Sleep Disorders & Parasomnias in Children

Identification & Treatment

Identify and treat organic sleep disorders and parasomnias that can contribute to poor sleep and lead to daytime fatigue, irritability, or behavioral issues. A pediatric Sleep Specialist/Pulmonologist referral can help in diagnosis and treatment of these disorders.

Obstructive Sleep Apnea (OSA)

With OSA (also known as hypopnea syndrome), a child may have snoring, drooling, mouth breathing, or even chewing and spitting during sleep. Consider a sleep study to titrate CPAP/BiPAP (see CPAP and Bilevel PAP) or referral to a pediatric ENT for possible adenoid (plus or minus tonsil) removal.

Restless Leg Syndrome (RLS)

With RLS/periodic limb movement during sleep (PLMS), there is a feeling that the legs need to move when going to sleep. Parents may even notice that the child has worn down the sheets from moving the legs. With PLMS the child moves a lot during sleep without waking up. For both, there is reasonable evidence that supplementing iron can be helpful (e.g., 3 mg/kg/day of elemental iron) [Amos: 2014]; some researchers advise a goal of ferritin >30-50. [Simakajornboon: 2003] [Blackmer: 2016] There is limited evidence for long-term iron therapy to sustain improved sleep. When these conditions are co-morbid with anxiety, consider clonidine or gabapentin.

Circadian Rhythm Sleep Disorders

For circadian rhythm sleep disorders/phase-shirting, address sleep hygiene (see Behavioral Techniques to Improve Sleep). Teens should get about 9.25 hours of sleep per night. If they are adhering to a new schedule, stick with it for a month before allowing them to sleep in later on the weekends (such as to 9-10 AM, not 2 PM). One approach is gradually to try to move the sleep time earlier, but this may meet with limited success. A more successful approach (but very difficult to do) is to gradually shift the child's sleep onset 1/2 hour later every few nights until he or she gets fully around the clock (only try this over long-term school/work holidays).
Exposure to bright, morning light also can help phase-shifting unless the child has no light perception; 30 minutes of full-spectrum light with eyes open is optimal. Melatonin can help when working toward earlier bedtimes. It may help those with complete blindness to normalize sleep cycles; however, substantial evidence is lacking. A typical dose is 0.5-5 mg 30-60 minutes before bedtime. See Sleep Medications for more information.

Partial Awakenings

Partial awakenings may include sleepwalking, sleep talking, or night terrors. In these instances, the parent should leave the child alone, although in some cases, gently waking the child 30 minutes before a predictable event on a nightly basis will help resolve the problem by shifting sleep cycles. If the child wanders during the night, advise parents to install room gates and/or door alarms.

Nightmares

Intervention involves reassurance and minimizing exposure to materials that may create a higher likelihood of frightening dreams. Night Terrors & Nightmare - Information for Parents provides parents with information on what these are and how to manage them.

Enuresis

Evaluation and treatment are generally the same as for typically developing children - limit fluids before bed, have the child use the toilet before bed and possibly once again later in the night, develop a token reward system for dry nights, and consider using a bedwetting alarm.
  • Neurogenic bladder is managed differently according to condition.
  • Consider Ditropan for a spastic bladder.
  • For children whose incontinence is not managed with these strategies, absorbent diapers are appropriate and may be covered by insurance or Medicaid for incontinent children, particularly if they are older than 3-5 years.

Bruxism

Grinding teeth may be managed with a mouthguard specially fitted by a dentist.

Growing Pains

Growing pains can be severe enough to wake children from sleep. Warmth, massage, stretching the legs, and ibuprofen or acetaminophen can help symptoms.

Resources

Information & Support

For Professionals

Obstructive Sleep Apnea (KidsHealth)
Article for parents/consumers on sleep apnea from Nemours Foundation.

Patient Education

Bedwetting Brochure (AAP)
Explains the causes of nighttime bedwetting and provides techniques to help parents manage the condition until it is outgrown. Also provides signs of a possible medical problem; available for a fee from the American Academy of Pediatrics.

Services for Patients & Families Nationwide (NW)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Helpful Articles

Haba-Rubio J.
Psychiatric aspects of organic sleep disorders.
Dialogues Clin Neurosci. 2005;7(4):335-46. PubMed abstract / Full Text

Authors & Reviewers

Initial publication: May 2021
Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP

Page Bibliography

Amos LB, Grekowicz ML, Kuhn EM, Olstad JD, Collins MM, Norins NA, D'Andrea LA.
Treatment of pediatric restless legs syndrome.
Clin Pediatr (Phila). 2014;53(4):331-6. PubMed abstract

Blackmer AB, Feinstein JA.
Management of Sleep Disorders in Children With Neurodevelopmental Disorders: A Review.
Pharmacotherapy. 2016;36(1):84-98. PubMed abstract

Simakajornboon N, Gozal D, Vlasic V, Mack C, Sharon D, McGinley BM.
Periodic limb movements in sleep and iron status in children.
Sleep. 2003;26(6):735-8. PubMed abstract