Complications
Pediatric patients with confusional arousal need treatment and close follow-up. Other household members need to be educated about the need to avoid intervention during the parasomnia and to maintain a safe environment for the patient.
Any measures to prevent the parasomnias by force, such as by restraining or forcefully awakening the patient, may result in further agitation and increased potential for injury.
Although rarely used, benzodiazepines may be prescribed in children with sleepwalking, sleep terrors, isolated recurrent sleep paralysis, and rapid eye movement sleep behavior disorder (RBD).
Children need to be monitored for improvement with therapy as well as for adverse effects. Daytime drowsiness may necessitate discontinuation of the therapy. Abrupt discontinuation of clonazepam, however, may precipitate withdrawal symptoms.[77]
Although rarely used, antidepressants may be prescribed in children with sleepwalking, sleep terrors, and nightmares. Children need to be monitored for improvement with therapy as well as for adverse effects.
Excessive sedation, behavioral disturbances, suicidal ideation, and cardiac arrhythmia are all possible adverse effects associated with antidepressant therapy.
In 2004, the US Food and Drug Administration (FDA) issued a black box warning on suicidality associated with pediatric use of antidepressants.[67]
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