4-8 PM SYNDROME IN PEDIATRICS OR DISTURBED SLEEP BABY SYNDROME

Introduction:As this article contains a vvolley of in formations it will be found very useful to lot of parents who might visit this site.It is hoped that all new moms grand parends, caregivers, creech owners would ffind very usefulin their dailychild rearing duties.This will be published in a national medical journal shortly.

4-8 pm syndrome in pediatrics:(disturbed sleep baby syndrome)
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Introduction;It is often a nightmarish experience,if a very young child cries violently,all on a sudden,as if beaten by someone,black&blue.Face often turns red.Tears flowing like water falls.parents become panicky.refuses to feeds.STOPS FOR A SECOND ONLY TO RESTART THE WHOLE EPISODE once again .1/2-2 hrs cry is quite acceptable though painful.EVERY parent has to undergo this bitter experience once in away atleast during child raising practice.What is the cause?Is it preventable?How should one meet such situation?Is gripe water an answer?The auther has not come across to get an answer after searching the world literature .Hence this attempt.There are instances where people have phone called 9 1 1(ambulance/policein U S A)

WHAT IS IT ?
-------------A new born often sleeps 18 hrs a day.may wake up & cry every 2 hrs for feeds.NEONATES go to sleep almost immediately after feeds/burping.Feeding duration increases after 3 months. But may start crying for no OBVIOUS reasons.common causes for crying are listed in tables.
Table one;

1. hunger



2. thirst



3. itching sense anywhere



4. 0bstipation/constipation.



5. diarrhoea



6. vomitig/regurgitation



7. hiccough



8. wet diaper.



9. unplascent atmosperic temperature



10. crude unplacent noices(noices from fan fridge, washing machine air conditioners are said to be producing sedation &sleep ;hence exclude from crude noice



11. fever.



12. post immunisation.



13. Any recent intra muscular injection.



14. wheezy chest(asthma)



15. severe pruritis anywhere(itching)



16. unplacent atmosphere.(cinema theater)



17. lack of mothers presence



18. stomach upset(gastro esophageal reflux),strangulated hernia,hiatus hernia,intestinal colic ,intussuseption,worms intestinal obstruction(abdominal dis tention,vomiting,fever,acute pancreatitis)
    

Table-two. Causes of continuous cryingfor hours/days.

1. abdominal pathology giving pain



2. venomous insect,scorpion sting,with or without cold arms,legs,



3. acute bronchiolitis/asthma unrelieved.



4. heart failure due to any cause(HR over 120-140 gallop rythm



5. jet lag .



6. congenital megacolon(passing stools once in 10 days or so,habitually)
   

Auther's experience:

One yr old brought for sleeplessness&;continuous cry,-duration72hrs.Already seen by 10 docters&;treated with sedation/injections.on exam;Restlessness.unable to fix child for i.v. injection.very loud cry.heart rate 200/mt,cardiac pulsation visible outside.Child rolled in a blancket to give iv scalp vein inj.Digoxin+lasix one dose given.cry lasted for 15 mts &slept.woke up after 3hrs& found playing.HR-100/mt.Had one full feed after 3 days..Discharged at request.
Auther's hypothesis
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The syndrome is due to a chaotic situation ,arising in the central nervous system,due to electrical impulses running in the axons&dendrites of the nervous tissues of the brain,inthe most disorderly way.LACK of sleep is the main cause.Sleep is a condition reflex,developed over years.FROM new born period onwards sleep duration decreases slowly to 6-8 hrs by age 12 yrs.Why should it become crancky,in the 4-8 pm period in the under 2-3 yr age group?When the child wakes up in the morning the alpha weaves are more in the electro encepalographic weave pattern(E E G) when it sleeps at night(complete unconciusness),theta weaves are predominent(the above facts are established )The developement of these are due to flow of electricity; it takes its own time as per maturity of the brain tissue,;it comes to a fair degree of satisfaction at age 2.The developement ,transformation&predominence of THEETA weaves usually takes place
usually around after 4-8 PM So the 4-8 pm time is the most vulnerably disturbed time&;hence the restlessness,cry inability to put to sleepy mood.This hypothesis can be confirmed or dismissed only if serial EEG is takenfrom 6AMto 8 PM IN A SIZABLE NUMBER OF CASES&RETROSPECTIVE analysis made.Many mothers put the babies to sleep in a swing &put the child in motion in order to make them sleep.This effect is reflected in the possible,coinsiding production of theeta weaves in EEG making them to sleep.
ONE MORE POINT WORTH MENTIONING IS THAT THE CHILDREN WHILE CRYINGsqueeze their eye balls& skull,above motor cortex of the brain accompanied by notable behavioural changes.It is sensible to postulate that the child is making a vain attempt "to squeeze the brain tissues" when in confusion,asthe electrical activities are disturbed.Afterall eyes are nothing butpart of brain tissue(window of the brain)Yawning,drooping of eye lids&a mild generalised hypotonia all point towards want of sleep

GENERAL DISCUSSTION:
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There is an array of differential diagnosis when a child cries.Many parents do not know that their babies will become fussy & restless now &then&mostly during 4-8 pm (pre sleeping hours)
is normal.Sothey always think that there is an abdominal colic&go running after gripe water!(because they were told that gripe water was given from the time of their great grand parents.Some people speak of SHACKEN BABY SYNDROME IF THE CHILD IS PUT ON SWINGS.In a moving car a crying or non crying child often sleepsIt shows that motion has a direct influence on the electrical activity of the motor cortex of the brain.Babies often sleep only for 30-to 60 mts,usually after afeed,when there is a slight post prandial increase in blood sugar level From 10 pm to 5 am it may wake up once or twice for feeds sake.A crying child is like a patient who will try the patience of the care giver who needs an enormous amount of forbearence.It will be out of place to discuss the various EEG abnormalities as this is not meant for doctors.Enough if the reader knows what &where is the problem SO the inability to sleep
is due to an electrical disturbance inthe brain tissue where there is constant transmission of impulses all 24 hrs.
SHAKEN BABY SYNDROME; It is a form of child abuse.Non accidental brain haemorrhage.Retinal haemorrhage(leads to blindness)These three constitute the problem.When child cries inconsolably the frustrated (psychopath)care giver looses emotional balance.Permanent brain damage, or death occurs..Symptoms:-1)irritability 2)behavioural change.3)Lithargy, sleepiness,not smiling.4)poorfeeding.5)loss of conciousness 5)vomiting 6)convulsions,7)not breathing,Many SBS victims may be undignosed vaccine inducsed encephalopathy.All vacines can produce throbocytopenia(low platlet count) causing brain haemrrhage.,most notably,Hep.B,Hib,chicken pox,MMR.Many parents have been wrongly punished &;imprisoned(in USA) for causing SBS WHEN THE CHILD UNDRGONE RECENT VACCINATION JUST PRIOR TO CLINICAL PROBLEM.This does not result from gentle swinging,uniform,whole body not involving head alone ,like shacking a coconut!.
ADVISE TO PARENTS/CREACH OWNERS/ BABY SITTERS /NANIES.
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WHEN a child CRIES AT 4-8 PM,rule out all possible common causes&;rectify.You may try all your trump cards at your hands,like singing a lul-a-by,or a soft radio music or a colourful toy which makes sound & movements.There are two donts:!)Never give a sedative 2)Never loose your temper &shake the baby's head vigorously.SOME BABIES SLEEP WHEN SWADLLED.,SOME IF AKERCHIEF IS GIVEN IN HAND.However the best would be to to embrace child in standing position(head on one side of your chest &legs on contralateral side of your abdomen)(please see photograph below). Then give a gentle rocking spiralling movement to and fro.99% babies would go to sleep. Our time tested remedy (yenai)(tamil)meaning swing is still the best remedy&there will be no shaken baby syndrome resulting .Next best is put the cuild in a car &drive. child will sleep in motion within 5-10 mts.If still the child cries drive the car to a doctor's clinic.Summery:When a child under 2 makes hyperkinetic cry the mother often looses temper.I t may be harmless in 99% cases,but should not forget hidden danger in 1% case. unless rulled out all possible cause.If one knows all the tricks of the trade child can allways be made to sleep if mother has developd a keen observation power which are specific in each child.All diferencial diagnosis discussed.Possible changes in electro encephalographic pattern ,postulated to be the cause.Dysrythmic electrical impulss causing a traffic JAM inside brain is most probable.CONCLUSION:pARENTS need not become panicky if child cries violently at 4-8 pm in the under age 2.Likefebrile fits the age & time factor is variable.Thereis no water tight compartmentment in medical matters.In the developing brain the nerve transmission of impulses takes time to settle down for full developementof condition reflexes as per individual variation enough to produce theeta activity in EEG,where child goes in to a good sleep mode.