Restless legs syndrome (RLS) has gradually been recognized as a cause for 
insomnia in adults, but there have been few reports about children with RLS in 
Japan. Here we described seven pediatric RLS patients. All of the parents of our 
patients had difficult times to make their children sleep due to irritability, 
restlessness, and demanding bedtime routines. All patients had asked their 
parents to rub their feet in bed, and it took more than half an hour to soothe 
them until they fell asleep. Their mothers had been exhausted from this 
night-time routine. However, they did not consider the routine abnormal, as it 
had been their habitual behavior since infancy. Some parents were too distressed 
or embarrassed to describe the symptoms of their child properly. Five patients 
had clear family history and none had obvious periodic leg movements during 
sleep. All patients showed low levels of ferritin and iron supplementation was 
effective in five cases. In the severest two cases, pramipexole, but not iron, 
was dramatically effective. Both patients started to show RLS symptoms in the 
early days of infancy, which may suggest more severe hereditary dopaminergic 
dysfunction. RLS does occur in childhood and pediatricians should bear it in 
mind as one of the differential diagnoses when seeing children who are irritated 
and/or having difficulty in initiating their sleep.