The Woolcock Institute of Medical Research

Dr Mimi Lu is a Respiratory and Sleep Physician who specialises in managing paediatric sleep conditions ranging from snoring, obstructive sleep apnea, restless sleep and childhood parasomnias. She’s also a mother to a one-year-old and returned to work in the Woolcock Clinic earlier this year with fresh perspectives on what the families she sees are going through.

“Whenever I think about sleep – especially since becoming a mother – I reflect on the interplay between genetics, environment and pathology. What I’ve come to realise is the breadth of what’s considered normal, and how that can be perceived differently depending on other influencing factors.”

“Early on, my daughter would only nap for 45 minutes – which isn’t a lot of time to get anything done. While I understood this was a normal part of sleep development for an infant still establishing her circadian rhythm, in the moment I found myself wondering, ‘Why is she catnapping?’ and ‘Is there anything I can do to change this?’ Even with that knowledge, I still used sleep apps and online resources. They were helpful for me as a parent, but I think it’s important for each family to find what works for them.”

CREATING A ROUTINE

Dr Lu acknowledges this can be an especially stressful time for new parents and that parental stress can unintentionally affect the baby. Taking early steps – such as seeking support from family and friends, working with a sleep consultant or coach and establishing good sleep hygiene – can help create a routine that supports both the baby’s sleep and the family’s wellbeing. Early planning and intervention can prevent challenges from escalating.

She is also emphatic in her belief in the importance of a routine. Establishing good sleep behaviour should be a priority and that includes avoiding snacks and naps.

“Babies need time to develop and mature their circadian rhythm. It’s important to establish healthy sleep onset behaviours from the beginning. A full tummy can help with longer stretches of sleep, but consistently feeding to sleep can set up a pattern where the baby becomes reliant on breastfeeding or a bottle to settle. If they wake in the night, that becomes the only way they know how to get back to sleep.”

“When I say routine, I don’t mean following a strict clock. Pay attention to your baby’s cues, aim for adequate volumes of food at regular mealtimes and age-appropriate sleep durations and wake times rather than falling into a pattern of constant snacking and catnapping.”

SEEKING AN ASSESSMENT

Many of the young children who are referred to Dr Lu are experiencing snoring, mouth breathing, teeth grinding and restless sleep. Their hearing and speech maybe also be impacted.

Impaired daytime functioning can be another feature of interrupted sleep.

“If your child is having frequent meltdowns beyond what’s typical for their age, if their daycare reports ongoing patterns of lashing out, if you’re concerned that their development or learning isn’t keeping pace with peers, or if it’s starting to affect your family’s day-to-day functioning – those are signs it’s time to seek an assessment.”

In young children, sleep disruption can often be due to large adenoids and tonsils, or an underlying component of allergy or allergic rhinitis.

“Then there’s this large, historically less well-defined group often referred to as ‘restless sleepers’. It frequently overlaps with symptoms like snoring, mouth breathing, teeth grinding and night terrors. Some of these children may have sleep apnea, where the apneas interrupt sleep and cause them to move or turn over.”

SOLVING COMPLEX CASES

Since 2018, a separate condition called restless sleep disorder has been defined in children. Research has shown that many of these children have low iron stores – measured by serum ferritin.

“Why are some people just naturally more restless than others? That’s still something we don’t fully understand,” says Dr Lu. “The proposed pathophysiology is that iron acts as a co-factor in the production of key neurotransmitters in the brain, but the levels of iron in the brain can be low even if your blood levels are adequate. Again, there’s still so much we don’t know yet.”

At the Woolcock Clinic, Dr Lu sees patients ranging from birth to 17 with the majority being either preschoolers or in primary school. The multidisciplinary nature of the Clinic means she can draw on expertise in allergies, immunotherapy, ENTs, psychologists and those with special interests such as narcolepsy.

“The system and our MDT meetings mean that, when we have complex cases, we have a range of resources to draw on which is really helpful in finding solutions for patients.”

Find out more

• Welcome to the Woolcock Clinic
• Paediatric Experts at the Woolcock Clinic
• Paediatric Sleep Clinic