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Some interesting information:
Here is a collection of articles related to sleep disorders/bedwetting.

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Sleep Well. Do Well.
Garfield the Cat knows about sleep! Kids don’t. Garfield is the official spokescat of the Star Sleeper Campaign launched in 2001 by the National Center on Sleep Disorders Research (along with the American Academy of Pediatrics, the American Academy of Sleep Medicine, the Better Sleep Council, and the National Association of Elementary School Principals). This 7-year campaign aims to get children ages 7 to 11 to really understand “that sleep is important to doing your best in whatever you do, including school performance, sports, other extracurricular activities, and establishing good friendships and family relationships.” Most kids get less than the average of 9 hours of sleep that they need. This leads to irritability, decreased attention, easy frustration, and difficulty controlling impulses and emotions. School performance suffers. Behavior worsens. Many kids who don’t get enough sleep are misdiagnosed with ADHD. Sleep, nutrition, and exercise are part of the foundation of a healthy childhood.

Alan Greene MD FAAP
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Side note: there was a story on 48 Hours in February 2002 that showed studies proving that a large number of children with apena, that caused excessive snoring at night, were misdiagnosed as being hyperactive or AD/HD. Once their apena was treated with minor surgery, their behavoir became normal. It was amazing!
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It's the middle of the night and everyone in your house is fast asleep. Suddenly, you are jolted out of bed when you hear your child scream. It's probably another nightmare, you think, as you head into his room to console him.

A nightmare is one type of parasomnia. Parasomnia, which means "around sleep," also includes sleepwalking, night terrors, bedwetting, and narcolepsy. All can create havoc in your home, and some can be harmful to your child. Keep reading to learn about the three categories of parasomnia (rhythmic, paroxysmal, and static disorders) and to find out how you can help your child.

Rhythmic Disorders
Rhythmic disorders, such as head-banging, head-rocking, and body-rocking, involve movements that range from mild to seizure-like thrashing. Other rhythmic disorders include shuttling (rocking back and forth on hands and knees) and folding (raising the torso and knees simultaneously).

During the rhythmic movements, the child may moan or hum. These movements seem to occur during the transition between wakefulness and sleep or from one stage of sleep to another.

There is no known cause for this type of disorder, but medical or psychological problems are rarely associated with it. Children who experience rhythmic disorders may have morning headaches, nasal problems, and ear infections.

Another rhythmic disorder is restless legs syndrome (RLS), a sensory and motor abnormality that seems to have a genetic basis. In RLS, the child's legs move repeatedly. Many people who have RLS also have periodic leg movement syndrome (PLMS) - this occurs during sleep when the legs move involuntarily.

Treatment for RLS can include:

music therapy (rhythmic sounds, such as the ticking of a metronome, may help induce and regulate sleep)
psychotherapy
hypnotism
motion-sickness medications
tranquilizers
stimulants
Paroxysmal Disorders
Paroxysmal disorders are those that come on or recur suddenly. They include night terrors, nightmares, sleepwalking, and bedwetting.

Night Terrors
Night terrors (also known as Pavor Nocturnus) are characterized by a sudden arousal from sleep with a piercing scream or cry. During the episode, heart and breathing rates may increase and the child's eyes may be open, but he probably won't remember what happened - other than waking up and feeling scared.

Night terrors occur in the first third of the sleep cycle, when the child is in deep sleep. Instead of waking or moving into another stage of sleep, the child gets "stuck" between stages. This can occur in as many as 15% of young children and can be caused by being overly tired or having an interrupted sleep cycle.

By themselves, night terrors are not dangerous, but what happens during one can be. A child may jump out of bed and do something that he might not otherwise do.

There is no known cause of night terrors, but some doctors believe that it has to do with physical causes. Apnea may be present.

Following evaluation to eliminate any possible physical causes (such as neurological conditions), medication may be used as treatment.

Nightmares
Nightmares differ from night terrors in that they are usually psychologically based, are more often remembered, and aren't usually dangerous.

Nightmares also occur only during REM (rapid eye movement) sleep. During REM sleep, the sleeping person's eyes move quickly, heart rate and breathing may be erratic, and dreams (or nightmares) may occur. Non-REM sleep (also called slow wave sleep) is deeper.

Sleepwalking
Sleepwalking, which is usually mild, can be hazardous when it's frequent or intense.

Because the child is not awake during an episode, dangerous objects should be removed from the room where he sleeps and the windows should be locked.

Following a medical evaluation, these treatments may help reduce or eliminate sleepwalking:

medication
consistent sleep-wake cycle
Bedwetting
Bedwetting, also called enuresis, is a common problem that can affect a child's self-esteem as well as his sleep. Because it occurs at night and can affect sleep, bedwetting is classified as a parasomnia.

It typically occurs in children who are between the ages of 3 and 8. Bedwetting usually stops on its own, but it sometimes continues into adolescence. A child who regularly wets the bed should see a doctor to rule out any physical cause.

Static Disorders
Static disorders, which are not disruptive, include sleeping with open eyes (this can be common in infants and young children) or in odd positions (such as upside down or arched).

Even though static disorders are not harmful, children who sleep in odd positions or with their eyes open should be examined by a doctor, especially if the behaviors persist or they are accompanied by other unusual symptoms.

Helping Your Child
If you're worried about your child's sleeping patterns, talk with your child's doctor. He or she may refer you to a sleep specialist or encourage you to establish good sleep hygiene for your child, which would include:

following a fixed bedtime and wake-up time (and nap times)
keeping consistent play and meal times
avoiding stimulants, such as caffeine, near bedtime
making the bedroom quiet, cozy, and conducive to sleeping
using the bed only for sleeping - not for homework, playing, or watching TV
limiting food and drink before bedtime if gastroesophageal reflux (GER) or bedwetting is a problem
It may also help to keep a pre-sleep diary for your child. In the diary, record what your child does before he goes to bed, when he goes to the bathroom, and what he eats and drinks. Other information you can include, such as the weather conditions, may help your child's doctor create a successful treatment program.

Updated and reviewed by: Kim Rutherford, MD
Date reviewed: September 2001
Originally reviewed by: Aaron Chidekel, MD

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Apnea and Your Child

Everyone has brief pauses in their breathing pattern called apnea - even your child. Usually these brief stops in breathing are completely normal. Sometimes, though, apnea or other sleep-related problems can be a cause for concern. Read on to find out what it means when your child's doctor mentions apnea.

Types of Apnea
The word apnea comes from the Greek word meaning "without wind." Although it's perfectly normal for everyone to experience occasional pauses in their breathing, apnea can be a problem when breathing stops for 20 seconds or longer.

There are three types of apnea: obstructive, central, and mixed.

Obstructive Apnea
This type of apnea is caused by an obstruction of the airway (such as enlarged tonsils and adenoids), and it is a common type of apnea in children. As many as 1% to 3% of otherwise healthy preschool-age children have obstructive apnea.

The most common symptom is snoring; others include labored breathing while sleeping, gasping for air, sleeping in unusual positions, and changes in color. Because obstructive sleep apnea may disturb sleep patterns, these children may also show continued sleepiness after awakening in the morning, and tiredness and attention problems throughout the day. Sometimes this can affect school performance. One recent study suggests that some children diagnosed with AD/HD actually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea.

Treatment for obstructive apnea involves keeping the throat open to aid air flow, such as with adenotonsillectomy (surgical removal of the tonsils and adenoids) or continuous positive airway pressure (CPAP). CPAP involves having the child wear a nose mask while sleeping.

Central Apnea
Central apnea results when the part of the brain that controls breathing doesn't start or maintain the breathing process properly. It's the least common form of apnea (except in very premature infants, in whom it is seen fairly commonly because the respiratory center in the brain is immature) and often has a neurological cause. A few short central apneas are normal, particularly following the deep breath that occurs with a sigh.

Mixed Apnea
Mixed apnea is a combination of central and obstructive apnea and is seen particularly in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep.

Conditions Associated With Apnea
Apnea can be seen in connection with:

Apparent Life-Threatening Events (ALTEs)
An ALTE itself is not a sleep disorder - it's an event that is a combination of apnea, change in color (bluish lips or face), change in muscle tone, choking, or gagging. Most ALTEs can be scary to observe, but they usually are uncomplicated and do not recur.

Some ALTEs, though, especially in young infants, are associated with medical conditions (such as gastroesophageal reflux (GERD), infections, neurological disorders) that can cause apnea. These medical conditions require treatment, so all children who experience an ALTE should receive emergency treatment. Call 911 immediately if your child shows the features of an ALTE listed above.

Apnea of Prematurity (AOP)
This condition can occur in infants who are born prematurely (before 34 weeks of pregnancy). Because the brain or respiratory system may be immature or underdeveloped, the baby may not be able to regulate his own breathing normally. AOP can be obstructive, central, or mixed.

Treatment for AOP can involve the following:

keeping the infant's head and neck straight (premature babies should always be placed on their backs or sides to sleep to help keep the airway clear)
drugs (such as aminophylline, caffeine, or doxapram) to stimulate the respiratory system
continuous positive airway pressure (CPAP) - to keep the airway open with the help of forced air through a nose mask
oxygen
Apnea of Infancy (AOI)
If the cause of apnea can't be found and it continues, this is called apnea of infancy. It occurs in children who are younger than 1 year old and who were born after a full-term pregnancy.

Infants can be observed at home with the help of a special monitor prescribed by a sleep specialist. This monitor records chest movements and heart rate and can relay the readings to a hospital apnea program or save them for future examination by a doctor.

The apnea usually goes away on its own, but if it doesn't cause any difficulties (such as low blood oxygen), it may be considered part of the child's normal breathing pattern.

What to Do if You Think Your Child Has Apnea
If you suspect that your child has apnea, call your child's doctor. If you suspect that your child is experiencing an ALTE, call 911 immediately.

Most cases of apnea can be treated or managed with surgery, medications, monitoring devices, or sleep centers. Many cases of apnea go away on their own.

Updated and reviewed by: Kim Rutherford, MD
Date reviewed: October 2001
Originally reviewed by: Aaron Chidekel, MD

Source: KidsHealth is a project of The Nemours Foundation which is dedicated to improving the health and spirit of children. Today, as part of its continuing mission, the Foundation supports the operation of a number of renowned children's health facilities throughout the nation, including the Alfred I. duPont Hospital for Children in Wilmington, Delaware, and the Nemours Children's Clinics throughout Florida. Visit The Nemours Foundation to find out more about them and its health facilities for children
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by Dreamfit

What are the signs of sleep deprivation?

There is often a link between lack of sleep and behavior problems in children. Although everyone recognizes that when a 2 year old has a tantrum, he is most likely overly tired, parents and teachers have forgotten to look at behavior and take sleep into account with older children.

Symptoms of sleep deprivation:

* Unmanageable behavior: (grumpy, excitable, wild)
* Inattentive, unable to concentrate, easily distracted, physically impulsive or alternately lazy
* "Wired behavior" is often shown before the sleep crash when a child is overly tired
* Decreased immunity- Even one bad night's sleep can hamper immunity. During sleep, the body releases an immune- boosting substance.


Is there a link between ADD/ADHD and sleep problems?

The symptoms of sleep deprivation and the symptoms of attention deficit hyperactivity disorder can appear the same. They show up in 3 categories:

1. Attention Problems
2. Difficulty controlling impulsive responses
3. Excessive motor activity

Not every child diagnosed as ADHD or ADD is sleep deprived or vice versa, however, the amount of sleep a child is getting should certainly be considered as a factor; keeping a sleep journal can be an effective tool. The issue of sleep deprivation versus ADHD is not simple. I have worked with many ADHD children and I do believe that some children who are sleep deprived may be being misdiagnosed as ADHD. Remember, most adults who are tired will yawn and nod, but children often go to the other extreme, bouncing around, unable to concentrate, losing interest quickly, and behaving as if they have attention deficit hyperactivity disorder. It's tricky; because many ADHD children have sleep difficulties and some sleep researchers believe that there may be a common link between some sleep disorders and ADHD. Other people theorize that our brains are actually changing due to the constant stimulation that we receive in our society today. Others believe that ADHD has always existed but has only become apparent in our modern times because of the demands put upon us at school and work.
I know that progressive relaxation and creative visualization work to calm and relax children. Teachers have often told me that the children who are the most active, respond best to these techniques. I believe these techniques should be the first line of defense when dealing with a diagnosis of hyperactivity or ADHD.


How does lack of sleep affect a child's learning?

Sleep is definitely related to our children's' ability to learn. Teachers are often not aware of the direct ways lack of sleep can keep students from remembering what they've been taught during the day. A full night's sleep is one of the most important factors for learning and is probably the most important period of the day for processing new information. A good night's sleep lets children process what they learn and helps them to be alert in class. Recently, researchers found that if the brain can't rest long enough and deeply enough to move information from temporary to long-term memory, the information is lost. Many sleep specialists now believe that as much as half of the new information gleaned during the day can be lost by lack of sleep at night. Sleep helps organize the brain. Our kids really do wake up smarter when they've had a good night's sleep. The best homework assignment a teacher could give would be to have their students get a good night's sleep. Time would be better spent going to sleep on time rather than staying up late, completing homework. I'd like to see gold stars given to children who go to sleep at an appropriate time.


How much sleep does my child need?

Although sleep needs vary, this will give you an idea of the average amount of sleep needed at various ages.

Age Average hours of sleep needed

Newborns 17
3-mon h-old 15
6-9 months 14
One-year-old 13-14
Two-year-old 13
Ages three to five 11-12
Ages 5-12 9-11
Teens 9-10
Adults 8-9

What is a sleep journal?

One of the best ways to determine how much sleep your child is getting, at any age, is to keep a sleep journal. If you suspect your baby or child isn't getting enough sleep, keep a sleep journal. For two weeks, record the time your child goes to bed and rises, the amount of time it takes them to drift off, their total hours of sleep and their energy level on waking and throughout the day. (Also note any naps they may take.) The results can help you recognize a sleep problem and at that point you may wish to consult with a physician who can help you to map out a plan.


What do you think of the family bed?

I have never read of a sleep expert who approved of "the family bed." They seem to all agree that children should learn at a very young age to settle themselves and fall asleep independently. I'll admit it. I used to plop my babies into bed with me and I enjoyed having them close. I'll also admit that the sleep experts do have a valid point. When your child gets used to sleeping next to you, they may have trouble falling asleep on their own and will often want Mom or Dad in the middle of the night. Although my oldest two children made the transition back to their own beds quite easily, my youngest daughter did not. She is the reason that I created "The Floppy Sleep Game." At some point, children need to learn to settle themselves and fall asleep independently. Whether it's at 4 months, or four years, is up to you. When anyone in the family is no longer sleeping well in the "family bed" it's time for your child to go to sleep on his or her own. At this point, it usually takes a great deal of consistency on the part of parents and children may very well need to be taught to relax and fall asleep on their own. Progressive relaxation techniques can be extremely helpful.

A note about safety and the family bed:

Advocates of the family bed believe that it is safe, has many health benefits, and especially encourages breast-feeding. In an opposing view, the U.S. Consumer Product Safety Commission said that the practice of parents sleeping with babies posed a significant risk of accidental death from smothering or strangling. If you do sleep with your baby, safety rules should include that mattresses be firm and tight fitting to their frames; infants should not be over-wrapped or their heads covered by blankets; babies should not be placed face down for sleep or permitted to sleep on pillows.

What special sleep concerns do preschoolers face?

Toddlers and preschoolers are creatures of habit. Even if they have slept well before, a vacation, move or illness can get them off their routine. If they come into your room in the middle of the night, get up and walk them back to bed giving them as little attention as possible.
Preschoolers need to have their bedtime rules strictly enforced. They will soon learn that they can get away with staying up longer by requesting just one more story, song, or drink of water. My daughter learned that I found it almost irresistible to turn down just one last kiss. Be strong and consistent! Remember you are not being mean, you are teaching your child good sleep habits that will last a lifetime. Bedtime fears are especially common in this age group. (See bedtime fears under sleep problems section.)

Naps:

Pre-school children who nap well are usually more adaptable. Many teachers believe that adaptability is the single most important trait for school success. Most children under age 4 still need to nap. Non-napping means lost sleep. In general, children do not sleep longer at night on a regular basis if they don't nap. Without naps your child may be too drowsy to learn well, be fussy, or hyper alert. Most children do not nap by age five. If your child is truly not tired at bedtime, you may need to shorten or eliminate the afternoon nap. (Hyper alert refers to hyper behavior that occurs when a child is overly tired.)


What special sleep concerns do teens face?

I generally work with younger children, but as a parent of two teenagers myself; I feel it's important to mention their special sleep needs. Most teens require 9-10 hours of sleep and get much, much less. They often have trouble falling asleep. Teenagers actually require more sleep than kids a few years younger and yet it's a time when school, homework, community service, extracurricular activities, and part-time jobs keep them busy from early in the morning to late at night. Many studies have suggested that if school started a little later, more in line with their natural biorhythms, teen's school performance would improve. A few years ago test scores on the SAT college entrance exams in Edina Minnesota jumped more than 100 points on average, when the morning school bell was delayed for an hour. Parents often tell me that their teens have a difficult time sleeping. It's really no wonder considering all the pressure that they are under. Encourage your teen to practice creative visualization and progressive relaxation techniques that will help them relax and fall asleep. Like all of us, they do best with a consistent bedtime. Don't forget to warn your teenagers about the dangers of driving while drowsy. Although we have all warned our teens about the dangers of drinking and driving, many of us forget to warn our kids not to drive when they're drowsy, a very real danger for our teens today. Drowsiness is the principal factor in about 100,000 car crashes each year, killing adults, teens, and children. Personally, I can't understand why there has not been a huge crusade to educate people about the dangers of driving without getting enough sleep

How do your techniques differ from more traditional sleep methods?

I incorporate techniques that are often used in yoga. Children find it very relaxing to focus on their breathing. It focuses attention, relaxes muscles and quiets the mind. If we watch babies breathe we will see that they breathe very deeply, filling their diaphragms and bellies with each breath they take. When I work with children, I remind each of them to breathe in and fill their belly like a big balloon. Then I tell them to breathe out and suck their belly in. I also teach them to stretch and relax their bodies in a variety of fun ways such as "flopping" their arms and legs and wrinkling and relaxing their faces.
Creative visualization is nearly second nature for children. First, children listen to stories and imagine it in their minds. Eventually they'll be able to make up their own stories. Creative visualization is really nothing new; for instance, "counting sheep" has been around at bedtime for as long as any of us can remember. Instead of counting sheep, encourage your children to count their blessings. In a lullaby on "The Inside Out Sleep Game," I gently challenge children with the question, "How high can you count? Count your blessings." Eventually, children will be able to make up their own stories and see pictures in their minds. Encourage them to close their eyes and think of something wonderful! Creative visualization is the conscious use of the creative imagination to attain goals, overcome obstacles and to increase self-awareness and the overall quality of life.


What is your favorite bedtime ritual?

Although I like storybooks, my youngest daughter always wanted me to "tell her a story" at bedtime. I'd make up a story about my daughter interacting with her siblings or friends. She was usually the hero, took part in one of her favorite activities, or visited one of her favorite places. At bedtime, the stories can be magical, but should not be scary. As children grow, they'll be able to make up their own stories in their minds taking themselves on magical adventures, or attaining any goal. Visualizing the attainment of a goal can help a child to reach it. When children are able to do this and they complain to you, "Mom, I can't get to sleep," respond with, "That's okay, think of something wonderful!"

Top
Sleep Problems

Bedtime Fears:

Children have vivid imaginations and bedtime fears are common, especially for preschoolers. It's a good idea to talk with your child about their fears in the daytime. Assure your child that you have strong locks, smoke alarms, a dog, etc. Some of their most common fears or phobias are of monsters, dogs, snakes, and spiders. Talk to your children about their fears in the daytime. Read "playful" stories about the objects they fear. Sing songs about them. If a child thinks there is a monster under his or her bed, look under the bed and show them that there is no monster there. Tell a story where your child is the hero, facing the monster who shrinks before his or her very eyes. Draw a picture of the monster and crumple it up. Tell your child that when scary thoughts come, to put on the "good tape" in her head and watch it. Encourage your child to tell you about her fears and acknowledge them, even if they're not real. Otherwise, they might keep their fears inside and they could become worse. Talk about what is real and what is make believe. Eventually, children will make the distinctions themselves and the monster under the bed just won't be there anymore.


Night waking and coming into parent's room in the night:

Experts recommend leaving your children's room while they are still awake so they learn to settle themselves. If your child is accustomed to falling asleep with your assistance, the "fade technique" may be helpful. The "fade technique" involves gradually removing yourself from your child's room. At first, you may want to sit on the edge of the bed while they relax themselves to sleep. (This is a good time for them to listen to "The Floppy Sleep Game" ,"The Inside out Sleep Game."or The Christmas Dream ). Over a period of several days, sit further and further from your son or daughter until they no longer need you in the room to fall asleep. This is a difficult time for parents because they are tired and vulnerable. Remember, it may take a week or two to retrain your child and the behavior will probably get worse before it gets better. Expect to be tested; at every stage of reduction of parent attention expect problems to get worse before improvement begins. Don't give up! It will be worth the effort when the whole family is getting a good night's sleep. Night waking is normal; children need to learn to fall back asleep without assistance.


Nightmares and night terrors:

Nightmares usually happen during the second half of the night because that's when dreaming is the most intense, during REM sleep. Children may wake up and call to you. They may be fearful and have trouble falling asleep because they can remember their troubling dream. Occasional nightmares are common; however, if nightmares occur frequently and persistently for more than a month, seek professional help. Often, night terrors are mistaken by parents as nightmares.

How to handle nightmares:

As soon as possible, go to your child. Assure your child that you're there and won't let anything harm him or her. Calm and comfort your son or daughter. He or she may wish to have a night-light on for reassurance.
Encourage your child to tell you what happened in his or her dream; it is very real to a young child. Encourage your son or daughter to go back to sleep as soon as he or she is calm.

How to handle night terrors:

Night terrors can be very frightening for parents. Unlike nightmares that happen in the second half of the night, they usually occur one to four hours after a child falls asleep and can last 5-30 minutes. Often the child experiencing a night terror is thrashing and confused. He or she may walk around in an agitated state or be angry and frantic. While a child is having a night terror, don't wake him or her. Keep the lights dim. If you try to wake him or her, it may get worse. Unlike nightmares, the child has no memory of the night terror. They are more likely to occur if close family members have a similar history of arousals. Two of my children had night terrors when they were about three years old. They often occurred during their naptime, especially if they were awakened abruptly. When a friend's preschooler had a night terror, she took her to the emergency room. I have since learned that this is not an uncommon reaction for parents. Night terrors often occur in overly tired children and sometimes, but not always, an earlier bedtime helps. In young children they do not signify physical or emotional problems. If they continue after age six, seek advice from a sleep specialist.


Bedwetting (Enuresis):

Bedwetting is a minor sleep disorder but it can be very upsetting and embarrassing to older children. Heredity is a strong contributing factor. Don't criticize or punish; a child wets the bed while she or he is asleep and has no knowledge that he or she is doing it. Work with you child's pediatrician, or with a sleep specialist to treat it if it becomes emotionally upsetting to your child.

Sleep apnea:

This is a medical condition that can appear at any age but frequently develops in the pre-school years. Children with sleep apnea are often tired even though they appear to get enough sleep at night.

Signs of sleep apnea:

Snoring, mouth breathing, restless sleep, nighttime sweating, difficulty waking, and sleeping in unusual positions are signs of sleep apnea.
The main symptom is daytime exhaustion from poor quality sleep and it may be the only symptom you see. This is a medical condition. If you suspect your child is suffering from sleep apnea, consult your pediatrician. Removing the adenoids and or tonsils often cures it.

Narcolepsy:

The main symptom of narcolepsy is excessive drowsiness. Many other factors can also cause excessive drowsiness such as illness, or medication. If your child is excessively sleepy, start with your pediatrician. Although it can affect children, it typically doesn't appear until the mid teens. Other symptoms may include sudden attacks of weakness during the day and temporary paralysis while falling asleep or waking. The treatment includes naps and medication. A sleep specialist should diagnose and treat it.

Depression or Mood Disorder:

If your child or teen seems depressed or alternates between sleeping too much and not enough, or has extreme mood changes, it could signal depression or a mood or anxiety disorder and you should take your child to see a specialist.


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~*~ Kristy ~*~





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