TY - JOUR T1 - Approach to a child with excessive daytime sleepiness JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed SP - 288 LP - 294 DO - 10.1136/archdischild-2014-307291 VL - 100 IS - 6 AU - Keshavamurthy Kallambella AU - Nahin Hussain Y1 - 2015/12/01 UR - http://ep.bmj.com/content/100/6/288.abstract N2 - Being alert when awake is an essential requisite for a child's overall development. Sleepiness affects a child's learning, behaviour, mood and physical health and has larger implications for the whole family.1 It is often an overlooked symptom in the paediatric practice, especially when present with other comorbidities and disabilities which increase its prevalence. A comprehensive exploration of this symptom and an accurate diagnosis of the underlying cause are very important as many of the conditions are treatable or remediable, though some of them will require specialist input.A child who is sleepy is more likely to: be bullied by his/her peers at schoolbe labelled as lazyhave low self-esteemhave poor academic performancehave concerns raised over parenting skillsA detailed history and physical examination will guide the clinician when to extend the assessment and when to refer for more specialist review.Conditions causing excessive daytime sleepiness (EDS) can be categorised into three broad groups (see figure 1); conditions that lead to insufficient sleepdecrease quality of sleepincrease sleep-driveThe first two groups with overlapping aetiologies will eventually lead to chronic sleep deprivation and account for the majority of cases. Insufficient duration of sleep among adolescents and young adults resulting in daytime sleepiness and impairment is becoming increasingly recognised internationally.2Figure 1 Causes of excessive daytime sleepiness. ADHD, attention deficit hyperactivity disorder; OSA, obstructive sleep apnoea.Sleepiness is defined as inability to stay awake and alert during the major waking episodes of the day, resulting in unintended lapses into drowsiness and sleep.3 It is not uncommon for parents to confuse fatigue or excessive tiredness on activity for sleepiness though both can coexist.4 If latter is the main symptom associated with sleep disturbances, then chronic fatigue syndrome and its differentials should be considered. Furthermore, the use of … ER -