Parents of a 6-year-old boy who sleepwalks two or three times a month from the first third of the night ask how to manage the condition. He has never been injured. What is the most appropriate initial advice?

• A Wake him fully during each episode so he learns to stop
• B Ensure bedroom safety measures such as locked windows and gates on stairs, and reassure the family ✓
• C Start nightly clonazepam
• D Refer for polysomnography before any management

Explanation

Childhood sleepwalking is usually benign and self-limiting, so the first step is environmental safety measures and reassurance. Forcing the child awake can provoke confusion, agitation and aggression. Pharmacotherapy such as clonazepam is reserved for frequent or dangerous episodes, and polysomnography is indicated only when another sleep disorder such as obstructive apnoea is suspected.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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