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Sleepwalking and other Sleep 'Problems'
By Vincent Iannelli, M.D.

Early 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.

But 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.

Since 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.

Facts about sleepwalking and other partial arousals (parasomnias) include that they:

" 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 partial arousals
" 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 inconsistent routine
" 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.

Although 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.

In 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.
Sleep Talking

Sleep talking is very similar to sleepwalking, although it is often only noticed if a child has a roommate that is disturbed by the noise.
Sleep Terrors

Sleep 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.

Although 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.

Since 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 to sleep.
When to Call Your Pediatrician

These sleep 'problems' are considered to be normal and are experienced by many children. You consider talking to your Pediatrician if they are:

" 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 anxiety
" 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.

Vincent 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 and pediatrics.about.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.

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