Table 2.

Common childhood parasomnias

Condition	Key Features/Symptoms	Primary Evaluation	Primary Intervention(s)
Confusional arousals	Partial arousal from sleep characterized by confusion, difficulty waking, sometimes agitation Child does not recall event later when awake	Clinical Interview, in some cases PSG and Sleep Diaries are helpful in differential diagnosis	Ensure safety Screen for and treat potential causes Provide parents with reassurance, education, and behavioral guidance Avoid waking and redirect to bed or comfortable position in bed (if need to urinate seems to precipitate partial arousal, redirect to bathroom) Avoid next-day discussions In rare cases, medication
Sleepwalking (somnambulism)	While still asleep or with altered consciousness, walking or engaging in nonsensical behaviors or routine behaviors in the wrong context Child does not recall event later when awake
Sleep terrors (aka “night terrors”)	Sudden episode of both behavioral and autonomic nervous system symptoms of terror while still asleep or with altered consciousness Child does not recall event later when awake
Nightmares	Child awakens from sleep with recall of frightening dream, perhaps crying or screaming Reasonably coherent and oriented May take time to calm enough to return to sleep Child can later recall period of awakening	Clinical Interview	Reduce frightening or stressful events, especially close to bedtime Provide reassurance Build self-soothing skills and tools In rare cases, medication
Sleep Enuresis (“bedwetting”)	Involuntary voiding during sleep at least twice per week in children > 5 years of age. Designated “primary” if never been dry >6 mos, “secondary” if starts after dry period >6 mos	Clinical interview	Screen for and treat possible causes (e.g., neurological, urological, OSA) Reassurance and use of pull-up if not a concern in family Enuresis alarms + behavior therapy In limited cases, medication