Sleepwalking in Children
by Bruce A. Epstein, M. D.

Sleepwalking (medical term somnambulism) is more common than one might guess. Thirty percent of all children between the ages of five and 12 have walked in their sleep at least once, and persistent sleepwalking occurs in 1% to 6% of youngsters. Boys walk in their sleep more often than girls and the tendency to wander during deep sleep is sometimes inherited from one of the parents.

Sleep walking should be distinguished from the occasional night wakening that occurs because of a thunderstorm or bad dream. In these situations, the child walks directly to their parents' bedroom and can usually be persuaded back to sleep with a little parental coaxing.
The typical sleepwalking episode begins about two hours after the child goes to sleep. At first glance, a parent would not know that their child was a sleepwalker. The youngster wakes from sleep and abruptly sits up in bed. Although their eyes are wide open, they appear glassy and the child just stares ahead (Shakespeare described the sleepwalking Lady Macbeth "You see, her eyes are open, but their sense is shut!") Even looking straight at their parents, the sleepwalker does not show any recognition. When asked, sleepwalkers respond with mumbled and slurred single-word speech. The child then may do common acts such as dressing and undressing, opening and closing doors, or turning lights on and off. Avoiding most objects in their way, sleepwalking children seem to see where they are going since they avoid most objects in their way, but are unaware of their surroundings. Unfortunately, this means that they cannot tell the difference between their bedroom door and the front door or the toilet and the wastebasket. The sleepwalker is usually impossible to awaken and does not remember the episode in the morning. The episode typically lasts five to fifteen minutes and may occur more than once in the same night.

When a parent finds their children sleepwalking, they should take the youngster by the elbow and gently lead them back to bed. The sleepwalker will usually end when the child as the child returns to sleep. Parents should not try to awaken the child to stop the episodes. Sleepwalkers are difficult to awake and might become frightened and disoriented. If this happens, "do not attempt to touch them or lead them back to bed," says Richard Ferber, M. D., director of the Center for Pediatric Sleep Disorders at Children's Hospital, Boston. "Touching an upset sleepwalker may cause them to flail out violently, putting the parent in danger."

Although sleepwalkers avoid bumping into walls and tripping over furniture, they lack any judgment. One child made her way to the kitchen and opened the refrigerator. Another walked into the garage and got in the car, ready to go to school at 4:00 in the morning. But their lack of judgment can be dangerous. One sleepwalker climbed a tree and another is found by the police walking down the middle of the street carrying his blanket. Therefore, sleepwalkers are in danger of hurting themselves and must be protected from self-injury. While fewer than 1% of sleepwalkers injury themselves, parents should take precautions to safeguard their child's environment.

* Remove sharp objects and obstacles in a child's room.
* Place protective gates on stairways.
* Lock doors securely with special locks high above the child's reach
* Keep clutter off floors to prevent tripping
* Move tables, nightstands, and other furniture out of the path to the bedroom door
* Close off dangerous areas like the laundry room where toxic products are stored.
* Attach a bell to the child's bedroom door that will ring when the door is opened, alerting parents that their child is up and about.
* Never let the child sleep on a top bunk bed.
* Lock away any firearms.
Parents should seek medical help for their sleepwalker when the youngster puts themselves in danger by their late night excursions or the episodes become disruptive to their family. Perhaps the physician might refer the child to a specialist in sleep disorders.

"It is important to remember that sleepwalking in children improves with time and does not represent any serious psychological problems," added Dr. Ferber. Most children outgrow sleepwalking by the time they are teenagers. Until this happens, parents should reassure the child that their sleepwalking is normal. In addition, make sure the child is well rested, since sleepwalking usually occurs only when the child is deep sleeping. Do not be angry or punish the sleepwalking. Remember, how parents react to sleepwalking will decide how the child will react. The message to the sleepwalker must be clear: "There is nothing wrong with you. We just want to take care of you and keep you from hurting yourself."As in every aspect of a child's life, understanding and love goes a long way.

As a reminder, this column is being written to draw attention to the issues discussed, and should not be relied upon as medical advice and is not intended to replace the advice of your child's physician.