Restless Legs Syndrome in Children
Reviewed by: HU Medical Review Board | Last reviewed: June 2020 | Last updated: November 2020
Restless legs syndrome (RLS) is a neurological condition that disrupts sleep in children and adults. That is why it is also called a sleep disorder. About 2 to 4 out of every 100 children have RLS.1
RLS in children often occurs with another condition, periodic limb movement disorder (PLMD). RLS causes uncomfortable sensations and restlessness in the legs late in the day while PLMD causes jerking and kicking while asleep. Children with RLS, like adults, often have both conditions.
Because childhood RLS leads to poor sleep, it may cause behavior problems such as attention deficit hyperactivity disorder (ADHD), depression, and anxiety. Daytime sleepiness and concentration problems are also common. Children with RLS may also have nightmares, sleepwalking, and bedwetting.1
What causes RLS in children?
The most common causes of restless legs syndrome in children are family history, anemia (iron deficiency), and issues with the brain chemical dopamine.
RLS also may occur in children with serious chronic health conditions such as kidney disease, sickle cell disease, anemia, obesity, high blood pressure, liver transplant, Ehlers-Danlos syndrome, migraine, and tension headaches. Children who were born too early (premature) have higher rates of RLS later in life.1
How is RLS different in children?
Adults are more likely to talk to their doctor about being unable to fall asleep because of the way their legs feel. However, leg symptoms usually are not the first thing a child or their parent brings up. When seeing a pediatrician, the parent is equally likely to bring up:1
- Sleep issues – 46 percent
- Behavior issues – 46 percent
Restless sleep and problems falling or staying asleep are the sleep issues most often mentioned by parents. Parents are also more likely to mention problems in school and ADHD than legs or arms jerking in sleep.
How is RLS diagnosed in children?
For a child to be diagnosed with restless legs syndrome, the child must be old enough to describe their symptoms in their own words. Some common questions the doctor may ask include:1
- Do your legs bother you at night? At school?
- Do you want to move your legs or feel ants wiggling or itching under the skin?
- Does this happen in the morning, the afternoon, or the evening?
- What are you doing when you get these feelings?
- Do your legs feel better if you move? Or does it feel about the same or worse?
The parent will be able to report on problems at school, moods, and sleep.
The doctor may order a polysomnogram, or overnight sleep lab test, to diagnose PLMD and its severity. Ankle accelerometry is another test that may be needed.1
How is RLS in children treated?
The most common treatments for children with RLS include:1
- Building healthy sleep habits
- Iron supplements
- Leg massage
- Cutting out caffeine, nicotine, or some cold medicines and antidepressants
No drugs are approved to treat RLS or PLMD in children. Because of this, doctors generally avoid prescribing RLS drugs off-label to children younger than 6 and very cautiously in children over 6. At age 12 and older, doctors may become more open to prescriptions to treat severe RLS.1
If RLS gets in the way of a child’s performance at school, the parent may need to ask for accommodations such as:
- Allowing physical activity during recess
- Avoiding sitting still for long periods
- Giving permission to move quietly if leg sensations are painful or distracting