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A 7-year-old boy presents with an 8-month history of inconsolable screaming 3 to 4 times per week. The father states that after falling asleep his son will typically awaken 1 to 2 hours later screaming at the top of his lungs and sweating. He is inconsolable and terrified. He does not remember what happens the following morning. What do you tell dad?

A. The symptoms are consistent with sleep terrors.

B. The symptoms are consistent with nightmares.

C. The symptoms are concerning for seizure disorder.

D. The child needs to be evaluated by a mental health professional.

E. The child needs to be evaluated by a neurologist.

Answer: A

A sleep terror is a parasomnia characterized by nighttime awakening in an agitated state from non–rapid eye movement (REM) sleep. The events correspond to prominent slow-wave sleep. Sleep terrors are associated with intense autonomic nervous system manifestations such as dilated pupils, diaphoresis, tachypnea, and tachycardia. After the event, the child is not consolable but returns to sleep after a few minutes. In the morning, the child has no recollection of the event. It is estimated that up to 6.5% of children experience night terrors, which are most common between 2 and 6 years of age. Sleep terrors can be precipitated by stress, sleep deprivation, anxiety, and environmental noises.

In contrast, a nightmare is a frightening dream that awakes a child. Nightmares occur during REM sleep. The child is consolable after the event and may also have a recollection of the event in the morning. Although night terrors occur in younger children, nightmares are more common in school-age children and adolescents. The occurrence is normal, and management is counseling and reassurance.

Night terrors and nightmares do not require referral to a mental health professional or a neurologist. There is no reported association with seizure disorders.

A 10-year-old girl presents with an inability to stop fidgeting for the past 6 months. Her mother states that both she and her teachers are complaining that the girl “cannot sit still.” The nonrhythmic movement occurs when she is awake prior to bedtime. Her physical exam is unremarkable. The girl states that she feels as if “bugs are crawling up her legs,” and she only feels better when she moves her legs as if trying to squash them. What is the most likely diagnosis?

A. Essential tremor

B. Periodic limb movement disorder


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