and other Sleep 'Problems'
By Vincent Iannelli, M.D.
on, most parents worry about getting their kids to fall asleep easily
and then stay asleep all night. And once your infant is sleeping
well, although he may wake up in the middle of the night every once
in a while, he will mostly be sleeping all night.
then the new sleep 'problems' may begin. During the toddler and
preschool years, and sometimes earlier, some kids begin sleepwalking,
sleep talking, or having sleep terrors.
these are all usually considered to be normal, they aren't really
medical problems, but they can cause anxiety for parents who think
that they are signs of more serious conditions.
about sleepwalking and other partial arousals (parasomnias) include
Tend to run in families, so a child is more likely to sleepwalk
or sleep talk if his parents or siblings also had problems with
" Are thought to be caused by an immature central nervous system,
and so are more common in children and are usually, but not always,
outgrown by adulthood
" Are not usually caused by an emotional or psychiatric condition
" Are most likely to occur 1 ½ to 2 ½ hours after
your child fell asleep, as your child has brief arousals from deep
non-REM sleep. That is why they are called partial arousals, occurring
when your child is not in a deep sleep, but also not really awake.
" Are more likely occur if your child is overtired or has an
" Don't usually require any special treatment, although you
should make sure that your child is getting routine naps until age
five or six, goes to bed early enough, and has a consistent schedule
Unlike other forms of partial arousals, sleepwalking can be dangerous.
The danger doesn't come from waking up a sleepwalker though, as
many parents believe. Instead, it is because your child may not
be safe as he sleepwalks. He may fall down a flight of stairs, leave
the house, or do other things that might cause him to injure himself.
your home should be well childproofed anyway, it is even more important
if your child is a sleepwalker. This includes installing childproof
covers on doorknobs, gates on stairs, and window guards and gates,
etc. Many parents also find it helpful to place a cowbell on their
child's door, so that it wakes them up if their child wakes up and
sleepwalks out of his room. If you are awake when your child is
sleepwalking, although you don't have to wake him up, you can make
sure he is safe and guide him back to bed. Otherwise you may find
him asleep on the floor somewhere, like the bathroom, a hallway,
or your own room.
addition to getting a good night's sleep, it may help to decrease
how often your child sleepwalks if you wake him up sometime before
he usually begins sleepwalking. This is supposed to disrupt their
sleep schedule, however it can be difficult to wake a child in this
early stage of deep sleep. A low, bedtime dose of a medication like
Valium can also help to decrease a child's episodes of sleepwalking
if it gets to the point that it is really a problem for the family.
talking is very similar to sleepwalking, although it is often only
noticed if a child has a roommate that is disturbed by the noise.
Terrors or night terrors are one of the most frightening events
that parents face. In addition to a 'blood curdling' scream, they
may wake to find their child confused and afraid, sweating, breathing
fast, and with a fast heartbeat. These children are also often impossible
to console, which makes sense since they aren't really fully awake.
scary, fortunately these episodes are usually very brief. They typically
only last about three to five minutes, although some can last for
up to half an hour. And unlike nightmares, children usually don't
remember that they had a sleep terror the next morning.
your child seems so afraid, it can be tempting to wake a child during
a sleep terror, but it is usually not a good idea. Although you
may end the sleep terror, you will likely have a very upset child
on your hands who will have a hard time going back to sleep. Instead,
you should try to stay calm, comfort her if it doesn't make things
worse, and just wait until the episode is over and she can go back
When to Call Your Pediatrician
sleep 'problems' are considered to be normal and are experienced
by many children. You consider talking to your Pediatrician if they
Disrupting your child's sleep, so that he is sleepy during the day
" Occurring often enough that they are disrupting everyone
else's sleep and you think your child may require treatment
" Accompanied by other symptoms, like fever, or if your child
has other daytime symptoms, especially a lot of stress, fear, or
" Beginning before your child is 12 months old (sleep terrors)
" Not typical, such as child who wakes up often in the night
and snores loudly, which can be a symptom of obstructive sleep apnea
and not a parasomnia.
Iannelli, MD is a board certified Pediatrician and Fellow of the
American Academy of Pediatrics. In addition to having a private
practice and serving as an associate professor of Pediatrics at
UT Southwestern Medical School, he publishes the websites www.keepkidshealthy.com
His first book, The Everything Father's First Year, will
be released early next year. Dr. Iannelli has been featured in national
print and is a member of the Texas Medical Association and the Dallas
County Medical Society. He lives with his family near Dallas, Texas.