Medscape spoke with Melisa E. Moore, PhD, a psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children’s Hospital of Philadelphia, about her own practice and her advice for pediatric primary care clinicians.

Has the pandemic changed the volume or type of sleep complaints you are seeing in your practice?

Early on, like most places, we were seeing fewer patients in person and more on video. Those children who were coming in were being seen for severe concerns, such as breathing problems during sleep and obstructive sleep apnea. Now that we have gotten into the rhythm of telehealth and video visits, we are packed with all kinds of different patients. Anxious children who can’t fall asleep. Patients with funny feelings in their legs that might have restless leg syndrome. Sleep terrors. Frequent night awakenings. As is true across the country, we’re seeing more kids for a wide range of concerns.

Clearly this would be different for kids of different ages, but what are the red flags that PCPs should know?

Our antennas should always be up for things like daytime sleepiness, snoring, disrupted breathing during sleep, that kind of thing. In terms of daytime sleepiness, naps are, obviously, normal for younger kids, and some of our teenagers also take naps to compensate for not getting enough sleep at night. But elementary schoolers really should not be that sleepy during the day. So a child that age who exhibits daytime sleepiness is a red flag for us.

During the pandemic, I’ve been thinking about two things. First, sleep disorders that affect our circadian clock ― a big concern for kids not on a schedule because they are at home and not physically present at school. So, if you have a patient that’s falling asleep at 3:00 AM and waking up at 2:00 PM the next day, that might be an issue they can’t just fix on their own and would be a red flag.

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