Getting good results from pediatric sleep studies requires a lot of legwork to make sure children – whether they’re in diapers or high school – have everything they need to be comfortable all night long.
By Lisa Rapaport
When it comes to sleep lab studies, children really can’t be treated like miniature adults. Everything about their experience needs to be tailored to their size and developmental stage, including the bed.
Parents shopping for a crib or transitioning an older child from a toddler bed to their first big kid bed at home have it relatively easy—they can focus on their budget, their bedroom decor, and maybe whether the mattress has to be a specific thickness to be safe on a top bunk. Even the harder things—like maybe finding side rails, a waterproof mattress, or hypoallergenic pillows—aren’t that tough in the grand scheme of things.
Sleep labs have to focus on a lot of the same things parents do at home, like childproofing so no wires or outlets are exposed to little hands. But labs also have to consider a wide range of logistics that parents never consider—like making sure beds are adjustable to accommodate leads for electrodes and finding equipment that moves smoothly and quietly enough to avoid waking a sleeping child.
“Pediatric sleep labs don’t just need beds that are miniature versions of adult sleep lab beds; they need options available for a wide range of patient sizes, weights, and needs—newborn, adolescents, bariatric, fall-risk patients, and parent co-sleepers, just to name a few,” says John Blackburn, director of marketing operations at Sizewise, a manufacturer of hospital and sleep lab beds, surfaces, and patient handling equipment.
Frame & Mattress Options
Sizewise offers several options that address these requirements including cribs, beds with higher weight limits for bariatric patients, beds that are low to the ground for children at risk for falls, and beds that will accommodate parents co-sleeping with their children, Blackburn says. These beds are also designed with top covers that can withstand hospital-grade cleaning for infection control—and even bedwetting —without harming the mattress.
Mattress options can also be tailor-made for younger patients, from pressure redistribution bassinet pads to air-adjustable number beds that allow even child and adolescent patients to find the right balance between softness and firmness, Blackburn adds.
“No matter the age, if patients are not comfortable, it’s more challenging to fall asleep and perform the actual sleep study,” Blackburn says.
Flexibility is key for providing optimal sleeping conditions for pediatric patients, and often their parents, says Jyoti Krishna, MD, FAAP, FAASM, director of pediatric sleep medicine at Akron Children’s Hospital in Ohio.
“Since typically developing and special-needs pediatric patients come in all sizes, we use standard hospital beds at our facility for our older patients,” Krishna says. These beds are rated up to 500 pounds, which can usually work for any pediatric patient with obesity. Then, the hospital also has cribs for infants and toddlers.
Wheels help, too. Cribs and beds can be rolled in or out of the room based on patient ages and needs. And all of the beds can be raised or lowered, with side rails that can come up or down to prevent falls, and with the ability to elevate the head of the bed. All rooms also have rocking chairs for parents who need to comfort younger patients, Krishna adds.
“Because the beds can roll, we sometimes can allow the child’s bed to be brought right next to the parental bed to allay anxiety,” Krishna says. “Other times, a parent may co-sleep in the child’s bed and then be asked to move out once the child is asleep.”
Falling & Staying Asleep
Placing CPAP masks and electrodes for sleep studies can be challenging under the best of circumstances, particularly when patients are unhappy with the feel or sound of the mask. This poses some risks for adult and pediatric patients alike— such as the risk for falls if patients toss and turn too much in an effort to dislodge the mask while they sleep—but it also creates a unique challenge for tiny patients who may scream or thrash when they’re scared or angry because they don’t yet have words to express themselves.
“A restless, scared, high acuity child, may not allow the staff to place the necessary electrodes without cooperation from the parent,” says Joel Porquez, BS, RPSGT, RST, CCSH, founder of Sleepkidzzz Pediatric Training, which offers instruction to sleep medicine professionals on serving younger patients.
“In my experience, a bed that has the ability to raise and lower in height is helpful in placing electrodes, as well as the ability to add or raise side rails to keep the pediatric patient safe.”
A sleep technologist who is experienced in working with children and families, and familiar with pediatric equipment needs, can also make or break the sleep lab experience—and outcomes from sleep studies, says Shalini Paruthi, MD, co-director of the Sleep Medicine and Research Center at St. Luke’s Hospital in St. Louis.
Technologists can ask parents to help hold a baby or toddler while wires are hooked up to avoid rolling or falls, and they can also wait to place all the sensors until kids are asleep to help increase the yield of sensor data throughout the night, Paruthi says.
In some instances, parents may also have sleep disorders, and pediatric sleep lab spaces need to be set up to accommodate parents who need their own adjustable beds and CPAP equipment set up, Paruthi adds. When kids are the patient, parents’ equipment needs to be arranged so there’s no risk of tiny hands getting at the wires or machines.
Perhaps the smoothest path to a successful pediatric sleep study is setting expectations for children and parents before they ever get to the sleep lab. Paruthi walks children and their parents through the process step-by-step during office visits and encourages families to bring things to the sleep lab that can help them replicate what happens at home to help children sleep well.
“For example, this means bringing in the child’s pillow, blankets, and books, even though we have most of that in our sleep lab,” Paruthi says.
Without enlisting the cooperation of the parent and the child it is less likely a pediatric study will yield clean data, Krishna says.
“Children often will take their sensors off, cry, be fearful or simply not understand what is required of them,” Krishna says. “A well-trained and pediatric friendly team of technologists and nursing staff as well as ample advance education is the key.”
Lisa Rapaport is a freelance journalist with experience writing and editing news about health, medicine, wellness, and science.