Video consultation

You are speaking to (Ahmed Majid), the father of Mohamed (7 years old)

Past medical history:

Nil

Social situation

Moved from Birmingham 2 months ago. Newly registered in the practice

Opening sentence:

“I want some sleeping pills for my son”

Open history:

Dad is asking for sleeping pills for his son. He knows a friend who uses these sleeping pills for his son. Since he moved her, he has been struggling to sleep.

History to give only if asked:

He goes to sleep at 8 p.m., but he stays awake until midnight. He wakes up at 6 a.m., and most days, he likes to have a nap.

They have moved house twice since Mohamed was born.

Your family has been under lots of stress over the last few months, due to difficulty in finding work. However, you have just got a new job. You have a strong relationship with your supportive wife, and there has been no domestic violence, alcohol, or other concerning family issues. Basma is 4 years old, and you have no concerns with her, but your son, Mohamed, is very challenging, and his behaviour has worsened since you moved in.

Your son wants to spend most of his time on the iPad.

He is very active, finds it difficult to stay still, and can’t follow instructions or finish a task. He is always charging off and doing his own thing. You are worried that he will struggle to follow instructions from his new teachers.

He doesn’t stick to the same routine.

He is physically well and has no problems with his appetite. He has no other medical health problems, and he is growing normally.

You and your wife don’t drink or smoke.

You are not working, and you are getting benefits from the government.

He hasn’t started school yet, but he will start in the next few weeks.

He was okay in his previous school, and there were no issues.

ICE:

Ideas: You think your son can’t sleep because it is a big change for him to move to a new place, and you think having better sleep will help his behaviour. 

Concerns: You are worried that this sleeping problem will continue, as it is affecting everyone in your family.

Expectation: You want sleeping pills to help you cope with the situation.

Management objective:

·       Explore any wider family issues further, as it is likely that the symptoms that Mohamed is presenting with are, in part, a symptom of other wider family issues.

·       Explore the family's understanding of issues such as neurodiversity and ADHD. Some families in this situation will be very keen for a diagnosis/ referral at the outset, whereas other families will have little knowledge of these conditions.

·       Give general advice to improve sleep hygiene, establish a regular sleep routine, avoid napping during the day, and avoid screen time before bedtime.

·       Offer F2F for assessment to discuss further management. This may include a referral for neurodiversity assessment, discussion with the school or school nurse, or further support for any difficulties other family members are struggling with.

·       Discuss web links and leaflets offering advice and local support groups for children with behavioural difficulties to support their parents.

·       Explain why doctors do not generally give sleeping pills to children in this situation.

Example consultation:

Ahmed, thanks for having a chat today. What a tough time you have been through with your family settling into a new place. Let’s see how we can support you and your son, Mohamed.

I understand you're concerned about Mohamed's sleep and want to explore options to help him.

Wider family dynamics

Can you tell me a bit more about how the rest of the family are settling in to a new area? How is your partner coping with things? How is Mohameds younger sister? Do you think you need any support for yourself?

Contact with new school

Have you had any contact with Mohamed's new school yet? If not it may be worth discussing your concerns at an early stage as they are likely to be able to offer further support and interventions.

I understand you're hoping for sleeping pills to help Mohamed, but I don't tend to recommend them for children in this situation. Sleeping pills don't address the underlying cause of the sleep problems, and they can have harmful side effects. It's better to try other approaches and look at long-term changes which help him manage this permanently.

Possible Causes for Mohamed's Sleep Problems:

Mohamed's sleep problems may be related to the stress of moving to a new place and being away from familiar surroundings. It's also possible that he has some underlying neurodevelopmental or behavioural issues, like ADHD, that are contributing to his sleep difficulties.

Improving Sleep Hygiene:

Let's focus on creating a better sleep routine for Mohamed:

• Regular Bedtime Routine: Establish a calming bedtime routine that happens at the same time every night. This could include a warm bath, reading a story, or listening to quiet music.
• Consistent Bedtime: Make sure Mohamed goes to bed and wakes up at the same time every day, even on weekends.
• Avoid Naps: Try to limit or avoid naps during the day, especially in the late afternoon.
• Screen Time: Avoid tablets, phones, and TV screens for at least an hour before bedtime. The light from screens can interfere with sleep.

While I understand how it could be difficult to do that, being moved between different places in a short duration of time, however, any little changes to these things you can make might make a difference.

 Addressing Potential ADHD:

I'm also hearing some things that might suggest ADHD, like difficulty staying still, trouble following instructions, and getting easily frustrated. It's important to remember that many children are easily distracted, impulsive and have high energy levels. This does not mean they have ADHD. It could be a sign of something else, like being tired, anxious or stressed.

Next Steps: Assessment and Watchful Waiting:

"I'd like to schedule a face-to-face appointment to assess Mohamed more thoroughly. After that, let's try these sleep hygiene strategies for three months. If things aren't improving, we can consider a referral to a specialist team for an ADHD assessment.

School Support:

The teachers and other staff at his new school will have a very important role in helping Mohamed in the coming months. They will get to know him far better than me, and if he is having issues in the classroom, they may be able to give him additional support. They can also refer him directly for further assessment if we are concerned about something like ADHD.

Resources and Support:

From what we have said so far, we cannot make a clear diagnosis of something like ADHD or another related issue, and it may be that he is simply struggling with moving house and starting a new school. However, it may be useful for you to learn a bit more about what parents can do to help with some of the behavioural issues you describe, and I will send you some leaflets and links about this.

There are many resources available to help families with children who have behavioural difficulties or ADHD. I can provide you with links and leaflets with more information. There are also parent training courses that can teach you strategies for managing challenging behaviours.

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