Children, sleep, and behavior: a complex association

Pediatric sleep physiology begins with development of the sleep/wake cycle, and the origins of active versus quiet sleep. The 24-hour circadian cycle becomes established at 3-6 months. Sleep disorders during infancy commonly include mild, usually self-limited conditions such as sleep-onset association disorder, excessive nighttime feedings, and poor limit-setting. These require behavioral management to avoid long-term deleterious sleep habits. In contrast, other sleep disorders are more ominous, including SIDS, central congenital hypoventilation syndrome, and sleep apnea. Childhood is generally considered the golden age of sleep, with brief latency to sleep onset, high efficiency, and easy awakening. Yet parasomnias, psychological factors, and sleep disturbances associated with common disorders such as ADHD disrupt the idealistic notion of childhood being a period of unfettered sleep. Adolescents have sleep requirements similar to adults, posing a challenge for them to adapt to school schedules and increasingly demanding lifestyles. Narcolepsy, usually diagnosed in adolescence or early adulthood, is a lifelong sleep disorder and has led to the identification of the hypocretin/orexin neurotransmitter system. Research advances in the complex interrelationships between developmental neurobiology, sleep disorders and behavior will lead to an enhanced understanding of the pathophysiology of sleep problems and lead to novel therapeutic strategies for sleep disturbances in children.