Primary parasomnias

Sleep-related rhythmic movement disorders, such as headbanging, occur in many young children, almost always remitting spontaneously by 3 to 4 years of age. Although alarming to parents, they are usually of no psychological significance (unlike daytime headbanging associated with severe neurodevelopmental disorder). However, protective measures such as padding the cot sides may be needed.

Hypnagogic (sleep onset) and hypnopompic(on waking) 'hallucinations' are common and may be frightening to the child. Parents are often distressed to witness confusional arousals which are a form of partial arousal disorder common in young children. The degree of agitation and confused behaviour may be extreme, suggesting that the child is suffering in some way. In fact, as in other arousal disorders, the child remains asleep. Understandable attempts to rouse the child and provide comfort should be discouraged, as this may cause real distress. Although violence during sleep is described mainly in sleepwalking adults, such behaviour can occur in children.(47)

Nocturnal enuresis(48) is very common, affecting about 5 per cent of 7-year-olds at least once a week. Delayed maturation often seems to be the explanation, but physical or psychological factors may be involved especially where previous bladder control is lost. Behavioural treatment can be very effective. The term nightmare is sometimes used misleadingly for any form of dramatic parasomnia. True nightmares (frightening dreams) are common.(49) If frequent and associated with intense bedtime fears, they may indicate an anxiety disorder and their content may suggest the cause.

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