An 8-year-old boy has recurrent episodes of sleepwalking (somnambulism) occurring two to three times per week, typically 45 minutes after sleep onset. He has never been injured. His parents are anxious and request treatment. Which is the most appropriate initial management?

• A Clonazepam 0.5 mg at bedtime
• B Scheduled awakenings 15 minutes before the usual episode time
• C Polysomnography to rule out nocturnal seizures
• D Safety measures including locking doors and removing obstacles ✓

Explanation

For uncomplicated sleepwalking in children without injury risk, the first-line management is parental education and safety measures (gates on stairs, locking doors, removing sharp objects). Medications like clonazepam are reserved for cases with significant injury risk. Scheduled awakenings have limited evidence. PSG is not routinely indicated for typical NREM parasomnias.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.