Children's health is vulnerable at any age. Parents regularly take various measures to protect their children’s bodies. One of these is vaccination. Most mothers and fathers are wary of vaccinations against various diseases.

One of the most controversial is DPT. This is an adsorbed pertussis-diphtheria-tetanus vaccine. It consists of a large number of killed pertussis microbes and purified diphtheria and tetanus toxoids.

Pediatricians always warn parents that after the administration of this drug they need to closely monitor the baby’s condition. This is necessary in order not to miss the moment when emergency medical care may be required. So what is the child’s behavior after DPT?

Normal sleep in babies and children

Sleep is an opportunity for the body to conserve energy, restore normal processes, and promote physical growth and mental development. The most obvious consequence of insufficient sleep is daytime sleepiness. However, sleepiness in children also commonly manifests as irritability, behavioral problems, learning difficulties, and poor academic performance. Distinguishing significant sleep disturbances from normal age-related changes can be quite a diagnostic challenge.

Sleep changes significantly during the first few years of a child's life, following physical maturation and development. Newborns require the most total sleep time and have a fragmented sleep-wake schedule. From the age of five months, babies can sleep longer. By the age of six months, babies can go without night feedings. In addition, infants experience more frequent night awakenings, shorter sleep periods, and slightly less total sleep time. As children grow older, sleep periods gradually lengthen and total sleep time decreases.

The wide variation in children's sleep behavior may be secondary to cultural or genetic differences. Knowing the normal stages of sleep development can help clinicians and parents differentiate normal sleep from common sleep disorders such as obstructive sleep apnea, parasomnias, behavioral insomnia, sleep phase disorder, and restless leg syndrome.

Associated symptoms

In some cases, along with drowsiness, additional signs of the body’s reaction to the administered vaccine are observed. If you notice the above symptoms, you need to sound the alarm and consult a doctor as soon as possible. Among them are the following aspects:

• the child sleeps all day after vaccination, and this condition occurs for more than three days;
• body temperature rises to critical levels, above 38.5 - 39 degrees Celsius;
• disturbances in the functioning of the gastrointestinal tract are observed, vomiting develops, and diarrhea begins;
• any rash on the skin indicates an allergic reaction after vaccination, which in turn is also dangerous for the child, as it can cause severe symptoms.

Often there is a reverse reaction of the child’s body to vaccination. Instead of a drowsy and lethargic state, the child suffers from insomnia, cannot fall asleep during the day, and behaves extremely restlessly. Babies are constantly fussy and cry for a long time. In some cases, problems falling asleep may be related not only to the vaccine administered, but also to a number of factors. Among them are:

1. Difficult labor process (occurs when a child is left without amniotic fluid for a long time, childbirth is too fast, as well as various intrauterine anomalies);
2. Functional disorders of the gastrointestinal tract (underdevelopment of systems and organs, accumulation of gases in the tummy, colic);
3. Teething (very often teething is manifested by severe symptoms, and at this time the child receives a dose of a drug with pathogens);
4. Incorrect microclimate in the nursery (sleep disturbances can occur if the environment is too hot and stuffy).

Parents should remember that prolonged sleep after vaccination is very important for a small organism. Therefore, if the child sleeps for a long time after the procedure, then there is no need to panic. The alarm should be sounded if the baby exhibits additional severe signs of the disease. In this case, you cannot do without medical help.

Obstructive sleep apnea

Obstructive apnea is characterized by obstruction of the upper airway despite respiratory effort, which interferes with normal sleep patterns and pulmonary ventilation. The disease may be associated with obesity, a decrease in the size of the upper airway, or insufficiency of the pharyngeal dilator muscles. However, in children, obstruction occurs primarily due to enlarged tonsils and adenoids. Initial manifestations usually occur between the ages of two and eight years, which coincides with the peak growth of the tonsils, but the condition can appear at any age. The overall prevalence in children is between 1% and 5%. Both boys and girls suffer from sleep apnea, but the condition is more common in ethnic minorities. Classic symptoms of apnea are snoring and breathing problems. However, not all children who snore have this condition. The prevalence of nighttime snoring in children is as high as 27%, which can make apnea difficult to recognize. Other common symptoms include unusual sleeping positions (eg, hyperextended neck, sleeping with the mouth open), sleep-related paradoxical breathing, night sweats or enuresis, morning headaches, and excessive daytime sleepiness. However, children are less likely than adults to experience daytime sleepiness. Sleepiness in children most often manifests itself as depressed mood, poor concentration, decreased attention, or behavioral problems. Physical examination may reveal enlarged tonsils, micrognathia, and pectus excavatum.

Children with suspected obstructive sleep apnea should be referred for polysomnography. In addition, a referral to a sleep specialist will be needed for children at risk who suffer from attention deficit hyperactivity disorder, cardiorespiratory insufficiency, cranial anomalies, congenital defects and Down syndrome.

Left unchecked, apnea can lead to neurobehavioral problems, decreased attention, emotional dysregulation, decreased academic performance, nocturnal enuresis, growth disorders, and, in rare cases, systemic hypertension, pulmonary hypertension, and cor pulmonale.

The main treatment method is adenotonsillectomy. Postoperative polysomnography demonstrates relief from apnea in more than 70% of normal-weight children and in less than half of obese children. Postoperative improvements in quality of life and behavior may also occur. After treatment, all children should undergo a clinical examination six to eight weeks after surgery, and polysomnography should be repeated to assess residual apnea in obese children. 18 When prescribed, polysomnography should be performed after the pharynx has completely healed, usually no earlier than six weeks after surgery.

Parasomnias

Parasomnias such as sleepwalking (somnambulism), talking in sleep, confused arousal, horror and nightmares in sleep occur in every second child. They are defined as unwanted events that accompany sleep and usually occur during the transitions from sleep to wakefulness. In addition, they are characterized by the child's complex activities that appear goal-directed but are characterized by a lack of interaction with others around them. Associated features include confusion, automatic behavior, difficulty waking up, amnesia, and rapid return to full sleep after the event.

Most parasomnias, such as sleepwalking, sleep talking, confusional arousal, and sleep fears, occur in the first half of the sleep period during non-REM sleep. Children usually do not remember such an event. In contrast, nightmares usually occur in the second half of the sleep period during rapid eye movement sleep. Children can remember these events. It is important to note that the symptoms and timing of nocturnal seizures can coincide with parasomnias. These disorders may be indicated by repetitive, stereotypical behavior and strange sleep positions adopted by the child.

Precipitating factors include insufficient sleep and disorders that cause partial awakening from sleep. Apnea is a common trigger for parasomnia: more than half of children presenting for sleep terrors or sleepwalking also have apnea. Other triggers may include restless legs disorder, gastroesophageal reflux disease, forced awakenings, and certain medications.

Parasomnias often resolve spontaneously by adolescence. Treatment focuses on calming, reducing triggers, and increasing total sleep time. When appropriate, parents should be informed of safety precautions (eg, lock doors and windows, use motion alarms, clear the floor of toys, place a mattress on the floor). Children who exhibit atypical, disruptive, or aggressive behavior or who do not respond to conservative treatments should be referred to a mental health professional for further evaluation.

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Video on the topic

Dr. Komarovsky about what to do after vaccination:

For every mother, the health of her own child is the most important thing in the world. Therefore, whether to vaccinate or not is up to each parent. He needs to remember that the introduction of vaccines is necessary so that the baby’s body learns to cope with serious infectious diseases.

If four or five days after the injection the child’s condition does not improve, an urgent visit to the pediatrician’s office is necessary. If your temperature rises and antipyretics do not work, you should urgently call an ambulance. Otherwise, there is a threat to the child's life.

Behavioral insomnia in childhood

Behavioral insomnia in childhood is characterized by a learned inability to fall asleep and/or stay asleep. The prevalence of pathology ranges from 10% to 30%. Some disorders are characterized by the child's inability or unwillingness to fall asleep or return to sleep in the absence of certain conditions, such as a soothing parent (sleep association disorder). The no-restrictions option occurs when parents fail to set appropriate boundaries, such as when parents allow the child to sleep in their own bed when the child refuses to sleep. Most children with behavioral insomnia exhibit traits of both types during childhood.

Prevention is the best treatment for behavioral insomnia in childhood. Clinicians should teach parents about normal sleep patterns, good sleep hygiene, realistic expectations, setting boundaries, and bedtime routines. These actions should focus on feeding your baby regularly and consistently, maintaining bedtimes, bedtime routines, and bedtimes. Babies are more likely to suck on a pacifier and fall asleep on their own if they are constantly placed in their crib awake rather than already asleep. Creating a regular routine will set expectations and eventually your baby will learn to fall asleep on his own. Ignoring techniques (putting the child to bed and ignoring him until the morning or for a certain period) are also effective in treating this disorder. Sleeping pills and sedatives are ineffective for treating this disorder.

Causes of increased drowsiness after vaccination

Some vaccinations are easily tolerated, others are quite severe for the immune system and are always accompanied by some kind of negative reaction. The heaviest vaccination is DPT, which is carried out in three stages. Among the reasons why a child constantly sleeps after vaccination are the following factors:

1. It is easier for the body to fight the disease when the baby is calm or sleeping. Building immunity to the vaccine is carried out in two stages. The first is the production of antibodies to the resulting strain, the second is the removal of pathogens from organs and systems. Therefore, drowsiness is quite common, especially on the first day after vaccination;
2. The effect of sedatives. Many pediatricians recommend after vaccination, when the baby is brought home, to give him the prescribed dose of a sedative, for example, Suprastin. This medicine has a mild hypnotic effect, so children sleep a lot after the vaccination procedure.

Drowsiness is a normal reaction of the body to the administered drug. For example, most babies are sleepy for three days after the DTP vaccine. Very often, along with lethargy and malaise, an increase in body temperature is observed. Against the background of hyperthermia, the child cannot lead his usual active lifestyle. A severe condition leads to a desire to sleep for a long time. When a child sleeps for a long time after vaccination, it is very important to monitor his body temperature. If there is a noticeable and rapid increase in the thermometer, it is necessary to give antipyretic drugs. As a rule, paracetamol-based medications are allowed.

Delayed sleep phase disorder

The master circadian clock, located in the suprachiasmatic nucleus, controls sleep time and operates on a 24-hour cycle for most people. The discrepancy between the internal clock and the external world requires constant “resetting” by temporal cues such as light, melatonin, physical activity, body temperature and food intake. Light is the most powerful of these pointers - synchronizers. Inappropriate timing of light exposure can alter circadian rhythms. For example, exposure to light before bed (especially blue light from TV screens) can suppress melatonin production and ultimately delay sleep onset. Children with delayed sleep phase disorder experience normal bedtimes and wake times that are at least two hours behind socially acceptable times. The disorder is more common during adolescence, when the circadian rhythm is thought to lengthen and the child becomes more social. The prevalence of the disorder among adolescents ranges from 7% to 16%. The condition is diagnosed based on the patient's medical history and documenting sleep and wake times in a diary or sleep log. Parental concerns typically relate to late bedtimes (2 a.m. or later), sleeping in, difficulty waking up, and being late for school. However, frequent night awakenings are unusual and sleep architecture is usually normal.

Treatment aims to align the circadian rhythm with desired sleep and wake times. As with all sleep disorders, maintaining a regular sleep-wake cycle and good sleep hygiene are the cornerstones of treatment. It is important to avoid bright light before bed. Removing all light-emitting devices (eg, electronics, portable media, tablet computers, cell phones) from the bedroom may be helpful. Bright light therapy used within the first one to two hours of waking up may also be helpful in improving circadian rhythm. There is good evidence that melatonin supplementation (0.3 to 5 mg 1.5 to 6.5 hours before desired bedtime) is an effective treatment for delayed sleep phase disorder.

Restless legs syndrome

The incidence of restless legs syndrome in children is about 2%. The condition is characterized by an unpleasant sensation in the legs with an urge to move the legs, starting in the evening. Rest worsens symptoms, but movement provides some relief. Other symptoms include difficulty falling asleep, bedtime resistance, growing pains, and symptoms similar to those of attention deficit hyperactivity disorder. The disease in children is associated with negative behavior and mood, decreased cognitive abilities and attention, and is more common in children with attention deficit hyperactivity disorder. Dopamine dysfunction and iron deficiency are thought to play a major role in the pathogenesis of restless leg syndrome. In addition, symptoms may be aggravated by excessive or insufficient physical activity or the use of caffeine, nicotine, antihistamines, selective serotonin reuptake inhibitors, or tricyclic antidepressants.

Diagnosing restless legs syndrome in children can be challenging because they may not be able to describe the main symptoms. The diagnosis can be made if the history is appropriate and at least two of the following are present: sleep disturbance, the disorder in a first-degree relative, or five or more periodic limb movements per hour of sleep during polysomnography.

Once restless leg syndrome is diagnosed, conservative treatment involves avoiding aggravating factors. Because iron deficiency is common in these children, measurement of ferritin levels is necessary. Iron replenishment therapy should be started if ferritin levels are less than 50 mcg/liter. There are no medications approved to treat restless legs syndrome in children. Patients with symptoms that do not respond to conservative treatment should be referred to a mental health professional for further evaluation.

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