Table 2

Red flags/concerning features

Sleep issueFeatures raising concern
Multiple stereotyped night wakings.Stereotyped movements.
Multiple episodes in the same night.
Predominant occurrence after first third of sleep period.
Event starts and stops suddenly.
While most unusual episodes during the night are parasomnias, the above features raise the level of concern for possible nocturnal seizures; consider referral for specialist assessment.
Also lowered threshold for further assessment in children with atypical development or daytime seizures.
Nightmares with specific imagery.Persistent, severe, disruptive nightmares.
Nightmares consisting of concerning imagery—consider potential traumatic events in child's life.
Excessive/unusual daytime sleepiness.Consistent inability to stay awake during the daytime (including during activities child is engaged with) is very unusual beyond the age of normal daytime napping.
Consider—narcolepsy, obstructive sleep apnoea.
Any sleep issue.In association with significant daytime behavioural change—consider full neurodevelopmental assessment as presenting sleep issue may be part of a wider neurodevelopmental dysfunction.