Rethinking pediatric "Periodic Limb Movement Disorder" (PLMD): A clinical review of pediatric PLMD and consensus criteria for an updated pediatric diagnostic category "Sleep Leg Movement Disorder of Childhood".

Pediatric Periodic Limb Movement Disorder (PLMD) is a sleep-related movement disorder characterized by repetitive limb movements, primarily in the legs, which disrupt sleep and potentially cause daytime functional impairments. This article reviews the clinical features, diagnostic challenges, and treatment approaches for pediatric PLMD, while emphasizing the importance of distinguishing it from simple periodic limb movements (PLMS). Although PLMD is associated with various conditions such as iron deficiency, attention-deficit/hyperactivity disorder (ADHD), and neurodevelopmental disorders, the exact prevalence and underlying mechanisms remain unclear. Diagnosis requires polysomnography, and adherence to standardized criteria, complicates the process. Treatment primarily involves iron supplementation, with behavioral interventions and off-label pharmacological options considered in more severe cases. Due to recent appreciation of non-periodic movements in many cases, this review proposes the introduction of a new diagnostic category, Sleep Leg Movement Disorder of Childhood (SLMDC), which would encompass a broader spectrum of pediatric limb movement disorders. This new category aims to improve clinical care by allowing for more tailored interventions and better communication between healthcare providers and families. SLMDC would facilitate long-term follow-up and offer a framework for understanding the continuum of these disorders from childhood to adulthood. The paper concludes by advocating for the retention of PLMD as a subset of SLMDC, emphasizing the need for updated diagnostic criteria and treatment strategies that reflect the unique characteristics of pediatric patients.