Thornton B.A. Mason II, MD, PhD, of The Children's Hospital of Philadelphia, and Allan I. Pack, MBChB, PhD, of the University of Pennsylvania, advise pediatricians to question the parents regarding what events typically occur, how soon after sleep onset these events are noted, and whether episodes take place during naps as well as at night. Parents should, in turn, describe in detail the movements and behaviors that are typically seen, said Mason and Pack. In addition, the authors noted, to complement the parents' descriptions, home videos often prove very useful for identifying and classifying parasomnias. A detailed history may also be supported through the completion of sleep diaries, in which parents record sleep periods, arousals/awakenings and parasomnia events, added Mason and Pack.

"The sleep history should be accompanied by a comprehensive physical and neurological exam, to look for features that would be associated with an underlying sleep disruptor: for obstructive sleep apnea, features such as adenotonsillar hypertrophy, retrognathia, and mid-face hypoplasia; for periodic lib movements in sleep, features such as peripheral neuropathy or myelopathy," the authors wrote.

According to Mason and Pack, clinicians should be aware that many pediatric parasomnias are benign, self-limited and may not persist into late childhood or adolescence.

The bottom line, said the authors, is that the parents need to monitor their child's sleep patterns and, if a problem persists, consult with the child's pediatrician, who will determine whether a visit to a sleep specialist is necessary.

"Persistent, prominent and complex cases require physician management, aided by the appropriate use of diagnostic studies (polysomnogtaphy, expanded EEG recordings) and possible pharmacotherapy. The further study of parasomnias in children may help elucidate the multifactorial etiologies of these fascinating conditions, shedding light on their potential genetic bases as well as environmental contributions," the authors concluded.

Parasomnias are unwanted physical events that occur after you fall asleep, while you sleep or when you are waking up. Some of the more common parasomnias in children include sleepwalking, confusional arousals and sleep terrors.

SLEEP is the official journal of the Associated Professional Sleep Societies, LLC, a joint venture of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society.

SleepEducation.com, a Web site maintained by the AASM, provides information about the various sleep disorders that exist, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

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