for Restless Legs Syndrome
    2. Gabapentin (Neurontin) has been used in severe cases

XII. Complications

  1. Sleep deprivation and secondary negative impact on behavior, mood, attention and cognition

XIII. References

  1. Carter (2014) Am Fam Physician 89(5): 368-77 [PubMed]
  2. Deshpande (2022) Am Fam Physician 105(2): 168-76 [PubMed]
  3. Picchietti (2007) Pediatrics 120(2): 253-66 [PubMed]
  4. Rajaram (2004) Sleep 27(4): 767-73 [PubMed]

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