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Restless Legs Syndrome (RLS), also known as Willis-Ekbom disease, is a neurological sensorimotor disorder characterized by an urgent and often unpleasant need to move the lower limbs, especially in resting states and during the evening hours.

Although it is mainly found in the adult population, it can also occur in children, in whom it is often underdiagnosed due to atypical symptomatology or difficulty in verbally describing the sensations by the children themselves.

Symptoms

Symptoms include paresthesias, i.e. abnormal sensations in the lower limbs such as tingling, burning or pressure sensations, as well as a feeling of something crawling or moving under the skin. These symptoms are worse at rest, relieved by movement, and vary daily, with worsening in the evening. Although they mainly affect the lower extremities, in some cases the upper extremities or trunk may also be affected. The impact of RLS on childhood is particularly significant, as the disorder can significantly disrupt sleep, leading to chronic fatigue, difficulty concentrating, reduced school performance, and behavioral problems, including irritability or hyperactivity.

The diagnosis of RLS is based solely on clinical criteria, as defined by the International Restless Legs Syndrome Study Group (IRLSSG). The main criteria include a compelling need to move the limbs, the presence or worsening of symptoms at rest, improvement with movement, and a greater occurrence of symptoms in the evening or at night. In addition, other conditions that could explain the symptoms must be ruled out. Assessment in children is unique, often requiring parental description and collaboration with the child. Useful tools include sleep diaries, sleep questionnaires, and, in selected cases, polysomnography.

The comorbidity of RLS with Attention Deficit Hyperactivity Disorder (ADHD) is significant. Research suggests that approximately 25% of children with RLS exhibit ADHD symptoms, while up to 44% of children with ADHD may exhibit RLS symptoms. This association is attributed to possible common pathophysiological mechanisms, the dysfunction of dopaminergic systems and iron deficiency, which is associated with both conditions.

When is it necessary to seek medical help

Seeking medical help is necessary when symptoms affect the child’s quality of life, sleep adequacy or behavior and learning performance. In these cases, checking ferritin levels is recommended in order to assess the status of iron stores, and, if indicated, administering iron supplements. In severe or resistant cases, pharmacological intervention with dopaminergic agents or anticonvulsant drugs may be considered, always under the supervision of a specialist.

Treatment

Non-pharmacological interventions also play an important role in the treatment of RLS. Maintaining a consistent sleep schedule, daily mild physical activity, avoiding stimulants such as caffeine, and creating a relaxing environment before bedtime (e.g., warm bath, gentle massage) can help reduce the intensity of symptoms. In addition, a diet rich in iron, such as red meat, green leafy vegetables, and fortified cereals, can support the improvement of the child’s overall condition. Early recognition and a holistic approach to the management of RLS in childhood are crucial for improving the quality of life and psychosocial development of children suffering from this disorder.

Scientific editor: Diagoras Zarganis, Pediatrician, Director of the 2nd Pediatric Clinic, Athens Pediatric Center.