Treating Pediatric Sleep Disorders

I would bet that if you asked first-time parents of an infant to describe their most idyllic image, for most of them, it would be of their baby peacefully sleeping. I remember that stage of life when I would fantasize about a few hours of sleep uninterrupted by whimpering or crying from the next room. While I sympathize with parents suffering through their baby's sleep problems, I tend to think most often this is a necessary developmental stage in which the infant is settling in. New parents tend to worry so much about what often turns out to be a normal, transient adjustment that babies go through. In such a situation, I find reassurance can often be the most important treatment.

Discerning when to urge patience and when to suggest acupuncture and herbal medicine for sleep issues is no straightforward matter, but the severity of the problem could tip the scales in one direction or the other. Also, if the sleep problem seems clearly related to another readily identifiable imbalance, then treatment might make sense.

In my experience treating babies, there are two main types of imbalance that affect sleep: those relating to digestion and those that affect the nervous system. Inquiring about the digestion is always a good place to begin with children, as the immaturity of their digestive systems make them prone to host of problems, from those recognizable as digestive in nature to developmental, respiratory, or endocrine, to name just a few.

Beyond the general investigation of the baby's bowel movements, appetite, energy level and growth, the behavior around sleep and wake-ups is most revealing. According to Acupuncture in the Treatment of Children, by Scott and Barlow, a child crying or screaming before fully awakening is often suffering from spleen cold with accumulation that causes extreme abdominal distress, an excess condition brought about by the spleen's weakness. On the other end of the spectrum, a pale, quiet baby who awakens every hour or two, whimpering for a little feeding and then drifts back to sleep depicts a deficiency in qi and blood. In my practice, I've seen both types improve rapidly with very simple points such as ST 36, LI 4 and moxa on CV 12. Herbally, straightforward formulas can be of enormous help. Er Chen Tang, Huang Qi Jian Zhong Tang, Huo Xiang Zheng Qi Wan or combinations of these, along with probiotics, are very often enough to get things back on track for either of these patterns.

The focus of this article is more on the second type of sleep disorder which stems from a nervous system imbalance. This is one that I've begun to see only in the last couple years. I vividly recall the first baby I saw with this problem. She was a 6-month-old who was waking up an average of eight to 10 times a night. During the day, the baby seemed to be resisting taking a nap, even when she appeared tired enough to need one. "It's as if she doesn't want to miss anything," the mom told me wearily. Sure enough, the most striking feature of this child was her hypervigilant, frightened appearance of a someone who didn't want to let down her guard for an instant.

The shen agitation and fright that this baby suffered from implies involvement of the heart and the kidney. The closest patterns described in the Scott book - a fright pattern and an obstructed heat in the heart channel - didn't quite fit the details of this case. Discussing this case with a cranialsacral therapist/colleague who referred the child to me, was more helpful. This particular energetic pattern was increasingly common in their pediatric practice. They consider that it involves an over-facilitation of the sympathetic nervous system, to the detriment of the parasympathetic nervous system. It is as though the baby's developing nervous system is stuck on high alert at all times.

I somewhat tentatively came up with a point prescription for this child which proved quite simple, elegant and effective. Utilizing a Dr. Tan-style balance-method approach, which I favor in the treatment of babies and small children, the points were as follows:

Left	Right
HT 7SI 3	KI 3UB 62

The idea here was to strengthen the Heart-Kidney axis, balance water and fire in both yin and yang aspects, and activate the Du Mai to facilitate development of a nervous system in which sympathetic and parasympathetic aspects are more in balance.

To my surprise, after the first treatment, the baby's wake-ups during the night dropped from 10 to three. On subsequent treatments, I added ST 36 bilaterally, thinking that since babies' digestive systems are immature and often straining to keep up with their growth and developmental needs, this might be beneficial to minimize this strain and help to stabilize the internal environment, and with any luck, maybe even downgrade that high alert to medium readiness.

Over the course of five treatments, the wake-ups decreased further to none or one a night and the little girl began to nap during the day. There were some relapses when the family's routine and environment changed, but after a treatment or two, the sleep patterns normalized once again.

I have since gotten more referrals of babies with this particular kind of sleep disturbance. In all these cases, there was some history of stress or anxiety during the pregnancy, suggesting to me that the mothers' stress hormones, either in utero, via breast milk, or both, may have had a unsettling influence on the babies' behavior. In all cases, though, the same simple point prescription, or variations on the same idea, have worked beautifully.

Acupuncture's capacity to help babies and children cope with the enormous challenges of adapting to their new environment, of growing and remaining healthy, is profound. Indeed, one of the great pleasures of treating young children is the prospect of helping to set them right at such a pivotal point in their lives, when being on the wrong track could set in motion a series of events and interventions that could have negative consequences for the rest of their lives.