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Pediatric and adolescent sleep disorders are common and often disturbing to either the patient or the family. Sleep disorders can adversely impact physical and mental health. Nonrestorative sleep can hamper a child's ability to concentrate and control emotions and behavior. Sleep disorders vary among age groups, but most can occur with varying frequency at any age. Several disorders are typically seen only during the first 3 years of life, including colic, excessive nighttime feedings, and sleep-onset association disorder. A number of conditions are common during childhood but begin to improve as the child ages. The non-REM sleep parasomnias—including sleepwalking, confusional arousals, and night terrors—are the most common in this category. Nightmares are also common in childhood but can occur at any age.

The sleep-related breathing disorders include obstructive sleep apnea, central sleep apnea, central alveolar hypoventilation syndrome, and Cheyne-Stokes respirations. These disorders can occur at any age, although the treatment options vary by age (Table 12-1).

Table 12–1. Pediatric Sleep Disorders

The most frequent sleep-related problem for children between ages 6 months and 3 years is difficulty going to sleep or staying asleep throughout the night.1 Multiple factors have been implicated in the occurrence of repetitive night waking and inability to fall asleep: infant temperament, nutrition, physical discomfort, mild allergy, and parental marital conflict.2,3

Sleep-Onset Association Disorder

Clinical Features

Complaints of sleep problems in the infant and young child usually come from the parents, not the child. Nighttime awakenings sometimes become worrisome to parents. However, most often the problems reflect certain established patterns of interaction between the parent and the child at time of sleep transition. Nighttime arousals are very common in all ages; however, older children and adults are usually unaware of these disruptions.


A parent may incorrectly conclude that nocturnal awakenings are abnormal, becoming involved in the sleep transition process. The child may become accustomed to parental intervention and become unable to make the transition back to sleep alone, creating a sleep problem or sleep-onset association disorder. The child becomes reliant on the parent to help complete the sleep transition regardless of the time of night.

Diagnosis and Treatment

Diagnosis is usually made with a careful history. Children with this disorder often rapidly respond to simple gradual behavioral interventions, which helps the child learn ...

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