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A mother brings her 8 year-old son to the pediatrician with the chief complaint that her son 'can't sit still.'

'He seems to have the 'fidgets', she tells the doctor. 'It seems to get worse at night and his sleep is not normal either', she says. 'He also complains of 'worms' in his legs, particularly after dinner.'

'Worms in his legs' exclaims the pediatrician, 'Wow, what an imagination you son has', he says.

'Well, when a eight year-old can't sit still it's probably Hyperactivity Syndrome', the pediatrician said.  'Let's try some Ritalin'.

'But, what about his sleep issues and the 'worms' in his legs?', his mother asked.  'Let's see what the Ritalin does', the pediatrician responds, ignoring the mother's pertinent questions.

The above scenario is a classic case of a doctor not listening to the patient and not forming a differential diagnosis-a list of ALL possible causes of the complaints. 

Nothing good will happen when these two serious errors occur together.

In my experience, nothing substitutes for a mother's sense of whether her child is ill and what is wrong with her child. Mother's, and fathers,  must be forceful in making their child's doctor listen to all of the complaints and demand a list of all possible causes for the complaint so each can be ruled out.

Hyperactivity syndromes, as in ADD and ADHD, the kind so often treated with Ritalin, are by no means the only cause of 'kids who can't sit still'.

There is growing understanding that Restless Legs Syndrome (RLS), an unfortunately inadequately descriptive name for an important chemical disorder of the brain, is responsible for many of the complaints of restlessness, fidgets, agitation, sleep disorders of all types, pain in the extremities, and much more.

Unfortunately, the knowledge obtained from studies that point to RLS in children is not yet being uniformly applied in the pediatrician's office.

RLS is diagnosed by meeting all of the following four criteria.  Note, in children, sometimes all four are not present:

1. An involuntary urge to move, could be one or more limbs or the whole body.

2. Sensations, often in the limbs that are described as 'creepy crawlers, worms, electricity, cramping, pain, and more.

3. The above complaints, or signs, generally begin towards evening, and may progress through the entire night disrupting the child's sleep.

4. The above complaints, or signs, diminish or go away with activity, such as getting out of bed and walking.

RLS is a serious disorder in that it can disrupt a normal life preventing sitting in school, sitting on an airplane, sitting to to take the SATs, or sitting in a movie theater or concert.  Not to mention the distortion of normal sleep patterns and the resultant effect during the day of the nighttime sleeplessness.

Mothers, fathers, grandparents of all ages, if there are issues similar to what I described above consider the diagnosis RLS and other disorders.

RLS is now known to be related to a number of factors.  There is a definite genetic predisposition and many children with RLS have parents with RLS.

At times RLS is related to iron deficiency in the brain. One point here, a 'normal' level of iron in the blood does NOT mean the level of iron in the brain is normal.  Doctor prescribed iron supplementation may help.

There are good, effective meds for RLS.

A good resource for RLS information is the RLS Foundation website: www.rls.org

PRACTICE HEALTH DEFENSE- Know about RLS.