A 4-year-old boy is brought to the office by his mother for an annual wellness examination. The mother mentions that the boy has recently experienced several thrashing episodes at night in which he awakens screaming and crying about an hour after falling asleep. She says, "It's baffling because his eyes are open during these episodes, but he does not appear to be aware that I am present. I try to calm him down and comfort him, but it seems to have no effect." Eventually he falls back asleep and appears to have no recollection of the previous night's events in the morning. The mother says, "He recently saw a horror movie with his older siblings and I wonder if this upset him." The only recent change has been moving to a new home within the same city. The patient has no other medical problems. Physical examination is normal, and the boy appears to be meeting all developmental milestones. For advising the mother about the child's prognosis, which of the following is the most accurate statement?

Question

A 4-year-old boy is brought to the office by his mother for an annual wellness examination.  The mother mentions that the boy has recently experienced several thrashing episodes at night in which he awakens screaming and crying about an hour after falling asleep.  She says, "It's baffling because his eyes are open during these episodes, but he does not appear to be aware that I am present.  I try to calm him down and comfort him, but it seems to have no effect."  Eventually he falls back asleep and appears to have no recollection of the previous night's events in the morning.  The mother says, "He recently saw a horror movie with his older siblings and I wonder if this upset him."  The only recent change has been moving to a new home within the same city.  The patient has no other medical problems.  Physical examination is normal, and the boy appears to be meeting all developmental milestones.  For advising the mother about the child's prognosis, which of the following is the most accurate statement?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c1ab_b9c0_8f63_b9c74956d8b0_MD0005_00 This child is experiencing sleep terrors, a common non-rapid eye movement (NREM) sleep arousal disorder of childhood that typically occurs between ages 4-12. The condition is usually benign and self-limiting, resolving spontaneously over 1-2 years. Sleep terrors occur during the first third of sleep and arise from slow wave sleep. The child awakens abruptly with a scream, a frightened expression, and signs of autonomic arousal (eg, tachycardia, rapid breathing, mydriasis). The child is typically inconsolable, difficult to awaken completely, and unable to recall the episode in the morning. In contrast, nightmares occur during REM sleep, are more likely in the second half of the night, and are associated with clear dream recall and complete awakenings (Choice A). In healthy children with classic presentation of sleep terrors, the diagnosis is clinical and no further workup is indicated (Choice D). Most patients do not require medication (Choice C). In addition, parents should be reassured and instructed to remove dangerous surrounding objects to ensure safety. Low-dose benzodiazepines at bedtime can be used if episodes are very frequent or impair daytime functioning. (Choice E) Sleep deprivation can trigger sleep terrors, and physicians should recommend obtaining adequate sleep. However, there is no evidence that this child has had inadequate sleep, and it would be inappropriate to offer false reassurance that the episodes will resolve with additional sleep. Educational objective: Sleep terrors are a common non-rapid eye movement arousal disorder in young children. The condition is benign, self-limited, and best managed with education and reassurance. References: Just a scary dream? A brief review of sleep terrors, nightmares, and rapid eye movement sleep behavior disorder. (http://www.ncbi.nlm.nih.gov/pubmed/24126984) Common sleep disorders in children. (http://www.ncbi.nlm.nih.gov/pubmed/24695508)

A 4-Year-Old Boy Is Brought to the Office by His