Restless Legs Syndrome And Periodic Limb Movement Disorder In

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S)12(imilarly)85(, systemic)]TJ 0 -1.13954 TD 0.095 Tw [(ir)5(on deficiency can induce or aggrav)6(ate RLS in)]TJ 0 -1.13953 TD 0 Tw (childr)Tj 2.24926 0 TD 0.057 Tw [(en, ev)6(en when the deficiency is not sev)6(er)9(e)]TJ -2.24926 -1.13954 TD 0.115 Tw [(enough to cause anemia. S)12(er)-8(um ferritin is the)]TJ T* 0.271 Tw [(best single measur)10(e of peripheral ir)5(on stor)10(es,)]TJ 0 -1.13953 TD 0.037 Tw (much mor)Tj 4.09559 0 TD -0.0001 Tc (e)Tj 0.68303 0 Td 0 Tc [(accurate than hemoglobin or ser)-8(um)]TJ -4.77862 -1.13954 TD 0.084 Tw [(ir)5(on tests. A lo)12(w ferritin lev)6(el, ev)6(en one in the)]TJ T* -0.029 Tw [(lo)12(w-normal range, indicates a potential pr)5(oblem.)]TJ T* 0.002 Tw [(Although r)10(ecognition of the association betw)5(een)]TJ 0 -1.13953 TD 0 Tw (lo)Tj 0.72071 0 TD -0.0002 Tc (w)Tj 1.05171 0 Td 0 Tc 0.142 Tw [(ir)6(on stor)9(es and RLS/PLMD in childr)10(en is)]TJ -1.77242 -1.13954 TD 0 Tw [(ne)-6(w)75(,)]TJ ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 5.375 0 0 5.375 51.9385 334.6045 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (12,44,45)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 74.5712 331.167 Tm 0 Tr 0 0 0 1 k 0 Tc 0.105 Tw [(the fact that sev)6(er)9(e ir)6(on deficiency in)]TJ -3.86709 -1.13954 TD 0.014 Tw [(childr)10(en can affect brain dev)5(elopment and func-)]TJ 0 -1.13953 TD 0.063 Tw (tion\321likely via alterations in dopamine metab-)Tj T* 0.215 Tw (olism\321has long been r)Tj 9.57747 0 TD 0 Tw (ecogniz)Tj 2.88037 0 TD (ed.)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 5.375 0 0 5.375 179.3357 297.8545 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (46-48)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 201.7959 294.417 Tm 0 Tr 0 0 0 1 k 0 Tc (I)Tj 0.32594 0 TD 0 Tw (nfants,)Tj -16.02788 -1.13954 TD 0.077 Tw [(toddlers, and teenagers ar)10(e at par)-8(ticular risk for)]TJ 0 -1.13953 TD -0.031 Tw [(ir)5(on deficiency)85(. S)12(ev)6(eral studies in adults and two)]TJ T* 0.015 Tw [(studies in childr)10(en hav)5(e sho)12(wn that r)10(eplenishing)]TJ 0 -1.13954 TD 0.347 Tw [(diminished ir)6(on stor)9(es can r)10(educe RLS and)]TJ 0 -1.13953 TD 0.118 Tw (PLMS symptoms.)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 5.375 0 0 5.375 109.0891 236.6045 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (44,45)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 125.1425 233.167 Tm 0 Tr 0 0 0 1 k 0 Tc 0.118 Tw (ADD/ADHD\321a comor-)Tj -8.5714 -1.13953 TD 0.005 Tw (bidity in some childr)Tj 8.0547 0 TD (en with RLS and PLMD\321)Tj -8.0547 -1.13954 TD -0.003 Tw [(has also been associated with lo)12(w ferritin lev)6(els.)]TJ ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 5.375 0 0 5.375 228.1251 212.1045 Tm 0 Tr 0 0 0 1 k 0 Tc -0.003 Tw (49 )Tj ET Q /GS3 gs q BT /F3 1 Tf 14 0 0 14 33 163.667 Tm 0 Tr 0.85 0.55 0.1 0.1 k 0 Tc 0.025 Tw [(TREA)70(TMENT OPTIONS)]TJ ET Q q BT /F3 1 Tf 11 0 0 11 33 148.417 Tm 0 Tr /CS0 cs 1 scn 0 Tc 0 Tw (NONP)Tj 2.89771 0 TD -0.019 Tw [(HARMA)12(COL)12(OGIC TREA)70(TMENT)]TJ ET Q /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 33 136.167 Tm 0 Tr 0 0 0 1 k 0 Tc 0.025 Tw [(N)30(onpharmacologic inter)-18(v)6(entions should always)]TJ 0 -1.13953 TD (be included in the tr)Tj 7.97843 0.00001 TD (eatment plan, and in some)Tj -7.9784 -1.1395 TD [(childr)10(en will pr)5(o)16(vide sufficient management of)]TJ T* [(RLS. I)12(n general, medication should be consid-)]TJ T* [(er)10(ed only when nonpharmacologic inter)-18(v)6(en-)]TJ T* (tions ar)Tj 2.8983 0 TD -0.0001 Tc (e)Tj 0.6708 0 Td 0 Tc (insufficient and an RLS-r)Tj 9.85746 0 TD (elated sleep)Tj ET Q endstream endobj 40 0 obj << /Length 3859 >> stream /GS0 gs q 0 0 265 612 re W n 1 g 0 612 0 0 re f Q /GS1 gs q /GS2 gs 0.102 0.066 0.012 0.012 k -9 -9 283.5 630 re f Q /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 33 562.7578 Tm 0 Tr 0 0 0 1 k 0 Tc -0.022 Tw [(disor)14(der is affecting the child)12<D5>80(s daytime function.)]TJ 0 -1.13954 TD 0.154 Tw [(The goals of therapy)85(, both pharmacologic and)]TJ T* 0.093 Tw [(nonpharmacologic, ar)10(e adequate sleep quantity)84(,)]TJ T* 0.048 Tw [(good sleep quality)85(, and suppr)9(ession of RLS sen-)]TJ T* 0.193 Tw [(sations, with a r)10(esultant impr)5(o)16(v)6(ement in day-)]TJ T* 0.025 Tw (time function. )Tj ET Q /GS3 gs q BT /F3 1 Tf 11 0 0 11 33 476.2578 Tm 0 Tr /CS0 cs 1 scn 0 Tc 0.025 Tw [(GOOD SLEEP HABIT)12(S FOR CHILDREN )]TJ 0 -1.18181 TD [(AND ADOLESCENT)12(S)]TJ ET Q /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 33 451.0078 Tm 0 Tr 0 0 0 1 k 0 Tc 0.243 Tw [(All childr)10(en and adolescents\321especially those)]TJ 0 -1.13954 TD 0.09 Tw [(with sleep disor)14(ders\321benefit significantly fr)6(om)]TJ 0 -1.13953 TD 0.002 Tc 0.373 Tw [(establishing a r)6(outine of good sleep habits.)]TJ T* 0 Tc 0.025 Tw [(Childr)10(en and adolescents often test the limits of)]TJ 0 -1.13954 TD 0.084 Tw [(sleep)16(, and for those with RLS the r)9(esult can be)]TJ 0 -1.13953 TD -0.022 Tw [(sleep depriv)6(ation that significantly incr)9(eases RLS)]TJ T* 0.197 Tw [(symptoms and adv)6(ersely affects daytime func-)]TJ 0 -1.13954 TD 0.285 Tw [(tion. P)42(ar)9(ents should be made awar)10(e of the)]TJ 0 -1.13953 TD 0.042 Tw (amount of sleep consider)Tj 9.75782 0 TD (ed normal for age, and)Tj -9.75782 -1.13954 TD -0.002 Tw (advised to help the child get sufficient sleep on a)Tj 0 -1.13953 TD (r)Tj 0.32202 0 TD 0.042 Tw (egular basis. )Tj 5.22426 0 TD (T)Tj 0.55005 0 TD [(ypical sleep needs ar)10(e as follo)12(ws:)]TJ -6.09633 -1.13954 TD 0.093 Tw (age 2: 12 hours (including one nap); age 5: 11)Tj T* -0.005 Tw [(hours; age 10: 10 hours; teen y)6(ears: 9 hours; and)]TJ 0 -1.13953 TD 0.155 Tw (adulthood: 7 to 8 hours. A child or teenager)Tj T* 0.036 Tw (should go to bed and awaken at about the same)Tj 0 -1.13954 TD 0.13 Tw (time ev)Tj 2.94882 0 TD [(er)-18(y day)85(, including w)6(eekends; av)5(oid caf-)]TJ -2.94882 -1.13953 TD -0.024 Tw [(feine intake, especially late in the day or ev)6(ening;)]TJ T* -0.003 Tw [(get r)10(egular ex)11(er)6(cise; and maintain a comfor)-8(table,)]TJ 0 -1.13954 TD 0.036 Tw [(quiet bedr)6(oom envir)5(onment, fr)10(ee of stimulating)]TJ 0 -1.13953 TD 0.006 Tw (activities. )Tj 4.05597 0 TD [(T)120(eens should av)6(oid the use of tobacco)]TJ -4.05597 -1.13954 TD 0.09 Tw [(and alcohol, which ar)10(e kno)12(wn to disr)-8(upt sleep;)]TJ 0 -1.13953 TD 0.017 Tw (confine any napping to the afternoon hours and)Tj 0 -1.13954 TD 0.343 Tw [(nap no longer than 45 minutes; and av)6(oid)]TJ 0 -1.13953 TD 0.025 Tw (driving when tir)Tj 6.28829 0 TD 0 Tw (ed.)Tj ET Q /GS3 gs q BT /F3 1 Tf 11 0 0 11 33 137.2578 Tm 0 Tr /CS0 cs 1 scn -0.0003 Tc (IR)Tj 0.94677 0 TD -0.0001 Tc (ON)Tj 1.85271 0 Td 0 Tc 0 Tw [(SUPPLEMENT)65(A)70(TION)]TJ /GS2 gs -2.79948 -1.27272 TD 0.85 0.55 0.1 0.1 k (T)Tj 0.53003 0 TD 0.025 Tw [(r)10(eatment of Lo)12(w F)36(erritin )]TJ ET Q /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 33 111.0079 Tm 0 Tr 0 0 0 1 k 0 Tc 0.285 Tw [(I)18(r)6(on supplementation should be giv)6(en if the)]TJ 0 -1.1395 TD 0.085 Tw [(child)12<D5>80(s ser)-8(um ferritin lev)6(el is lo)11(w or in the lo)12(w-)]TJ T* -0.032 Tw [(normal range, belo)12(w 35 mcg/L. )15(While most labs)]TJ T* 0 Tw (hav)Tj 1.3447 0 TD -0.0001 Tc (e)Tj 0.667 0 Td 0 Tc (lo)Tj 0.7209 0 TD 0.021 Tw [(w)6(er cut-off v)6(alues than 35, it is clear that)]TJ -2.7327 -1.1395 TD -0.028 Tw [(ir)5(on deficiency is common in the 10 to 35 range,)]TJ -0.0001 Tc (as)' 1.0532 0 Td 0 Tc 0.076 Tw [(demonstrated b)6(y the \324)39(gold-standar)14(d)12(\325 measur)10(e)]TJ ET Q endstream endobj 41 0 obj << /Length 5008 >> stream /GS0 gs q 0 0 265 612 re W n 1 g 0 612 0 0 re f Q /GS1 gs q /GS2 gs 0.03 0.04 0.11 0 k -9 -9 283.5 630 re f Q /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 34 561.2577 Tm 0 Tr 0 0 0 1 k -0.005 Tc 0.014 Tw [(for ir)6(on deficiency\321bone marr)5(o)13(w testing.)]TJ ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 5.375 0 0 5.375 207.3176 564.6953 Tm 0 Tr 0 0 0 1 k -0.005 Tc 0 Tw (50)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 217.7213 561.2577 Tm 0 Tr 0 0 0 1 k -0.005 Tc 0 Tw (The)Tj -17.09035 -1.13953 TD 0.071 Tw [(dosage and course of therapeutic ir)6(on should be)]TJ 0 -1.13954 TD 0.021 Tw [(the same as that typically used to tr)10(eat anemia in)]TJ T* 0.002 Tw [(childr)10(en. A multivitamin that includes ir)5(on does)]TJ 0 -1.13953 TD -0.037 Tw [(not hav)6(e enough ir)6(on to r)9(eplenish lo)12(w ir)6(on stor)9(es.)]TJ 0 -1.13954 TD -0.031 Tw [(H)18(o)12(w)6(ev)6(er)59(, once full r)10(eplenishment of ir)6(on stor)9(es is)]TJ T* 0.083 Tw (obtained, a daily multivitamin supplement with)Tj 0 -1.13953 TD 0.174 Tw [(ir)5(on can be used to help maintain ir)6(on stor)10(es.)]TJ T* 0.056 Tw [(S)12(er)-8(um ferritin testing should be av)6(oided when a)]TJ 0 -1.13954 TD -0.004 Tw [(child is ill, because the v)6(alue can be falsely elev)6(at)-1(-)]TJ 0 -1.13953 TD 0.041 Tw (ed b)Tj 1.67028 0 TD -0.0051 Tc (y)Tj 0.71918 0 Td -0.005 Tc (acute illness such as colds and other infec-)Tj -2.38946 -1.13953 TD 0.285 Tw [(tions. S)24(tudies in childr)10(en and in adults hav)5(e)]TJ 0 -1.13954 TD -0.028 Tw [(sho)12(wn decr)10(eased signs and symptoms of RLS and)]TJ 0 -1.13953 TD 0.014 Tw [(PLMS in association with ser)-8(um ferritin concen-)]TJ 0 -1.13954 TD 0.015 Tc 0.489 Tw [(trations rising to lev)6(els abo)15(v)6(e 35 to 50)]TJ T* -0.005 Tc 0 Tw (mcg/L.)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 5.375 0 0 5.375 63.374 380.9452 Tm 0 Tr 0 0 0 1 k -0.005 Tc 0 Tw (44,45,51-53)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 94.2212 377.5077 Tm 0 Tr 0 0 0 1 k -0.005 Tc 0.021 Tw [(The r)10(esults of ir)5(on therapy should)]TJ -5.60197 -1.13953 TD 0.032 Tw [(be monitor)10(ed b)5(y follo)12(w-up testing. U)36(nless ther)10(e)]TJ T* 0.241 Tw (is concern about possible hemochr)Tj 14.1142 0 TD (omatosis $a)Tj -14.1142 -1.13954 TD 0 Tw (disor)Tj 1.86735 0 TD 0.101 Tw [(der of ir)6(on o)15(v)6(erload$ or another r)10(eason for)]TJ -1.86735 -1.13954 TD -0.02 Tw [(par)-8(ticular caution, a daily multivitamin with ir)6(on)]TJ 0 -1.13953 TD 0.14 Tw (should be used to help pr)Tj 10.33883 0 TD [(ev)6(ent the body)29<D5>80(s ir)6(on)]TJ -10.33883 -1.13954 TD 0.002 Tc 0.368 Tw [(fr)5(om becoming depleted during the gr)6(o)12(wth)]TJ 0 -1.13953 TD 0 Tc (y)Tj 0.42714 0 TD -0.005 Tc 0.025 Tw (ears. (note: mcg/L equals ng/mL))Tj ET Q /GS3 gs q BT /F3 1 Tf 11 0 0 11 34 275.7577 Tm 0 Tr 0.85 0.55 0.1 0.1 k 0 Tc (I)Tj 0.32006 0 TD 0.025 Tw [(r)6(on A)12(bsorption )]TJ ET Q /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 34 263.5077 Tm 0 Tr 0 0 0 1 k -0.005 Tc 0.375 Tw [(T)110(aking an ir)6(on supplement with vitamin C)]TJ 0 -1.13953 TD 0.148 Tw (enhances absorption of the ir)Tj 11.63396 0 TD [(on. M)12(any bev)6(er)-1(-)]TJ -11.63396 -1.13954 TD 0.08 Tw (ages, such as orange juice and fr)Tj 12.58277 0 TD (uit drinks, con)Tj 5.74856 0 TD 0 Tc (-)Tj -18.33133 -1.13954 TD -0.005 Tc 0.026 Tw [(tain vitamin C. )15(V)10(itamin C tablets ar)9(e also av)6(ail-)]TJ 0 -1.13953 TD 0.08 Tw [(able. I)18(deally)85(, food, calcium, and tea should not)]TJ -0.0051 Tc (be)' 1.14255 0 Td -0.005 Tc 0.012 Tw (taken within two hours of taking an ir)Tj 14.60441 0 TD (on sup)Tj 2.58439 0 TD 0 Tc (-)Tj -18.33135 -1.13954 TD -0.005 Tc -0.033 Tw [(plement. )45(These decr)10(ease ir)5(on absorption and will)]TJ 0 -1.13953 TD -0.002 Tw (delay full r)Tj 4.0468 0 TD (eplenishment of the body)Tj 9.70013 0 TD 0 Tc <D5>Tj 0.15003 0 TD -0.0051 Tc (s)Tj 0.56073 0 Td -0.005 Tc 0 Tw (ir)Tj 0.57301 0 TD -0.002 Tw [(on stor)10(es.)]TJ ET Q /GS3 gs q BT /F3 1 Tf 11 0 0 11 34 148.7577 Tm 0 Tr /CS0 cs 1 scn 0 Tc 0.025 Tw [(MEDICA)70(TION OPTIONS)]TJ ET Q /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 34 135.5077 Tm 0 Tr 0 0 0 1 k 0 Tc 0.112 Tw (The potential risks of medication must be bal-)Tj 0 -1.13954 TD 0.297 Tw (anced against the long-term consequences of)Tj T* 0.043 Tw (poor intellectual and emotional function due to)Tj T* 0.174 Tw [(these sleep disor)14(ders. )45(T)130(wo medications found)]TJ T* 0.041 Tw [(par)-8(ticularly useful to tr)10(eat childr)9(en with RLS or)]TJ T* -0.015 Tw (PLMD ar)Tj 3.7541 0 TD -0.0001 Tc (e)Tj 0.6305 0 Td 0 Tc (clonidine $Catapr)Tj 6.79486 0.00001 TD (es$ and clonaz)Tj 5.37823 0.00001 TD 0 Tw (epam)Tj -16.5576 -1.1396 TD 0.134 Tw ((Klonopin). Clonidine is the most commonly)Tj 0 -1.1395 TD 0.186 Tw [(used medication for childr)10(en)69<D5>80(s sleep)16(,)]TJ ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 5.375 0 0 5.375 190.9601 53.1952 Tm 0 Tr 0 0 0 1 k 0 Tc 0 Tw (54-56)Tj ET Q /GS3 gs /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 208.1214 49.7577 Tm 0 Tr 0 0 0 1 k 0 Tc 0.186 Tw (and is)Tj ET Q endstream endobj 42 0 obj << /Length 5670 >> stream /GS0 gs q 0 0 265 612 re W n 1 g 0 612 0 0 re f Q /GS1 gs q /GS2 gs 0.102 0.066 0.012 0.012 k -9 -9 283.5 630 re f Q /GS2 gs q BT /F3 1 Tf 10.75 0 0 10.75 33 561.2577 Tm 0 Tr 0 0 0 1 k 0.006 Tc 0.369 Tw [(especially beneficial in childr)10(en whose RLS)]TJ 0 -1.13953 TD 0 Tc 0.032 Tw [(r)10(esults in sev)6(er)9(e sleep-onset pr)6(oblems. An occa-)]TJ 0 -1.13954 TD 0.01 Tw (sional side effect of clonidine is the induction or)Tj T* 0.018 Tw [(aggrav)6(ation of sleep terr)5(ors. 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All Rights Reserved.Gill Sans is a registered trademark of The Monotype Corporation Plc. (C) Copyright 1989, 1990 The Monotype Corporation Plc. All Rights Reserved. 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All Rights Reserved.Gill Sans is a registered trademark of The Monotype Corporation Plc. (C) Copyright 1989, 1990 The Monotype Corporation Plc. All Rights Reserved. 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