Restless legs syndrome

What is restless legs syndrome

Restless legs syndrome is a neurological disorder of the legs mainly, but can also affect the arms. It causes discomfort in the legs (or arms) and an urge to move (get up and walk) to relieve the discomfort. Moving around (walking, exercising) seems to only relieve symptoms temporarily in most people.

Since restless legs syndrome affects the legs (and arms) on resting, sleep may be difficult, so people with this disorder often do not get enough sleep and feel sleepy during day, making it difficult to concentrate on work, school or other activities.

Some scientists think that restless legs syndrome may be present in as many as 25% of people with sleep disorders.

There are two types of restless legs syndrome (RLS):

• Primary RLS – this is the most common type of RLS and once it begins, it is present for life with symptoms usually getting worse over time for most people unless the RLS is a more milder form, which does not usually get worse and may have periods of no symptoms
• Secondary RLS – this is when RLS is caused as a symptom of another disorder, or as a side effect of taking certain medications; once the condition is resolved or the medication stopped, the RLS seems to improve as well

Facts about restless legs syndrome

• Onset of symptoms are reported mainly in children and young adults aged between 10 and 20 years
• Studies show this condition is more common than either epilepsy or diabetes in children and young adults between the ages of 10-20 years
• People who have a more severe form of the condition are usually middle-aged or older
• People who have RLS are often sleep-deprived from the symptoms keeping them awake at night
• Other conditions can mimic restless legs syndrome, so a medical diagnosis is required to diagnose the condition
• Restless legs syndrome become worse when sitting or lying down

Symptoms of restless legs syndrome

Symptoms of restless legs syndrome can range from mild to severe:

• Discomfort in the legs (or arms) caused by itching, tingling or “crawling” sensations
• Strong urge to move the legs (or arms) to get some relief from the discomforting sensations
• Restlessness, pacing around, tossing and turning in bed and rubbing the legs
• Inability to sleep from the discomfort in the legs (or arms)
• Symptoms normally just occur on sitting or lying down and usually improve with physical activity, unless very severe where nothing seems to help

People with restless legs syndrome usually report symptoms getting worse later in the day to later at night and especially when they are trying to go to sleep.

Many people with restless legs syndrome also have another condition, called periodic limb movement disorder (PLMD), which is a disorder that causes the legs to twitch or jerk uncontrollably about every 10 to 60 seconds, normally during sleep. These movements of the legs (and sometimes the arms) cause repeated awakenings that disturb or reduce sleep.

Causes of restless legs syndrome

The underlying cause of primary restless legs syndrome is not known, although there is ongoing research to determine the risk factors predisposing a person to this condition.

Some of the current research areas are:

• Neurotransmitter abnormalities – current research is looking into whether abnormalities in the regulation of certain neurotransmitters, such as dopamine cause restless legs syndrome symptoms
• Central nervous system abnormalities – current research also centres on determining if abnormalities in the central nervous system that controls muscles causes restless legs syndrome symptoms to develop

Secondary restless leg syndrome

Secondary restless legs syndrome is thought to be caused (or worsened) by the following:

• Certain medical conditions – studies show that there is a correlation between a number of conditions and development of restless legs syndrome. The conditions most linked with restless legs syndrome are: kidney disease (especially if dialysis is required), diabetes, fibromyalgia, myelitis, nerve disease, rheumatoid arthritis, varicose veins
• Mineral deficiencies – studies show that deficiencies in either iron or magnesium can cause secondary restless legs syndrome to develop
• Peripheral neuropathy – damage to the nerves of the legs and arms is thought to be to one of the main causes of secondary restless legs syndrome
• Vitamin deficiencies – studies show that a deficiency in vitamin B12 can cause secondary restless legs syndrome to develop

Prevention of restless legs syndrome

Non-preventable risk factors

Restless legs syndrome may be unpreventable in certain circumstances:

• Abnormal CNS function – some research suggests that a central nervous system which does not function properly and is not abe to control the muscle effectively, can be one of the risk factors associated with the development of restless legs syndrome
• Abnormal neurotransmitter function – some research suggests that if the neurotransmitter dopamine does not function properly, this can cause restless legs syndrome
• Certain health conditions – people with certain conditions may be predisposed to developing secondary restless legs syndrome and there may be very little that can be done to prevent this. Secondary restless legs syndrome is most commonly associated with: kidney disease (especially if dialysis is required), diabetes, fibromyalgia, myelitis, nerve disease, rheumatoid arthritis, varicose veins
• Certain medications – people who are taking the medications that are known to be a risk factor for causing secondary restless legs syndrome may not be able to prevent their symptoms very effectively while taking the medications. The medications most likely to cause this condition are: anti-convulsants, anti-depressants, beta-blockers, H2 blockers, lithium and neuroleptics
• Peripheral neuropathy – damage to the nerves of the legs and arms is a major risk factor for this condition, as it is thought be to one of the main causes of secondary restless legs syndrome
• Pregnancy – up to 40% of all women who are in their second trimester of pregnancy experience symptoms of restless legs syndrome, which means pregnancy is a risk factor for this condition. Fortunately, the symptoms usually resolve within a few weeks of delivery. Studies show this is possibly due to the greater amount of blood volume and blood flow during pregnancy

Preventable risk factors

There are ways to prevent worsening of symptoms or even prevent restless legs syndrome from occurring:

• Certain substances – a number of substances increase the risk of developing temporary secondary restless legs syndrome. The most common substances responsible for this are: alcohol, smoking cigarettes and caffeine. Avoiding or strictly limiting these substances usually resolves symptoms
• Fatigue – extreme fatigue is a risk factor for exacerbating restless legs syndrome symptoms due to the body not being able to rest properly during sleep
• Nutrient deficiencies – certain deficiencies (iron, magnesium and vitamin B12) are known to to be a risk factor for causing secondary restless legs syndrome. These deficiencies are generally preventable (unless caused by a metabolic inability to absorb these nutrients which needs to be checked out properly by a medical doctor) by following a good diet that includes lots of fresh fruits and vegetables, legumes, nuts and seeds, protein and grains to prevent these deficiencies
• Prevention of type 2 diabetes – one of the associated conditions with restless legs syndrome is peripheral neuropathy, a disorder common in people with diabetes. Type 2 diabetes is mostly preventable by engaging in an adequate exercise plan and eating mostly healthy, unprocessed food
• Stress – any excessive stress is detrimental to any disorder as it aggravates symptoms ad prevents healing from occurring very quickly. In addition to this, being stressed uses up the body’s stores of magnesium very quickly and a magnesium deficiency is associated with incidence of restless legs syndrome
• Unhealthy lifestyle choices – drinking too much alcohol, smoking cigarettes or having excessive amounts of caffeine are all linked to causing secondary restless legs syndrome. Choosing healthier lifestyle choices can all help to prevent symptoms from getting worse, or even prevent the development of this condition in the first place

Complications of restless legs syndrome

There are no seriously major complications of restless legs syndrome, but severe symptoms can be very disruptive to a person’s life and cause the following:

• Mood problems – consistent and prolonged sleep deprivation is a factor that can cause detrimental mood problems due to the tiredness and inability to rest properly from sleep deprivation. The longer and more severe the sleep deprivation, the more severe the mood problems, including anxiety symptoms and depression. Theses mood problems may need further treatment with medications, most commonly with anti-depressants, but alternative therapies can also be used
• Deep sleep deprivation – severe and continued restless legs syndrome symptoms can result in a severe lack of sleep which is especially worrisome if there is a deprivation of deep sleep, a time for the immune system to heal the body and rest adequately for proper functioning the next day. This has the effect of not only creating extreme tiredness, but also, even more importantly, reducing the function of the immune system, which cannot do its work properly during deep sleep. In addition to this, deep sleep deprivation can can affect concentration and memory and can affect one’s ability to perform daily tasks properly, so it has a very wide ranging and almost debilitating effect

When to see a doctor about restless legs syndrome

People who have any of the symptoms of restless legs syndrome should visit their doctor for a check-up in order for the doctor to either confirm this condition or rule it out. The doctor will perform a series of tests in order to diagnose (or rule out) restless legs syndrome.

People who have been diagnosed with restless legs syndrome need to see their doctor if:

• Their symptoms suddenly get worse and none of the medications or other strategies to alleviate symptoms are no longer effective
• They experience different symptoms to the ones they normally experience

Diagnosis of restless legs syndrome

Initial diagnosis of restless legs syndrome is done through the following tests:

• Medical history of symptoms – the doctor will ask a series of questions about your symptoms (especially the duration and severity), your family medical history (if anyone else has similar symptoms), onset of symptoms and to determine whether you are in one of the groups at risk of restless legs syndrome
• Physical examination – the doctor will examine the legs, feet and hands for signs of the disorder and also perform a general checkup of lungs and heart (blood pressure), if needed

Further tests

If secondary restless legs syndrome is suspected due to nutrient deficiencies, based on initial examination, then the following tests will be requested:

• Blood tests – a blood test can be performed to detect if there any deficiencies of certain nutrients (iron, magnesium and vitamin B12), if the doctor suspects that these deficiencies may be the underlying cause of secondary RLS

Conventional treatment of restless legs syndrome

Conventional treatment of restless legs syndrome involves a combination of strategies, including:

Diet modifications

Some dietary modifications may be helpful in reducing symptoms:

• Limit alcohol – people who drink a lot of alcohol often notice that symptoms get much worse when their intake of alcohol is high. Conventional advice is to limit alcohol intake to reduce severity and duration of symptoms
• Limit caffeine – people who drink a lot of coffee or energy drinks, which are high in caffeine, often notice that symptoms get much worse when their intake of caffeine is high. Conventional advice is to limit caffeine intake to reduce severity and duration of symptoms

Lifestyle modifications

Some lifestyle modifications may be helpful in reducing symptoms:

• Avoid smoking – people who smoke cigarettes often notice that symptoms get worse when they smoke, so giving up is highly recommended
• Exercise regularly – physical activity is vitally important to help the muscles, nerves and tissues function properly. Regular exercise helps improve circulation and may also help to improve symptoms
• Massage – especially of the legs and feet, helps to improve circulation, warms the leg muscles to help to them to function properly and may improve symptoms
• Reduce stress – one the biggest triggers for worsening of symptoms is chronic stress. The way to reduce stress is through some type of relaxation therapy – some good ones are meditation, tai chi and yoga
• Sleep – adequate sleep and proper rest is very necessary for any type of health condition, but especially for chronic conditions which especially require the body to get enough sleep to help it heal more effectively
• Spa or bath – many people often report symptoms get better when they have a bath, spa, or other warm water treatment

Medications

In addition to the above lifestyle and dietary strategies, medications can also be used for relief of symptoms, which can be used alone or in various combinations, prescribed by a doctor or specialist:

• Alpha2 agonists – these medications stimulate the part of the brain that activate neurons to slow down muscles movements and sensations in order to help reduce symptoms
• Anti-convulsants – these medications are used for strong muscles spasms, pain and peripheral neuropathy that do not respond to the dopamine agonists
• Dopamine agonists – these medications increase the levels of dopamine in the brain, but cause fewer side effects than Levodopa. They are long-acting and treat moderate to severe cases of restless legs syndrome as well as mild cases that do not respond to Levodopa
• Levodopa – this medication helps with milder forms of restless legs syndrome, is short-acting and is also used to treat Parkinson’s disease. It works to increase levels of the neurotransmitter dopamine in the brain and enable symptoms to be alleviated
• Sedatives – benzodiazepine medications assist with sleeping for people who cannot sleep properly due to the severity of symptoms
• Strong pain-relievers – these are used to treat the pain and discomfort some people experience. These medications are used when pain is really severe and if dopamine agonists also do not work to relieve symptoms

Supplements

If the secondary restless legs syndrome is determine to be from a nutritional deficiency, then supplementation will be recommended, depending on the nutrient (below) in short supply. The type of supplementation (oral, intravenous) will also be advised by the treating doctor or specialist:

• Iron
• Magnesium
• Vitamin B12

Alternative/complementary treatment of restless legs syndrome

There are a number of alternative/complementary strategies which can be undertaken, especially in mild to moderated cases of restless legs syndrome before taking medication.

People who have more severe symptoms need to get approval from their doctor to try any of these strategies, because they may conflict adversely with any medications being taken.

Herbs

These herbs may reduce symptoms, improve ability to get to sleep and improve quality life:

• Chamomile (matricaria chamomilla) – studies show the herb chamomile has mild calmative effects (it has a calming effect on the whole body), so it may be useful to have a cup of chamomile tea before retiring to bed
• Ginkgo biloba – studies show that the herb ginkgo biloba, which has been used in Chinese medicine for centuries, has beneficial effects on peripheral circulation and may help to improve symptoms
• Hops (humulus lupulus) – studies show the herb hops is useful in insomnia as it has mild calmative and sedative effects. Herbal formulas for insomnia generally include hops as one of the ingredients
• Passionflower (passiflora incarnata) – studies show that this herb is effective in inducing sleep without any of the side effects that occur with conventional sleeping medications because it has sedative and analgesic properties
• Skullcap (scutellaria lateriflora) – studies show the herb skullcap has mild calmative and sedative effects which means it is generally used in herbal formulas for insomnia as one of the ingredients
• Valerian (valeriana officinalis) – studies show that the herb valerian is effective in inducing sleep as it has sedative effects that help to improve the quality of sleep. Valerian is often used in herbal preparations for insomnia. Note: some people may experience the opposite effect of sedation (wide-awake alertness) when taking valerian, so try it at the lowest dose possible to determine if this is the case

Vitamins

Certain vitamins can be beneficial in reducing symptoms in people with restless legs syndrome:

• Folic acid – studies show that supplementation with folic acid alleviates symptoms and especially more so when symptoms are caused by a deficiency in this vitamin or in vitamin B12. In addition to this, people with a family history of restless legs syndrome seem to have a higher incidence of folic acid deficiency, so it is important to have a blood test to determine if this is the case
• Vitamin B1 (thiamin) – this vitamin assists the nervous tissue to perform correctly and reduces incidence of symptoms. Vitamin B1 (thiamin) may be more useful for reducing symptoms in combination with the rest of the B vitamins
• Vitamin B5 (pantothenic acid) – this vitamin helps the nervous system tissues perform properly and reduces incidence of symptoms. Vitamin B5 (pantothenic acid) may be more useful for reducing symptoms in combination with the rest of the B vitamins
• Vitamin B12 (cyanocobalamin) – a deficiency of vitamin B12 (cyanocobalamin) is known to cause secondary restless legs syndrome, so this vitamin is very important to help reduce symptoms. In addition to this, vitamin B12 helps the nervous system function more effectively
• Vitamin C – the antioxidant vitamin C helps to strengthen the capillary and other blood vessel walls, so it may help with those people that have peripheral neuropathy symptoms as the underlying reason for the restless legs syndrome
• Vitamin E – studies show that the antioxidant vitamin E may help to reduce symptoms in people with peripheral neuropathy, as it helps to ensure there is proper circulation in the peripherals (legs/arms) and the blood in the veins and arteries is circulating properly

Minerals

Studies show that a deficiency of certain minerals could be the underlying reason for this conditions and supplementation may either resolve the condition or greatly reduce symptoms:

• Calcium – the mineral calcium is necessary to enable proper muscles contraction and to ensure the muscles work effectively, so it may assist with reduction of symptoms (in conjunction with other nutrients)
• Iron – studies have shown that an iron deficiency can be a cause of secondary restless legs syndrome so supplementation may be warranted if a blood test confirms that there is an iron deficiency
• Magnesium – the mineral magnesium is essential to enable the muscles to relax and calm down and studies show it may assist in reducing symptoms associated with this condition, especially as a deficiency in magnesium can cause secondary RLS
• Potassium – the mineral potassium is also necessary for proper muscles contraction and ensuring the muscles work properly, so may assist with reduction of symptoms (especially in conjunction with the other nutrients)

Other nutrients

Certain other nutrients may assist with reducing symptoms:

• Essential fatty acids – the omega 3 essential fatty acids are needed by the body to help reduce inflammation, especially in the muscles, tendons and nerves. The essential fatty acids may be especially useful in reducing severity of symptoms
• GABA – the amino acid GABA is also one of the neurotransmitters which helps the body to relax. GABA is also required to help make the important other neurotransmitter dopamine, which may not be functioning properly in people with restless legs syndrome
• Tryptophan – studies show there is a link between low levels of the amino acid tryptophan and increased incidence of restless legs syndrome and this is most likely because tryptophan and vitamin B3 (niacin) are closely related and vitamin B3 (niacin) may be especially required to relieve restless legs syndrome symptoms

Dietary modifications

These may help to reduce symptoms, improve ability to get to sleep and improve quality life:

• Eat folate-rich foods – studies show that a deficiency of folic acid may be implicated in the development of restless legs syndrome. Ensure folate levels are adequate by eating lots of leafy green vegetables
• Eat magnesium rich foods – studies show that magnesium deficiency may play a role in development of restless legs syndrome, so eating foods rich in this mineral may prevent the condition from occurring
• Eat vitamin B12 rich foods – studies show that a deficiency of vitamin B12 may be implicated in the development of restless legs syndrome. Ensure vitamin B12 levels are adequate by eating lots of food rich in this vitamin
• Ensure iron levels are adequate – iron deficiency is a known cause of secondary restless legs syndrome, so ensuring iron levels are adequate by eating iron-rich foods is vital
• Limit alcohol – people who drink a lot of alcohol often notice that symptoms get much worse when their intake of alcohol is high. Conventional advice is to limit alcohol intake to reduce severity and duration of symptoms
• Limit caffeine – people who drink a lot of coffee or energy drinks, which are high in caffeine, often notice that symptoms get much worse when their intake of caffeine is high. Conventional advice is to limit caffeine intake to reduce severity and duration of symptoms

Lifestyle modifications

There are a number of lifestyle modifications which can be undertaken to help reduce symptoms and improve quality of life:

• Avoid smoking – people who smoke cigarettes often notice that symptoms get worse when they smoke, so giving up is highly recommended
• Exercise regularly – physical activity is vitally important to help the muscles, nerves and tissues function properly. Regular exercise helps improve circulation and may also help to improve symptoms
• Hot and cold packs – using alternating hot and cold packs seem to work on reducing symptoms in many people as this strategy helps to reduce the inflammation and pain in the legs (or arms)
• Massage – having a regular massage, especially of the legs and feet, helps to improve circulation, warms the leg muscles to help to them to function properly and may improve symptoms greatly
• Reduce stress – one the biggest triggers for worsening of symptoms is chronic stress. The way to reduce stress is through some type of relaxation therapy – some good ones are meditation, tai chi and yoga
• Sleep – adequate sleep and proper rest is very necessary for any type of health condition, but especially for chronic conditions which especially require the body to get enough sleep to help it heal more effectively
• Spa or bath – many people often report symptoms get better when they have a bath, spa, or other warm water treatment
• Stretch – exercises which stretch the legs (and arms) may help to reduce symptoms in many people because these types of exercises help to increase circulation and reduce tension in the muscles

Alternative treatments

• Acupuncture – there are some studies which show that acupuncture may assist with a reduction in symptoms by enabling the blood to flow more effectively in the veins and arteries in the legs, increasing circulation to normal levels and reducing pain

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with restless legs syndrome

Self care strategies

There are a number of strategies which are recommended to help deal with restless legs syndrome:

• Adequate nutrients – a blood test will determine if you have a deficiency in iron, magnesium or vitamin B12 (cyanocobalamin), all of which are implicated as risk factors for the development of restless legs syndrome. In addition to this, blood levels of folic acid should also be tested as it is another risk factor for this condition. If you are deficient in certain important nutrients, your doctor will advise you take supplements and eat foods high in these nutrients too, to reduce your deficiency and help your body more effectively deal with the condition
• Avoid smoking and exposure to smoke – if you smoke, you need to try to give it up, as smoking cigarettes is not only detrimental to the body, but cigarettes also make symptoms of restless legs syndrome much worse. Take care to avoid exposure to any second-hand cigarette smoke as the effects can be just as detrimental on symptoms
• Exercise regularly – even if it just walking, regular exercise helps to improve circulation in the peripheral extremities, boosts energy levels and makes you feel good. Try to aim for at least a half-hour walk every day and keep to this schedule. Not only will the regular exercise help to reduce symptoms, but it will also help you to manage your weight
• Hot and cold packs (alternate) – a very effective remedy for any type of nerve/muscle pain in the body is to put on a hot pack for about 10-15 minutes, followed by a cold pack for the same time. This should help to alleviate the worst of the pain, but if it continues, apply the packs again alternating between the hot and cold with some time in between without the packs and continue until the pain subsides
• Limit alcohol intake – try to limit your alcohol intake because a high alcohol intake is associated with increased and more severe symptoms, probably due to the diuretic effect that alcohol has on the body, which reduce the diameter of the blood vessels and this can reduce circulation, which can make symptoms much worse. It is recommended to drink as little alcohol while symptoms are at their worst, to prevent them worsening
• Limit caffeine intake – try to limit your caffeine intake as high caffeine intake is associated with increased and more severe symptoms, probably due to the diuretic effect that caffeine has on the body, which reduce the diameter of the blood vessels and this can reduce circulation, which can make symptoms much worse. It is recommended to have as little caffeine while symptoms are at their worst, to prevent them worsening. Caffeine is mostly found in: coffee, tea, chocolate and some energy drinks
• Reduce stress – it is imperative to reduce stress as it can exacerbate an mood problems that are caused from the sleep depravation or insomnia. Effective ways of reducing stress are: meditation, tai chi, yoga and any other type of relaxation strategy. Not only will reduced stress levels help you cope with the symptoms of the condition but it can also assist with reducing symptoms as well
• Regular massage – a regular massage is highly recommended as an effective way to help improve circulation in the legs (and arms), reduce inflammation and ultimately reduce symptoms. Find a certified massage specialist to provide regular massages
• Side effects from medications – ensure you tell your doctor if you experience any type of side effects from any medications you have been prescribed. Your doctor may need to lower the dosage or swap the current medication with another one
• Sleep – one of the most common symptoms of restless legs syndrome is sleep depravation or insomnia and this only leads to other symptoms (such as mood problems and daytime sleepiness and inability to concentrate properly). There are a number of herbs (passiflora, hops, skullcap and chamomile) which are effective at inducing sedation without the side effects of conventional sleeping medications

Caring for someone with restless legs syndrome

Partner

If you have a partner with restless legs syndrome, there may be some strategies you can use to assist them:

• Avoid caffeine – encourage your partner not to drink any liquids which have a high caffeine content, such as coffee and tea (this includes green tea) and energy drinks and foods high in caffeine, such as chocolate as the caffeine will only exacerbate your partner’s symptoms
• Avoid smoking – don’t smoke inside the house or car, as the exposure to second-hand smoke can aggravate your partner’s symptoms. If you need to smoke, do so outside, away from your partner to reduce their exposure
• Hot and cold packs – use alternating hot and cold packs on your partner’s limbs when the pain is at its worst. Keep each pack on for about 10 minutes (use a towel on your child’s skin so you do not burn or freeze it) and then alternate with the other pack. Keep the skin free for about 10 minutes after one rotation and then start again. It is more beneficial (and less stressful for your partner), if you take responsibility for the application of the hot and cold packs, because if they are just lying down they can relax more easily, than if they have to monitor the time that the hot and cold packs need to be removed and having to get up to do this reduces their relaxation, even if the pain starts to subside
• Massage – if you are good with your hands, you could try to very gently massage your partner’s legs with as little pressure as possible, to avoid hurting them or any other complications. The warmth of your hands may help to heat their legs and this may assist with increasing circulation and so reducing symptoms

Friends

If you have a friend with restless legs syndrome, there may be some strategies you can use to assist them:

• Avoid alcohol – one of the risk factors that can greatly increase symptoms is alcohol, so make your time together alcohol-free to help your friend prevent worsening of their symptoms
• Avoid smoking – if you are with your friend, avoid smoking near them as exposure to second-hand smoke can aggravate their symptoms
• Support – it is really important to be supportive of your friend, as they may be going through a difficult time when their symptoms are at their worst due to the insomnia, pain and inability to concentrate properly

Parents

If you have a child with restless legs syndrome, there may be some strategies you can use to assist them:

• Avoid caffeine – ensure your child is not drinking any of the energy drinks, many of which are packed with more caffeine than a very strong cup of coffee, as these can greatly increase symptoms
• Avoid smoking – don’t smoke inside the house or car, as the exposure to second-hand smoke can aggravate your child’s symptoms. If you need to smoke, do so outside, away from your child to reduce their exposure
• Adequate nutrients – ensure your child is eating foods high in iron, magnesium, folic acid and vitamin B12 (cyanocobalamin) to avoid a deficiency in these nutrients. Ensure your child has had a blood test to confirm if their levels of these nutrients are not too low, but if they are, your doctor will advise they take supplements, so you will need to ensure they take these on time and the correct dosage
• Herbs for insomnia – there are many herbs which are recommended to help induce sleep and reduce the effects of insomnia, but talk to your doctor first before trying any, as they may conflict with your child’s current medications or condition
• Hot and cold packs – use alternating hot and cold packs on your child’s limbs when the pain is at its worst. Keep each pack on for about 10 minutes (use a towel on your child’s skin so you do not burn or freeze it) and then alternate with the other pack. Keep the skin free for about 10 minutes after one rotation and then start again

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Last reviewed and updated: 14 May 2024