3 Year Old Jerks in Sleep Several Times a Night During Sleep (Since Birth)

My 3 year old has never lost his startle reflex or at least that is what what his first peditritian would tell me, when I woud complain about this when he was 6 months & 1 year. Because of moving, he has had 2 new ped's and neither of them have been concerned with the fact that he does this. However, he is now 3 years old and he will continously, jerk, hands and arms fly up, when he is calmly asleep. He can do this 40 times a night- How can he get any good rest like this? It is just like a newborn sleeping and them having a startle reflex- its just he has never outgrown it.

Background: My son was born at 37 weeks on the dot, was on 12 hours of oxygen and now have mild to severe behavior problems that we are now getting help for and have been seeking help for since the age of 2. My pregnancy high stress, and was on bedrest at 28 weeks, and in at 29 weeks, it felt as though, he just went crazy/ fast movements/ jerking type motion/ my doctors thought perhaps he had had a stroke, but test showed he was okay. Other then that, my son has been a picture of health. My son, does not sleep through the night, he wakes up, constantly, not after the startle reflex, but on his own, and this could be why his behavior is so poor.

We have been to 3 doctors, 1 psychologist, school experts--- nobody is concerned about this, but I am---- should I be concerned about this startle reflex, it doesn't seem normal, I don't know of anyone else's children still having it. Is there somewhere I can take him to get him checked out, is there tests that I can demand his ped administer, I am in the dark on this, any help would be great- thank you.

[CCFNeuroMD JT, MD]

Dear njbryan,

Thank you very much for your question. I am happy to address the issues that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a replacement for an office visit with a neurologist.  Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.

Although your child's movements during sleep may in fact be benign as your pediatricians suspect, there is a possibility that your child's movements are manifestations of a seizure disorder known as infantile spasms (AKA hypsarrhythmia).  The classical description of these spells are similar to what you describe: brief, jerking of the child, oftentimes with the hands flipping back and frequently occurring multiple times in clusters.  Infantile spasms are generally divided into 2 broad categories: symptomatic and idiopathic/cryptogenic, the latter category a wastebasket for all of the cases that have no attributable etiology.  Patients in this category generally have a better prognosis than those in the symptomatic category.

As we become more knowledgeable about neurologic disease, we are finding that infantile spasms often fall into the symptomatic category; that is, the seizures are simply a manifestation of a larger neurologic disorder.  A multitude of conditions can produce infantile spasms including a host of hereditary conditions, metabolic diseases, and brain malformations (to name a few).  Morevover, given your "high stress" pregnancy and your baby's need for supplemental oxygen perinatally, there is quite possibly an increased risk for abnormalities in brain development which also increase the risk for seizure.

One other key point you offered in your thorough description is that your son is starting to have some behavioral problems.  This is by no means diagnostic of epilepsy, although it should be noted that patients with seizure disorders tend to have a high incidence of comorbid psychiatric and behavioral problems.

What does this mean for you?  I don't mean to alarm you but I think it is important for you to be informed of what this could be.  My advice would be to seek out a pediatric neurologist or epileptologist (a neurologist that specializes in seizure) who can better evaluate your son.  He or she may opt to conduct an EEG (electroencephalogram) which is a painless, non-invasive brain wave test that can be used to determine whether your son's brain has the propensity to produce seizures.

Again, thank you for your inquiry.  I am not sure where you live, but we do have a number of exceptional pediatric epilepsy doctors here at the Cleveland Clinic who will be able to address your concerns and perhaps provide you with some answers.  Best of luck!

Sincerely,
JBT, MD

[SadieSunflower]

It is a very good idea to make a 5min video tape your sons movements when sleeping and take it with you to the neurologist. They don't always have a VCR in the office, so if you could put the video on a laptop, then that would be optimal. Make sure that you see an epileptologist, just like Dr. Troub recommended. Many times, a parents complaints will be ignored, but a video tape can be persuasive.

[njbryan]

Thank you for all your information. We do have a referral to a pediatric neurologist, as of yesterday, it will be months though. Our regular pedatrician was really not interested in what we had to say, and tried to convince me that our son is experiencing a bad dream like falling from a cliff, or a high distance, like we all do at one time or another. Extremely frustrating to say the least. I was so thankful to get your message to read something that sounded like someone understood what our son was experiencing. At, 7 or 8 months they did suspect a brain malformation but then ruled it out after a 4-D scan, and we do have epilectic hisotry, my grandma and uncle in my family. I am very anxious to get to someone who can help us. If need be, I will bring him up to Clevelend Clinic, my grandfather had a heart transplant there and my mother was patient there as a child for months, so I am very familiar with the hospital. Again- Thank you.  Natalie Bryan