Restless Legs Syndrome

What is restless legs syndrome?

Symptoms of restless legs syndrome

Signs and symptoms of RLS include: 

• Strong urge to move the legs while at rest 
• Uncomfortable sensations in the legs, such as itching, crawling, pulling, or aching 

The sensations often feel like they are inside the legs, not on the skin. Your child may describe them as: 

• Needing to move, kick, or stretch their legs 
• Feeling like ants or bugs are crawling in or on their legs 
• Legs feel “tingly,” “squirmy,” “twitchy,” “creepy-crawly,” or “wiggly” 

Families may sometimes think that symptoms are part of “growing pains,” but talk to your care team if symptoms don’t go away or seem to happen during rest or at night.  

Symptoms of RLS:  

• Are often worse at night 
• Usually affect both legs   
• Sometimes affect only 1 leg or switches sides  
• May come and go 
• Can be mild or more severe 
• May happen often or only once in a while 

Gently moving your child’s legs or applying pressure may help ease symptoms. 

Contact your child’s care team if symptoms affect sleep, daily activities, or school, or if symptoms get worse over time. 

Causes of restless legs syndrome

Several factors can increase the risk of RLS in children. These include: 

• Low iron or ferritin (iron storage) levels 
• Medicines, including certain antidepressant medications and anti-nausea medicines 
• Family history of RLS 
• ADHD 
• Anxiety 
• Depression 
• Kidney disease 
• Sickle cell disease 
• Peripheral neuropathy

Diagnosis of restless legs syndrome

There is no single test to diagnose RLS. Diagnosis is based mainly on symptoms. 

To diagnose RLS, your child’s care provider will: 

• Do a physical exam and review your child’s health history  
• Ask about symptoms or ask you to fill out a questionnaire 
• Review your child’s medicines to see if any may cause RLS symptoms 
• Order blood tests to measure iron and ferritin (iron storage) levels 

Care providers look for 5 key things to diagnose RLS: 

1. A strong urge to move the legs, often with uncomfortable sensations 
2. Symptoms that start or get worse when your child is resting or not active 
3. Symptoms that improve when your child moves their legs 
4. Symptoms that happen mostly at night 
5. Symptoms that are not caused by another condition 

Treatment of restless legs syndrome

Treatment of restless legs syndrome (RLS) depends on: 

• The cause 
• How severe the symptoms are 
• Your child’s age 

No single treatment works for everyone. Your child’s care plan may change over time as symptoms change.  

Lifestyle changes

For mild to moderate RLS symptoms, treatment often starts with simple lifestyle changes. These steps may help your child feel more comfortable. 

Always check with your care team first before making lifestyle changes. 

Changes to daily habits and lifestyle for RLS may include: 

• Healthy sleep habits
• Regular physical activity and gentle stretching 
• Avoiding caffeine (soda, tea, energy drinks, chocolate) and nicotine (cigarettes and other tobacco products) 
• Massage or warm baths to help relax your child’s leg muscles 
• Heating pads or ice packs to help with comfort. Use heating pads carefully and avoid high temperatures. 
• Relaxation methods, such as deep breathing or meditation

Iron supplements 

Your child’s care team may suggest an iron supplement if blood tests show low iron or ferritin levels. Always talk with your child’s care provider or pharmacist about the correct type and dose.  

A care provider will usually recheck your child’s iron levels after your child starts taking supplements. 

Some children may have side effects from iron, such as an upset stomach or constipation.  

Too much iron can be harmful, especially for young children. It is important to use iron only as directed. Store iron supplements out of children’s reach.  

Other medicines for restless legs syndrome 

If your child has more severe RLS symptoms, your care team may prescribe medicine. Most medicines used to treat RLS in adults are not approved specifically for treating RLS in children. Many of the medicines used to manage RLS symptoms are also used to treat other conditions. 

• Anti-seizure medicines: Some medicines used to treat seizures can help with RLS. Gabapentin is often prescribed first. It is usually taken before bedtime. 
• Benzodiazepines: Benzodiazepines are medicines that can help reduce anxiety, relax muscles, and improve sleep. Your child’s care provider may prescribe a low dose to help reduce RLS symptoms. This medicine is usually taken before bedtime. 
• Dopamine: Some medicines affect dopamine, a chemical involved in movement. These medicines are often used to treat Parkinson's disease in adults. They may also help RLS. Care providers use these medicines less often in children with RLS than adults. 

Follow the dosing instructions carefully. The dose and timing of medicine for RLS symptoms may be different than when these medicines are used for other reasons.  

Taking more medicine than prescribed can be unsafe. Families should store medicines safely and keep them out of children's reach. 

Questions to ask your care team

• What is causing restless legs syndrome (RLS) in my child? 
• Could low iron levels or another health condition be making my child’s RLS symptoms worse? 
• Does my child need an iron supplement for RLS? 
• What lifestyle changes can help manage RLS symptoms? 
• What medicines are available for RLS, and what are the possible side effects? 
• When should we contact the care team if RLS symptoms change or get worse? 

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