Bisacodyl: 5-mg tablets, 1–3 tablets/dose 1–2 × daily Abdominal cramping, diarrhea, hypokalemia
Bisacodyl: 10-mg suppositories, 0.5–1 suppository, 1–2 × daily Abdominal cramping, diarrhea, hypokalemia *Single agent may suffice to achieve daily, comfortable stools.
†Stimulants should be reserved for short-term use.
Sleep is a universal phenomenon that is critical to child health, development, and daily functioning. This complex behavioral and physiologic process is characterized by a reversible state of partial unresponsiveness and disengagement from the environment. Sleep is broadly categorized by polysomnographic patterns into rapid eye movement (REM) sleep and non-REM (NREM) sleep. REM sleep is characterized by an active, awake-like electroencephalography (EEG) pattern and muscle atonia. NREM sleep is further divided into three stages—from stage 1 (N1), which is the lightest sleep stage and consists of low-amplitude, high-frequency EEG activity, to stage 3 (N3), also known as deep or slow-wave sleep, characterized by low-frequency, high-amplitude delta waves. REM and NREM sleep alternate in cycles throughout the night.
Sleep architecture changes from fetal life through infancy and childhood. Sleep cycles last approximately 60 minutes in newborns and gradually lengthen to 90 minutes in children and adults. Neonates typically begin their sleep cycle in REM sleep, whereas older children and adults begin sleep in NREM sleep. REM sleep in neonates is termed active sleep, and frequent muscle twitches and facial grimaces are common. REM sleep comprises up to 50% of total sleep time in newborns and gradually decreases to 25% to 30% by adolescence. Slow-wave sleep is not seen before 3 to 6 months of age. Beginning from 6 to 12 months and continuing through adulthood, the amount of REM sleep shifts toward the last third of the night, while NREM sleep predominates during the first third of the night.
The timing and duration of sleep also change with age. Sleep patterns become more diurnal and total daily sleep time gradually decreases. Full-term infants sleep on average 16 to 18 hours per day in fragmented intervals throughout the day and night. One-year-old children sleep on average 10 to 11 hours per night and nap for 2 to 3 hours during the day. Naps decrease from two naps to one during the second year of life. In the United States, over 80% of 2-year-olds nap, decreasing to 50% by age 3. By 12 years old, the average child sleeps 9 to 10 hours per day. By adolescence, the average sleep duration has dropped to 7½ hours per day, even though adolescents need an average of 9 hours per day. Adolescents also develop a physiologically based shift toward later sleep-onset and wake times relative to those in middle childhood.
Cultural factors strongly influence multiple sleep practices, including whether children sleep independently (the norm in the United States) or with parents, other siblings, or grandparents (the norm in many other cultures). Awareness of the varying cultural practices regarding sleep is essential to respectful and effective intervention.
Sleep problems are one of the most frequent complaints in pediatric practice. Numerous sleep disorders exist, including behavioral insomnias (bedtime refusal, delayed sleep onset, nighttime awakenings), parasomnias, and circadian rhythm disorders (Table 15-1). Obstructive sleep apnea (OSA) and sleep disorders associated with mental and physical illness should also be considered.