Public Release: 

Injury to a parent can lead to sleep issues in children and teens

Research being presented at the 2018 American Academy of Pediatrics National Conference & Exhibition suggests that physicians should consider sleep when evaluating children whose parents are injured

American Academy of Pediatrics

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IMAGE: Adjusted Incidence Rate Ratio of Outpatient Visits for Sleep Disorders Following Parental Injury view more 

Credit: Saira Ahmed

ORLANDO, FLA. - Research has shown that getting a good night's sleep plays an important role in children's growth and development, both physically and emotionally. When children face an unsettling experience, such as the injury of a parent, it can alter their sleep habits, according to new research being presented at the 2018 American Academy of Pediatrics National Conference & Exhibition.

The study abstract, "Children's Sleep Issues after a Parent is Seriously Injured," examined how sleep habits of younger children and adolescents were impacted by the serious injury of a parent, such as post-traumatic stress disorder from military combat.

The serious injury of a parent can alter a child's daily routine, and the child may observe their parent's pain and recovery. Researchers examined whether children with injured parents had increased visits for sleep disorders, such as circadian rhythm disorder, excessive sleeping, insomnia, narcolepsy, sleep walking, restless leg syndrome and sleep disordered breathing.

They found that children of parents with both post-traumatic stress disorder and traumatic brain injury had a 48 percent increase in sleep visits.

"It's important that medical providers ask about stressors in the home such as an injury to a parent, and ask about how their child has been sleeping," said CPT Saira Ahmed, MD, pediatrics resident at Walter Reed National Military Medical Center. "These conversations are important to help the family catch and treat sleep issues early to avoid physical and emotional problems down the line"

Using records from the Military Health System to locate children up to age 18 years with a parent seriously injured in combat or daily life, the researchers examined the records of 485,002 children of 272,211 injured parents. Common injuries were brain or battle injuries. The child's median age at time of the parent's injury was 7 years.

Using outpatient pharmacy records, they compared visits for sleep disorders and sleep medication prescriptions before and after a parent's injury. Overall, the use of sleep medications decreased. However, following an injury, children were 17 percent more likely to seek outpatient care for sleep disorders. According to the study authors, this may be due to children being seen by a sleep specialist, as injured military personnel are often transferred to larger facilities for treatment, increasing their children's access to specialty care. They suggest that when seeing a new patient, especially young children, physicians may wean the child off sleep medications and begin behavior modification and non-pharmacological efforts to reduce sleep disorders.

Teenagers had a 37 percent increase in sleep visits after a parent's injury. Teens especially may have more difficulty adjusting to the injury of a parent. Puberty and its altered sleep schedules, as well as the challenges of high school, can predispose teens to sleep issues, Dr Ahmed said.

"It is imperative that medical providers discuss their children's sleep with parents and consider sleep in the care plan of children of injured parents," said Dr Ahmed.

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Dr Ahmed will present the abstract, available below, at 3:00 p.m. ET on Nov. 4, in Regency Ballroom P at the Orange County Convention Center.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media or may be preparing a longer article for submission to a journal.

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Abstract Title: Children's Sleep Issues after a Parent is Seriously Injured
Saira Ahmed
Bethesda, MD,

Background: Parental injuries can increase family stress and child behavioral problems and subsequently have a negative impact on a child's sleep. Poor sleep quality and duration can negatively impact neurodevelopment with negative effects lasting into adulthood. Military families may be at increased risk. Purpose: To determine the impact of parental injury on child sleep diagnoses and sleep medication use.

Methods: Children aged 0-18 with a parent seriously injured in 2004-2014 were included. Children received at least two years of Military Health System (MHS) care before and after their parent's injury.

International Classification of Diseases 9th edition (ICD-9) codes identified sleep disorder visits including circadian rhythm disorder, hypersomnia, insomnia, narcolepsy, parasomnias, restless leg syndrome, sleep disordered breathing, and sleep disorders not otherwise specified. Outpatient pharmacy records identified sleep medication prescriptions before and after the date of injury. Parental injury was identified by inclusion in the MHS Ill, Injured, and Wounded Warrior Database and includes serious injuries sustained either in combat or daily life. Negative binomial regression analysis clustered by child compared visits for sleep disorders and sleep medication prescription days before and after parental injury. Secondary analysis explored the impact on children by age and parental brain or battle injury, with models adjusted for child sex, child age, and parental injury type. Results: There were 485,002 children of 272,211 injured parents included. The median child age at time of parental injury was 7.9 years [IQR 4.7-11.9]. The median length of parental deployment was 1.14 years [IQR 0.68-1.96]. Of included parents, 39% experienced a Traumatic Brain Injury (TBI) or Post-Traumatic Stress Disorder (PTSD). Following parental injury, children had a 17% increased rate of outpatient care for sleep disorders, yet a 29% decrease in sleep medication days. Visits for circadian rhythm disorder, insomnia, narcolepsy, restless leg syndrome and unspecified sleep disorders accounted for the increased outpatient visit rate (Table 1). Teenagers had a 37% (IRR 1.37 [95% CI 1.25- 1.50]) increase in sleep visits and a 32% (IRR 1.32 [95% CI 1.05-1.65]) increase in sleep medication days.

Children of parents with both PTSD and TBI had a 48% (IRR 1.48 [95% CI 1.33-1.63]) increase in sleep visits, but did not differ on sleep medication days (IRR 0.89 [95% CI 0.77-1.03]). For children of battle injured parents sleep visits did not increase (IRR 1.49 [95% CI 0.95-2.36]), and medication days decreased (IRR 0.66 [95% CI 0.45-1.95]). Conclusions: Serious parental injury is associated with increased child outpatient care, likely indicating increased severity, although medication use for sleep disorders in children decreased. Teenage children and children of parents with both PTSD and TBI are at increased risk. Sleep should be included in the care plan when providing care to children of ill or injured parents.

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