Follow-up appointments within the service are limited.
The majority of children seen in the service are not offered long-term follow-up appointments.
It is therefore essential that all children referred to the sleep service have active follow-up at secondary care level (for example general or community paediatrics, or CAMHS) with a named paediatric consultant.
This is for three main reasons:
- Management of complex sleep problems often involves optimisation of management of all other existing medical problems which may impact on sleep. Sleep quality may be adversely affected by symptoms of a wide range of common (and less common) paediatric conditions, including but not limited to asthma, eczema, reflux, epilepsy, autism or ADHD. It is essential that these conditions are identified and managed where present.
- Following initial assessment, recommendations for further management may include the use of medication. In general, the service aims to manage children without medication where possible but in some children this may be required. Medications used to affect sleep in children are often ones which GPs are less able to prescribe. Prescriptions therefore often need to be provided from secondary care. We are very happy to provide input into discussions about medication prescription, adjustment and review where required, for medications which have been recommended following clinic attendance. Medications will only be supplied directly from Evelina London in exceptional circumstances.
- For many children, even in those with complex medical backgrounds, behavioural intervention and modification is the foundation of improving sleep quality. Unfortunately we have limited capacity to offer ongoing behavioural support to all of the families that are seen in the clinic and therefore have to ask that behavioural interventions are supported locally.
A selected group of children and families may be referred to our advanced sleep workshop.
Our priority is to offer assessment appointments, to provide appropriate access to specialised diagnostic investigations and to offer recommendations regarding management to referring secondary care paediatricians, for the children most likely to benefit from our service.
Where follow-up is offered, this will usually be at a 12 month interval, with ongoing management and follow-up continuing primarily at secondary care level.
Where the above points are not possible, then we are likely to be of limited help to children and families referred into the service.