Parasomnias in childhood.

Common childhood parasomnias, including those occurring at sleep onset and during rapid eye movement sleep or non-rapid eye movement sleep and their ontogeny are discussed. The events may be distressing to both the patient and family members. Stereotypic movements characteristic of some parasomnias most likely arise from disinhibition of subcortical central pattern generators. Genetic predisposition, an inherent instability of non-rapid eye movement sleep and underlying sleep disturbances such as obstructive sleep apnea may predispose to the activation of confusional arousals, sleep walking or sleep terrors. Many parasomnias can be recognized by history alone, but some require nocturnal polysomnography for appropriate diagnosis and management. A scheme to distinguish non-rapid eye movement sleep parasomnias from nocturnal seizures is provided. Behavioral therapy has a role in the management of many childhood parasomnias, but evidence based recommendations are as yet unavailable.