Sleepwalking or pediatric somnambulism is when children wake up just enough to walk in their sleep. Some 15 percent of children will sleepwalk at some point or another. Most children who sleepwalk do so from four to eight years of age. Kids almost always outgrow this phase, and parents should be reassured that sleepwalking is normal and not a sign of poor health or emotional problems. If your child walks in their sleep, your main concern should be keeping them safe and secure in your home during bouts of sleepwalking.

When a child begins to sleepwalk, it is natural for parents to worry. The behavior is new and you wonder if walking in their sleep is a sign or symptom of illness, anxiety, or stress. Sleepwalking, however, is often seen in healthy children, and in general, has nothing to do with emotional or mental difficulties.

You might notice that your child’s sleepwalking happens during the first stages of sleep, an hour or two after falling asleep. If your child sleepwalks, make sure your child has a regular sleep routine. Remove all objects your child could trip over during sleepwalking bouts, lock the windows and doors, and wall off any staircases with a baby safety gate to prevent falls. Providing a safe, secure home is the most important thing a parent can do for their children who sleepwalk.

Sleepwalking Defined

Anya McLaren-Barnett, a pediatric respirologist and sleep medicine physician located in Ontario, Canada says that sleepwalking tends to happens during the first few hours of sleep.  “Sleepwalking can be thought of as an undesirable episodic physical event or experience that occurs as a child falls asleep, while they are asleep, or during an arousal from sleep. Parents and caregivers are usually very worried when their children walk in their sleep.  Sleepwalking belongs to a group of conditions called parasomnias, or disorders of partial arousal. Parasomnias may be either non-REM related or REM related. Sleepwalking is non-REM related.

“As a child falls asleep, they go from being awake to light stage sleep (N1) to a deeper stage sleep (N2) and then to very deep sleep (N3) and then back to lighter stages of sleep before transitioning to dream sleep. Sleepwalking typically occurs at the transition from deep NREM stage 3 sleep into lighter stages of sleep or into the awake state. It most often occurs in the first third of the night when slow wave sleep is predominant.

“Sleepwalking occurs in about 15% of children (with some studies showing as much as 40%, and peaks between 8 and 12 years. Mild episodes may look like a toddler sitting up in bed and crawling around the bed or walking quietly to stand by the bed of the parents. In some cases, the behavior can be simple walking, often with eyes open and with a ‘glassy stare.’ The child may mumble or responding inappropriately to questions. In some cases, children may appear agitated and/or run around the house or have confused and inappropriate behaviors such as urinating in unusual places. Some children can leave the house on a cold night and suffer accidental hypothermia. Children often do not recall the event the day after.”

Pierrette Mimi Poinsett MD, a pediatrician and consultant for Mom Loves Best adds that sleepwalking children may be difficult to awaken, and they may not respond when spoken to. “Children may also sleep talk during an episode. A children will generally return to bed on their own and not remember sleepwalking the next day.

Edna Skopljak, a physician and editor at Instador comments that sleepwalking children may perform complex tasks such as eating or getting dressed while sleepwalking.

Causes of Sleepwalking

“There are several factors that contribute to sleep walking,” says McLaren Barnett. “The first is family history. The likelihood that a child will sleep walk is measurably increased if one parent has the disorder and even more if both parents have it. Sleepwalking tends to be more common in individuals with migraine headaches and Tourette syndrome. Not getting enough sleep also makes it more likely that a child will sleepwalk.”

Dr. McLaren Barnett lists several factors that can trigger or worsen sleepwalking including:

• Irregular sleep schedule
• Inadequate sleep
• Change in the sleep schedule (such as ending daytime naps)
• Sleep disturbances like sleep apnea or periodic limb movements
• Fever and illness
• Medications (lithium, benzodiazopenes, tricyclic antidepressants)
• Caffeine
• Sleeping with a full bladder
• Sleeping in a different environment
• Noise and light
• Situational stress and anxiety

Sleepwalking in the Literature

Dr. Poinsett says that sleepwalking was first described in the literature—at least in America—in 1838, when Dr. Issac Ray, a forensic psychiatrist documented the phenomenon. McLaren-Barnett, however, says that somnambulism was documented even before the third century AD. The sleep condition was described by luminaries such as Hippocrates and Aristotle, in their writings. In the West, somnambulism was, during medieval times, tied to religious beliefs. “Since then, somnambulism has been featured in medical dissertations and books on medicine. Shakespeare and other famous writers wrote sleepwalking into their plays, operas and novels.

“Over the years,” said McLaren-Barnett, “somnambulism has been described as a mental illness, epileptic convulsion, and dream walking. However, with the discovery of the electroencephalography or EEG near the middle of the twentieth century, somnambulism has been discovered to be a disorder of slow-wave sleep and not of REM or dream sleep. This goes against the vision of early physicians, namely that individuals who sleepwalk are acting out their dreams.”

Skopljak remarks that in the medical literature, the earliest known description of sleepwalking was made by the ancient Greek physician Aretaeus of Cappadocia in the 2nd century AD. “He referred to the condition as ‘a Somnus,” meaning ‘the sleep.’ The German physician Heinrich Hofmann coined the term ‘somnambulism’ in 1877.”

Sleepwalking Management Strategies

“The most important approach to the parent of a child who sleepwalks is reassurance and education,” says Dr. McLaren-Barnett. “Education should focus on the fact that sleepwalking is benign and self-limited. Typically, children will stop having episodes by the time they enter adolescence because slow wave sleep is significantly reduced. By 8 years old, 50% of children with sleepwalking will no longer experience episodes. About 10% will continue to have sleepwalking for 10 or more years and can continue to do so into adulthood.”

McLaren-Barnett suggests the following management strategies for parents during the time the child experiences episodes of sleepwalking:

• Ensure safety in the home.
  • Doors that lead to the outside of the home or windows on the second level should be inaccessible. Other safety measures include the use of gates at doorways as well as staircases, and lighting the hallways. It is also important to ensure that the area that the child can access is safe, with no clutter on the floors, and no access to fire or sharp objects like scissors or knives. Parents can consider a notification measure such as an alarm system or a bell attached to the bedroom door.
• Ensure healthy sleep habits
  • Insufficient sleep is the primary contributor to sleep walking. As such it is important to ensure that a child is having adequate sleep and a consistent sleep-wake schedule. Avoiding caffeine which is a sleep disruptor and can decrease sleep efficiency thereby contributing to sleep deprivation is another measure to take.
• Ensure appropriate response to the event
  • It is important to not wake a child from sleep walking as this can increase agitation and prolong the event. Instead, gently guide the child back to bed and encourage return to normal sleep. Discussing the event the following day can increase worry and anxiety in the child so it is generally advised not to.
• Ensure that parents know when to seek medical attention
  • If sleepwalking episodes are severe or have a high risk of injury, violent behavior, or significant disruption to the family, and parents should discuss the situation with their child’s doctor, as there are medications available to treat the condition.

Scheduled Awakening Technique

“In children that have episodes on a nightly basis at the same time, scheduled awakening can be a helpful technique,” says McLaren-Barnett. This involves gently rousing the child (not fully awake; just to the point where they change position or mumble) about 15 to 30 minutes before the event for 2-4 weeks.

“In any child that sleepwalks, consideration should be made for nocturnal seizures which can look similar except that with nocturnal seizures, there may be multiple episodes throughout the night, and daytime sleepiness. These seizures can occur at any time throughout the night and are associated with incontinence, tongue-biting, drooling and stereotypic, repetitive behavior. Of course when there is a family history of seizure, this is also an important consideration. If a child has any of these features, parents should discuss further with their child’s doctor.”

Poinsett says the most important thing to do is to remove obstacles in the child’s bedroom over which the child might trip or fall over during episodes of sleepwalking. “Your child should not sleep in the upper bunk of a bunkbed to prevent a serious fall. Windows and doors should be locked.

Don’t Wake Them

“If you encounter your child sleepwalking do not try to wake them,” adds Poinsett. “Rather carefully lead them back to bed.”

Skoljak suggests that parents should try to pin down the cause of the child’s sleepwalking. “It is essential for parents to try to identify any triggers that bring on bouts of sleepwalking. In the case where sleepwalking is brought about by stress or certain medications, a parent should address these causes if possible. A sleep specialist may need to be consulted if the sleepwalking is severe or causing significant disruption to the child’s sleep or daily life.

There’s no doubt that there’s something creepy about sleepwalking. That is until it becomes routine. After the first several times watching your child sleepwalk, it will begin to seem like any other phase of childhood. Just as you baby proof your home when a child begins to crawl, walk, and climb, the main task of the parent whose child sleepwalks, is to keep them safe.

Also, keep in mind that children almost always outgrow sleepwalking, and learn to sleep undisturbed—that is until they have children of their own!

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