Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Sleep-associated respiratory, neurological or safety emergency
Cyanosis, prolonged apnoea, severe respiratory effort, an unresponsive event, status epilepticus, overdose or imminent self-harm is not a routine sleep problem.
Action: Use ABCDE, open the airway, give oxygen and ventilation support as required, check capillary glucose and call emergency paediatric help. Treat a prolonged convulsive seizure according to the local status pathway. A child who is blue, difficult to rouse, injured or breathing abnormally after a nocturnal event needs urgent assessment even if the event has stopped. Suspected sedative or melatonin overdose requires exact product and amount, observations and National Poisons Information Service or TOXBASE-guided care. Escalate suicidal intent, unsafe nighttime wandering or caregiver exhaustion that prevents safe supervision through urgent mental-health, safeguarding and family-support pathways.
Synopsis
Assess paediatric sleep in developmental and family context, distinguish behavioural insomnia and normal parasomnias from respiratory, neurological and mental-health disease, implement collaborative behavioural treatment, and reserve medicine for selected specialist indications with safe monitoring.
First-line assessment is a sleep history plus a 2-week diary recording sleep opportunity, estimated sleep, awakenings, naps, events, caffeine, screens and daytime effects.
Set one consistent wake time every day, provide age-appropriate sleep opportunity, use morning light and daytime activity, and build a predictable calm wind-down.
For behavioural insomnia, first-line management is a collaboratively chosen routine plus behavioural strategy such as bedtime fading, graduated checking or consistent low-interaction return to bed.
Key red flags
Cyanosis, prolonged breathing pauses, marked chest recession, stridor or difficult arousal during sleep requires urgent respiratory assessment.
Investigation priorities
01
First-line: 2-week sleep diaryFirst stepFirst line
Quantify schedule, opportunity, latency, waking, naps, events, triggers and daytime function before and during intervention.
02
Reference standard: polysomnography for obstructive sleep apnoeaReference standard
Measure sleep state, airflow, respiratory effort, gas exchange, heart rhythm and movements when sleep-disordered breathing is suspected.
Management branches
AssessmentClassify before intervening
Sleep timing, night events or daytime function concerns the family.
Screen for respiratory compromise, seizure, acute mental-health risk, overdose, regression and safeguarding or supervision danger.
Take an age-appropriate sleep, health, medicine and environmental history and start a 2-week diary with wake time, naps and events.
Key medicines
Melatonin prolonged-release tablets, SlenytoLicensed paediatric indications: start 2 mg once daily, 30–60 minutes before bedtime and with or after food. If response is inadequate, increase to 5 mg and then maximum 10 mg daily according to the SmPC and specialist review.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.