Frightening parasomnias of childhood sleep

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If childhood parasomnias are excessive or there is concern for nighttime seizure, a sleep professional or neurologist should be consulted.
If childhood parasomnias are excessive or there is concern for nighttime seizure, a sleep professional or neurologist should be consulted.

No parent wants to hear their child scream in the night. It is often a more frightening experience for the adult than it is the child, and if it is due to a parasomnia, the child is unaware of the event in most cases. Parasomnias often occur in preschool-aged children and decrease in frequency by early adolescents. Most of the parasomnias that occur do so in healthy children, but the differential can include neurologic, psychiatric, and mental disorders, so careful observation and a good history and physical are important.

Parasomnias can be divided into those that occur in non-REM (NREM) sleep and rapid eye movement (REM) sleep. NREM parasomnias include sleep terrors and sleep walking. These usually occur during the first third part of sleep when the child is in stages of NREM sleep. They are called partial or confusional arousals as they occur when transitioning from deeper stages to lighter stages of NREM sleep.  Children who sleepwalk often have parents who did the same when they were young.  Other sleep disorders such as obstructive sleep apnea and restless leg syndrome can be triggers, as can gastroesophageal reflux, fever, and sleep deprivation. Nocturnal seizures can mimic sleep terrors and sleepwalking so careful attention must be paid to a parent's concerns.

Parasomnias that occur in REM sleep include nightmares, sleep paralysis, and REM sleep behavior disorder (RBD). Sleep paralysis is usually seen in young adults and is common in those with narcolepsy. RBD is usually seen in older adults over the age of 60 but can rarely be seen in children.

Here is a chart that might help you distinguish one parasomnia from another:

If these parasomnias are excessive or there is concern for seizure, a sleep professional or neurologist should be consulted. Most of these resolve with time and reassurance from the parents. Sleep deprivation in children and teenagers can trigger parasomnias, so make sure children are getting adequate sleep.

References

  1. Principles and Practice of Sleep Medicine, Sixth edition.
  2. Kotagal, Suresh. UpToDate. Sleepwalking and other parasomnias in children.
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