Current opinion in pediatrics
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To enhance the ability of the practitioner to diagnose and manage children with parasomnias in the office setting. ⋯ Common childhood parasomnias such as hypnic starts, rhythmic movement disorder, sleep paralysis, confusional arousals, sleepwalking, sleep terrors, enuresis, and nightmares are discussed. These events may lead to significant concern and worry for the parents. Most parasomnias are recognizable by history alone, but some may require nocturnal polysomnography for accurate diagnosis and determining an underlying trigger factor. Findings on nocturnal polysomnography are described. Sleep terrors, confusional arousals and sleepwalking may mimic seizures; distinguishing seizures from parasomnias is discussed. There is a genetic predisposition to many childhood parasomnias. Management techniques, including behavioral therapy, are reviewed. Unfortunately, evidence-based recommendations are as yet unavailable. The management of sleep enuresis continues to remain a significant challenge.
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There is a growing awareness of the importance of cultural competency in pediatrics. The authors review the most recent studies that examine the impact of cultural competency on general pediatric care, explore cultural beliefs and practices affecting clinical care, and describe culturally sensitive interventions designed to address racial/ethnic health disparities. ⋯ A goal for the pediatrician is to provide culturally competent healthcare by using trained medical interpreters with limited English-proficient families, being familiar with normative cultural values that affect the healthcare of commonly encountered racial/ethnic groups, and asking about folk illness beliefs and ethnomedical treatments.