Child who doesn't sleep
Posted: Fri Jul 09, 2004 5:04 pm
I found it difficult to prescribe for this child today so I present the case I took as I would be interested to see what anyone else would come up with!!
9th July 2004
Background – This 16 month old girl presented initially quiet and shy, as a blond slim child of average height. She didn’t walk unaided but held onto the furniture. She played with toys on her own but quickly got bored and went to something else. She was quite inquisitive, wandering around and pulling out books etc. She did not come to me when I opened my arms out for her initially but at the end of the consultation she let me hold her. She was friendly and brought things over to me. She didn’t seem over clinging with her parents who were both at the consultation. To me she looked like a healthy little girl albeit slow with walking and not talking yet.
Presenting Complaint – not sleeping
She is put to bed at 7-8pm and will sleep for a couple of hours. She wakes between 11 and midnight and then again at 4 or 5 a.m. She will begin with muttering which if she is left it goes into a frenzy. Mum does just soothe her head and doesn’t talk to her. They have tried putting her to bed later and she still wakes. However she did sleep last night from 2.30-6.30pm and seems more alert for it in that she ate better this morning at breakfast. In the last month or so sometimes she has woken every hour. The bedclothes are off but she feels warm. The back of her head feels sweaty. Her head is sometimes at the wrong end of the bed because she is so restless. The sleep problem has been erratic but Mum is due to give birth to her second child next week.
Sometimes she doesn’t finish her bottle in the evening so is given one when she wakes at 11. She will drink it all. Between 4 and 5 she is ready to get up for the day. Occasionally she has passed a stool.
Mum doesn’t think she eats enough. She weighs 22lbs and when born was 6.9.
Teeth – at 4 months
Walking – not as yet but she crawled before she sat up.
Talking – not yet. I made out the word “door” which she pointed to as she left the room.
Stool – goes every day – no problems
She appears to understand everything that is said to her.
She likes climbing and laughs if she is thrown up in the air. She doesn’t appear to have a fear of the dark.
She now goes to nursery a couple of mornings a week. She waves goodbye when she gets there. Before this mum couldn’t put her down. She will play on her own.
She was a wanted child. Mum during the pregnancy had hyperemesis (severe vomiting) and was hospitalised at 16 weeks. Towards the end of the pregnancy she had HBP and was on beta blockers. She was induced because of this on the due date. M was delivered by Venthouse. When pregnant mum had lots of vivid dreams.
When she was born M had light therapy for jaundice which quickly cleared up. She was breast fed for 3 weeks. She cried and didn’t settle between feeds which is why Mum went onto a bottle. She cried a lot after the birth and couldn’t be put down. However Mum said that she was crying a lot and thinks that M sensed it.
In December she had vomiting and then diarrhoea for 2 weeks with a fever. She developed a chesty cough and was wheezy. She had a temperature and an ear infection for which she was given 1 dose of an antibiotic but as it made the diarrhoea worse mum didn’t give her any more. At this time her hands and arms were blue.
She likes sorting things and appears to be a tidy child. She shuts cupboards when her dad opens them and will pick up bits from the carpet. She loves getting things out of bags and putting them back in again. She doesn’t seem too upset if she has a messy face and loves splashing around in water.
She seems to prefer company.
She doesn’t make an undue fuss when she falls over.
Loves being tickled – Dad was stroking through her hair which she seemed to enjoy.
Food – loves fruit particularly bananas. She likes juicy fruits as well. She likes milk – possibly prefers it cold. She will eat eggs. Mum says she is not good at trying new foods. She will eat a bit of veg like broccoli and cauliflower. Sometimes she will eat chicken. She didn’t appear to like ham when she was given it. He eats toast and dry cereal.
She had a bit of eczema after some baby rice at the back of her neck and on her shoulders.
She doesn’t like it when Mum hugs dad or anyone else.
She doesn’t seem to like the heat or the cold. Likes being wrapped up.
Can be a bit stubborn but from what I saw was very easily distracted out of it.
Mum describes her as a smiley child with a sense of humour.
Family History
Father has had asthma in the past
Grandparents, HBP, DVT One great grand mother had breast cancer at 60 but is now in her 90’s and fine!!
www.rochellemarsden.co.uk
[Non-text portions of this message have been removed]
9th July 2004
Background – This 16 month old girl presented initially quiet and shy, as a blond slim child of average height. She didn’t walk unaided but held onto the furniture. She played with toys on her own but quickly got bored and went to something else. She was quite inquisitive, wandering around and pulling out books etc. She did not come to me when I opened my arms out for her initially but at the end of the consultation she let me hold her. She was friendly and brought things over to me. She didn’t seem over clinging with her parents who were both at the consultation. To me she looked like a healthy little girl albeit slow with walking and not talking yet.
Presenting Complaint – not sleeping
She is put to bed at 7-8pm and will sleep for a couple of hours. She wakes between 11 and midnight and then again at 4 or 5 a.m. She will begin with muttering which if she is left it goes into a frenzy. Mum does just soothe her head and doesn’t talk to her. They have tried putting her to bed later and she still wakes. However she did sleep last night from 2.30-6.30pm and seems more alert for it in that she ate better this morning at breakfast. In the last month or so sometimes she has woken every hour. The bedclothes are off but she feels warm. The back of her head feels sweaty. Her head is sometimes at the wrong end of the bed because she is so restless. The sleep problem has been erratic but Mum is due to give birth to her second child next week.
Sometimes she doesn’t finish her bottle in the evening so is given one when she wakes at 11. She will drink it all. Between 4 and 5 she is ready to get up for the day. Occasionally she has passed a stool.
Mum doesn’t think she eats enough. She weighs 22lbs and when born was 6.9.
Teeth – at 4 months
Walking – not as yet but she crawled before she sat up.
Talking – not yet. I made out the word “door” which she pointed to as she left the room.
Stool – goes every day – no problems
She appears to understand everything that is said to her.
She likes climbing and laughs if she is thrown up in the air. She doesn’t appear to have a fear of the dark.
She now goes to nursery a couple of mornings a week. She waves goodbye when she gets there. Before this mum couldn’t put her down. She will play on her own.
She was a wanted child. Mum during the pregnancy had hyperemesis (severe vomiting) and was hospitalised at 16 weeks. Towards the end of the pregnancy she had HBP and was on beta blockers. She was induced because of this on the due date. M was delivered by Venthouse. When pregnant mum had lots of vivid dreams.
When she was born M had light therapy for jaundice which quickly cleared up. She was breast fed for 3 weeks. She cried and didn’t settle between feeds which is why Mum went onto a bottle. She cried a lot after the birth and couldn’t be put down. However Mum said that she was crying a lot and thinks that M sensed it.
In December she had vomiting and then diarrhoea for 2 weeks with a fever. She developed a chesty cough and was wheezy. She had a temperature and an ear infection for which she was given 1 dose of an antibiotic but as it made the diarrhoea worse mum didn’t give her any more. At this time her hands and arms were blue.
She likes sorting things and appears to be a tidy child. She shuts cupboards when her dad opens them and will pick up bits from the carpet. She loves getting things out of bags and putting them back in again. She doesn’t seem too upset if she has a messy face and loves splashing around in water.
She seems to prefer company.
She doesn’t make an undue fuss when she falls over.
Loves being tickled – Dad was stroking through her hair which she seemed to enjoy.
Food – loves fruit particularly bananas. She likes juicy fruits as well. She likes milk – possibly prefers it cold. She will eat eggs. Mum says she is not good at trying new foods. She will eat a bit of veg like broccoli and cauliflower. Sometimes she will eat chicken. She didn’t appear to like ham when she was given it. He eats toast and dry cereal.
She had a bit of eczema after some baby rice at the back of her neck and on her shoulders.
She doesn’t like it when Mum hugs dad or anyone else.
She doesn’t seem to like the heat or the cold. Likes being wrapped up.
Can be a bit stubborn but from what I saw was very easily distracted out of it.
Mum describes her as a smiley child with a sense of humour.
Family History
Father has had asthma in the past
Grandparents, HBP, DVT One great grand mother had breast cancer at 60 but is now in her 90’s and fine!!
www.rochellemarsden.co.uk
[Non-text portions of this message have been removed]