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Thursday, June 20, 2013
My 2yr old wakes and bangs every night
My 2 year old daughter wakes up around 3 to 4 hours after she has gone to sleep every night and either rocks back and forth in her crib, sits and bangs her head against the crib or stands and rocks back and forth hitting her arms & shoulders. She does not cry, she whines, moans and sings. She mumbles, talks and laughs also. I go and check on her and she doesn`t appear to want my attention or even to be picked up. I tell her to lay down and she does. I can sing to her and rub her and the minute I leave the room - its back to banging. It gets so bad that we have had to wedge her crib between things so she doesn`t "walk" the crib across the room. I have also noticed that her eyes seem to dart around uncontrollably to the right as if she is in a trance sometimes. I have talked to my pediatrician and he seems to think that if she is still doing this when she is 2 1/2 - then it will be time to look into it more seriously. Does this sound like a phase?
While I can't make a diagnosis based on just your history, it sounds likely that this behavior probably represents rhythmic body movements, though a disorder of arousal could also be considered (though seems less likely).
Rhythmic body movements can be seen during the night in normal individuals, usually as they are either falling asleep or when they are aroused from sleep. The movements may include repetitive body rocking, head banging, and head rolling. They are typically associated with the transition from wakefulness to sleep but may be sustained in light sleep or during arousals from sleep. The movements may be alarming in appearance and often parents become concerned for a child's physical and mental well-being, though children with this problem are usually developmentally, behaviorally and medically normal. The rhythmic movements occur in up to 20% of children until 18 months of age and 8% of children by 4 years of age. While the movements may spontaneously resolve in early adolescence, symptoms can persist into adulthood.
The diagnosis of rhythmic body movements is based on identification of the character of symptoms in the absence of other medical or psychiatric disorders. At times the motor activity and head banging can be violent and physical injury can occur, although it is uncommon.
A disorder of arousal could also be considered, though seems less likely. These disorders occur when a child partially arouses from nondream sleep and, in confusional arousal disorder, usually consists of movements including sitting up with mumbling without apparent interaction with the environment. Unlike another type of parasomnia known as "sleep terrors", the child does not scream or appear very agitated but rather seems confused and disoriented.
Confusional arousals usually start between 3-10 years of age. About 15 % of children develop them. They occur more frequently during periods of stress, after sleep deprivation or with fever. They generally occur in the first half of the night, typically during deep slow wave sleep.
Rarely, the symptoms you describe could represent some sort of seizure activity, though the disorders described above seem much more likely.
If you are concerned, you could ask your pediatrician for a referral to a Sleep Center that has some experience in diagnosing people with rhythmic body movements or seizures. In some cases, testing by an overnight polysomnogram (sleep study) may be helpful to demonstrate the typical rhythmic movements and rule out other conditions.
Depending on the diagnosis, there are a variety of treatments that can be tried, but none have been well-studied or are universally accepted.
Mark Splaingard, MD
Clinical Professor of Pediatrics
College of Medicine
The Ohio State University