When Parent’s get hurt, Kids’ Sleep Suffers


CME NUGGETS

Ed Susman

Mr. Susman is a freelance medical writer based in Florida, USA. He travels worldwide to report from medical conferences, writing regularly for wire services, internet websites, and medical journals such as the Journal of the National Cancer Institute and AIDS.

For comments, edwardsusman@cs.com


ORLANDO, Florida – If a parent suffers a traumatic brain injury or experiences post-traumatic stress disorder, their children may also be affected – with problems in sleep often surfacing, researchers reported here at the annual meeting of the American Academy of Pediatrics.

Among teenagers whose parents experience post-traumatic stress disorder or traumatic brain injury, clinic visits for sleep problems increased by 37 percent, reported Capt. Saira Ahmed, MD, a pediatrics resident at Walter Reed National Military Hospital.

Dr. Ahmed said she accessed records from the military health System and determined there was an overall 48 percent increase in sleep visits among the children of parents who experienced post traumatic stress disorder and traumatic brain injuries.

Although the information came from military records, Ahmed said that only a tiny percentage of the injuries to the parents in the study were from combat issues. “These were common injuries that occur such as vehicular accidents or falls around the home,” she said, “and therefore it is likely that the findings are applicable to the general population.”

“It is important that medical providers ask about stressors in the home such as an injury to a parent, and ask how their child has been sleeping,” she said. “These conversations are important to help the family catch and treat sleep issues early to avoid physical and emotional problems down the road.”

Her study identified 485,002 children of 272,211 injured parents during the period from 2004 to 2014. About 39 percent of the parents experienced post-traumatic stress disorder or traumatic brain injury.

Dr. Ahmed said that teenagers appeared to be at a greater risk than younger children because they apparently had a more difficult time adjusting to the injury to the parents. She suggested that not only do teens have to cope with the unsettling injury to a parent, but teens are also going through puberty and challenges of high school – all of which can have their own impact on sleep.

Overall, compared with children whose parents did not suffer serious injuries, children with injured parents were 17 percent more likely to seek outpatients care for sleep disorders, Dr. Ahmed said.

She found children whose parents were injured were more likely to experience circadian rhythm disorders, insomnia, narcolepsy and restless leg syndrome. She said that use of prescribed sleep medication was reduced once the child was diagnosed with sleep disorders, probably because they were referred to sleep specialists who were able to employ non-medical sleep behaviors.

Grandparents do fine with kids In another study at the meeting, researchers suggested that overall grandparents who are forced to raise their grandchildren do a remarkably good job.

An offshoot of a worldwide opioid crisis is that parents often are incapable or incarcerated and cannot care for their own children, and grandparents have to take up the slack. In comparing households with children headed by parents or grandparents, Andrew Adesman, MD, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center, Northwell Health, New Hyde Park, New York, said that after adjusting for variables, 63.9 percent of the grandparent households reported they were handling day-to-day demands of raising children ‘very well’ compared with 67.2 percent of parent-led households – not statistically different.

Dr. Adesman said 94.1 percent of the grandparents said that stress associated with parenting occurred seldom, similar to the finding in parent-led households where 95.3 percent of those survey participants said stress occurred seldom during the past month.

The research team accessed the 2016 National Survey of Children’s Health, which is conducted by the Centers for Disease Control and Prevention, Atlanta, Georgia, and scrutinized the surveys from 44, 807 traditional parent-led households and compared those findings to 1,250 grandparent headed households.

Dr. Adesman said that while it is recognized that children in the grandparent households were likely to have more behavioral problems that traditional families and that it was expected that grandparents would have more health and mobility issues, it appeared to the researchers that overall the kids were doing okay with grandpa and grandma. “Our findings suggest they are coping well,” he said.

The researchers noted that grandparents compared to parentled households were likely to think the grandchild was more likely to get angry when transitioning from one activity to another; some time it was more difficult to get the child to calm down; that the child wouldn’t sit still and/or the child argued too much.

“A large and increasing number of mothers and fathers aren’t able to meet the responsibilities of parenthood, prompting their own parents to take on the primary caregiver role for their grandchildren,” Dr. Adesman said. “One of the main factors for an increase in kinship care is the opioid epidemic, although there are many other factors in which children are taken from their parents and are placed either in foster care or with the grandparents or other relatives. There are now 2.9 million grandparents who are raising their grandchildren in the United States.”

Adesman noted that a substantial group of both the grandparents and parents raising kids did feel that they didn’t have a Plan B. someone to help out if there was a crisis. In the grandparent group, 31.1 percent said they had no one to turn to for day-to-day emotional support, and 23.6 percent of those parents raising kids also didn’t have someone to provide that emotional support when it might be needed.

In commenting on the study, Wendy Sue Swanson, MD, chief of digital innovation at Seattle Children’s Hospital, said, “It is kind of sad that we have reached this place where grandparents are raising children because of the opioid epidemic.”

Dr. Swanson noted that grandparents are older; they may be more frail; they won’t be running around playing football with their grandchildren; they may even have less resources; but they also have an advantage over the parent households: Experience. “From experience comes wisdom,” she said, “and that can make the parenting chores easier in man respects.”

Children Targeted

In a policy statement of the American Academy of Pediatrics, doctors outlined the extent of how worldwide armed conflicts impact the lives of hundreds of millions of children, and urges pediatricians to address the evolving international crisis.

While focus on the fate of children is often in Africa, Asia and the Middle East, Jeffrey Goldhagen, MD, MPH, professor of community and societal pediatrics at the University of Florida, Jacksonville, said that the United States is not spared involvement.

“Armed conflict is any organized dispute that involves the use of weapons violence or force,” Goldhagen said in a press conference. “It is critically important that we recognize that there is a substantial impact or armed conflict and in particular on issues related to gangs, trafficking, narcotics traffic in the United States,” he said. “This is not an issue that we can say belongs to the ‘other world.’ It does belong to our world as a result of complex social and political issues. US public policy is critically intertwined with conflicts, not just here in the US but internationally.”

Dr. Goldhagen said that the involvement of children in the armed conflicts is not just profound, but is perverse as well. “It is perverse because children now are not just casualties, they are now being targeted, and are being engaged as combatants,” he said.

Across the globe, 223 armed conflicts of one type or another exist, and in 43 of these conflicts there is outright war. “One in 10 children in the world – hundreds of millions of children – are being impacted by these armed conflicts,” Dr. Goldhagen said. “Of the 65 million refugees in the world today, almost half are children, and all of these children are being impacted by multiple issues, not the least of which is psychological trauma. About 90 percent of casualties in these conflicts are civilians.”

He said that about half the refugees are internal refugees, uprooted from their homes and forced to move to what may only be a temporarily safer situation. He said that includes children in the United States who move due to local gang violence or to escape domestic violence.

But the situation is not completely bleak, Dr. Goldhagen noted: “Children are resilient, and they do have a future if we can provide them with the right environment.”

4 (80%) 1 vote