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Cause for increased sleepiness and happy when awake.

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My daughter will be 2 April 30th as a preemie. The last 4 days she has been taking her nap at 2pm and sleeping until the next morning, roughly 8am. She will wake up about midnight to eat but goes right back to sleep. She has no other symptoms, when she is awake she is happy and plays. Should I be very concerned? She laid down for her nap yesterday at 2pm and woke up at midnight for food, went back to sleep till 6 am and is now back asleep at 10am and it is 11:15 am now as I send this.

Category: Pediatrician

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Category: ICU/ Critical Care Specialist
 21 Doctors Online

Dear parent,
Thank you for your query at DoctorSpring.com

I can understand your concerns. This behaviour is definitely bordering on abnormal. It is true that children may have varying sleeping patterns as they grow up. But, any child who has recently started sleeping for over 18 hours a day is definitely of concern.
Is she febrile?
Is there a recent change in her behavior?
Is her weight and height normal for age?
Has she had any similar episodes in the past? Is there any family history of any inborn errors of metabolism or hyperammonemia?
Does the child have any other peculiar behaviour?
What was the cause identified for her heart murmur? How severe is her infantile scoliosis? Has she undergone evaluation to rule out any associated congenital anamolies?
Is the child having any weakness or paucity of movement in any limb or facial asymmetry? Is there any history of neurological illness or seizures in child or family?
Is there any setting for substance abuse? Does the child have any chance of coming in contact with opioids or other drugs?
Regards
Dr. Saptharishi L G


Patient replied :

Thank you for your responce Dr. Saptharishi L. G. She is not Febrile, her weight and height is in normal range. I have noticed that her and her twin brother have kind of started their terrible twos in fighting with each other and that it is. She has not had any symptoms like this in the past. The only problem she had in the past was she never wanted to sleep. Her doctor then was not concerned and said it was typical. There is no family history on either side of the family that has had "Inborn errors of metabolism or hyperammonemia. There has not been any peculiar behavior. We do have a newborn in the house. She was born on Valentine’s Day. But my two year old just loves her and loves on her a lot. Her heart murmur went away on its own; no doctor has heard it in almost a year. Her spine was curved at 25 degree. She had a checkup with her specialist and her spine is straight. She went to therapy and the specialist for about a year and half. Her current pediatrician has been blowing me off all week about my daughters sleep pattern changing. This all just started Monday and he keeps telling me that it is normal. As a mother I know it is NOT normal for my child to be sleeping like this and I know something is wrong. She is not showing any signs of weakness or paucity of movement in her limbs and face. There is also no history of neurological illness or seizures in her or family. Lastly, there is no chance what so ever that she would have come in contact with opioids or any other drug. She does take probiotics twice a day. I am sorry, I just noticed how I worded about her age. She will be two years old next month she was born a premature at 31 weeks with her twin brother.


Dear parent,
Thank you for answering all my queries. You have definitely helped me understand the whole clinical scenario better.
Your observation is perfectly right. I would agree that any child who has recently started sleeping for 18 hours a day is abnormal.
Please observe the child for another 24 hours. Do not let her sleep in the afternoon today. Observe her behaviour closely when she is awake. Allow her to sleep only at night, may be around 9 pm. Do not let her sleep beyond 8 am. If she does insist on sleeping in the noon, do wake her up after 1-2 hours. We ll try doing this and you can get back to me in 24-48 hours.
All the best. Hope she recovers soon.


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
Dr. Saptharishi L G and 4 other Medical Specialists are ready to help you

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