Strange Body Positions In Children's Sleep - "Quiet" Pathology

The child sleeps soundly and quietly without moving and without disturbing anyone. Still, his sleep might be considered deviated. Among the peculiarities of children's sleep, it is important to mention the statistic phenomenon. Examples of this phenomenon could be a strange body position and sleeping with open eyes. These phenomenon have escaped the attention of research but are quite important for practicing physicians and parents. It is very helpful to have some information to be able to distinguish between deviations and normal sleep features.

Strange Body Positions

Old medical books make frequent reference to the strange way some people sleep. In recent years, we have had a chance to rediscover the importance of body positions in sleep, especially for treatment of Obstructive Sleep Apnea Syndrome in adults. Unusual and peculiar positions in sleep are common in children as well. They are part of normal development. When and what kind of positions can be considered abnormal?

All parents know that body position in a short-lived feature. If a child sleeps with his head hanging off the bed of his arms twisted in a peculiar way, his is simply perceived as being uncomfortable. We know that the child will soon change his position and if not, we can easily move his head back into the pillow and his arms back in order to make him more comfortable. Many unusual positions may be especially favored by the child and may look "cute" to us. It is perfectly okay to have many and varied sleep positions.

But the situation may be different. Certain particular, unusual and strange positions may last too long. Most importantly, you may not be able to change them. If you try to put the child's head, for example, back on the pillow, he immediately slides down back into his former position. If you do this another time, it will have the same effect. If you forcefully prevent him from returning to the same position, the child may wake up, get irritated or exhibit some somatic symptoms. He might urinate, have an asthma attack, or start coughing.

Observation convinced us that some kind of inner physiological process forces such positions. They are internally set. What is important is that the children who have strange positions may later on develop various sleep deviations, or some somatic problems. It has become apparent that such specific, strange positions reflect some changes in the integrated activity of the sleeping brain. The following types of sleep positions in our experience, may predict the appearances of psychosomatic problems:

There is a group of so-called get-ready positions, which increases tones of muscles. They have what we call hyper-tonus. For example, the child looks as if he is stretching his arms or legs, and his muscles are very firm. The child pushes or butts his head and arms against the headboard of his bed. The tonus of his muscles is increased. Some of the observed children developed compulsive hair pulling later on. This positions is usually associated with Stage 2 of the first two sleep cycles.

The so called upside-down position. As in other forced positions, such as the first one described the tones of muscle increase. In this case, the child stays for a long period of time and his head down and does not change his position. If you try to put his head back, the child slides down, to the same position. Several children with similar sleep patterns were found on the trauma unit, having experienced a concussion from head trauma. Such children sometimes also developed body rocking.

Arched positions. The whole body is over-extended. It looks as though the child is standing on his head and feet. The body seems to be arched in an odd fashion. There was a case when a doctor saw a child in this strange position in the hospital. He perceived it as a symptom of increased intra-cranial pressure. However, neither lumbar puncture nor a thorough neurological examination demonstrated any abnormality. These types of positions were also observed in children who later developed nocturnal asthma attacks. This position, just as the upside-down position, is usually common in Stage 2 sleep.

These body positions are almost entirely opposite to the previous ones. All muscles of the body are completely relaxed, and even the chest is not visibly moving. To the observer, it looks like the child is "dead". Many mothers, in fact, call them dead positions. They often check to see if the child is breathing. Sleep recording shows Stage 2 sleep. Such positions are typical of bedwetters before they actually urinate and of the patients with sleep apnea before apnea develops. This position can also be seen in head-bangers.

Parents also report sleep with stretched arms. The arms are stretched in front of the child when he is sleeping on his back, and in some cases the child waves them in front of him. Sleep recording shows Stage 3 sleep. These children are also prone to having sleepwalking and/or sleeptalking episodes.

Sleep with open eyes is quite common for newborns and infants and sometimes perhaps for older children. During the first stages of sleep, the child's eyelids are not closed completely, and you can see the eyes between the eyelids. However, sometimes in older children and adolescents, the space between the eyelids is large enough to leave the impression that the person is staring at you. This looks somewhat scary, and it is called "rabbit eyes." The view might be quite disturbing for parents. This phenomenon is not seen during naps, nor is it observed in REM sleep. The significance of open eyes for diagnosis or for the prediction of different disorders is not clear, and requires further investigation.

Analysis of how normal positions develop with age shows that positions mature in accordance with the child's age. It is important to know the face of "maturation", because different ages are associated with different types of dominant positions in sleep. With every year the general characteristics of basic positions are also changed. It is quite fascinating that often the position changes to the opposite type. We call it "inversion" of positions. For example, newborns have predominantly "tense" types of positions, but after six months the child's positions become "relaxed". His muscles are very soft and look as if they are paralyzed. During the second year of life, a single position quickly changes into several different positions. At age 8, we can once again see predominantly one position. When the child gets sick, sleep positions change, often to the most recent previous ones, or the position favored by the child when he was an infant.

Position changes are very sensitive to internal (somatic) and external (psychological) factors. In older children, we have seen regression to the position of young children, especially if the person got sick or depressed. Strange positions in sleep are, in fact, an exaggeration of positions seen in normal situations. In 1962, Dr. A Peiper described the position similar to the arched position in children who were suffering from vitamin D deficiency.

There are so many different positions, some of them very elaborate, whose significance is not clear. Some have the same characteristics as those described above. For example, the child covers his head with a blanket when touching the cold surface with his feet.

Strange positions may have a clinical significance. If these positions are associated with problems in sleep and awakening, you should bring them to the attention of your pediatrician or sleep specialist.

Source: "The World of Childrens Sleep" Reprinted with permission by Alexander Golbin, M.D., Ph.D.

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