Paediatric sleep clinic, by a specialist paediatric sleep physician.

Prices vary by clinic, by paediatric sleep physician and by whether attended polysomnography or actigraphy is needed. Adenotonsillectomy is arranged on a separate ENT pathway.

1. 01

   Before

   You send us a short sleep history

   A short, confidential form. Age, the presenting problem, a two-week sleep diary if you have one, and any video of concerning night events.

2. 02

   Before

   We come back with a recommendation

   Within one working day: which paediatric sleep physician fits, whether actigraphy or attended polysomnography is needed, and an indicative price.

3. 03

   Before

   We arrange the consultation

   Usually within one to two weeks. Iron studies, thyroid, ferritin and mood or ADHD screening are arranged if the history flags them.

4. 04

   At the clinic

   The first appointment (45 to 60 minutes)

   Full sleep history, examination for tonsillar and adenoidal Brodsky grade, craniofacial review for retrognathia, and a plan for investigations.

5. 05

   At the clinic

   Investigation, if indicated

   Home wrist actigraphy over two to four weeks, or an attended paediatric polysomnography night in a hospital sleep lab with video and full physiology.

6. 06

   After

   Diagnosis and treatment plan

   A written plan: behavioural programme, melatonin dosing, ENT referral for adenotonsillectomy, CPAP set-up, or narcolepsy medication and planned naps.

7. 07

   After

   Follow-up and review

   A review at four to eight weeks to check sleep-diary progress and, where relevant, repeat actigraphy or a titration study.

• Behavioural insomnia (toddler and preschooler)

  Bedtime resistance, frequent night wakings, dependence on rocking or feeding to fall asleep. Managed with a structured behavioural programme.

• Adolescent delayed sleep phase (DSPS)

  Cannot fall asleep before 2am, cannot wake for school. Managed with chronotherapy, morning light, evening melatonin and reduced evening screens.

• Night terrors and parasomnias

  Screaming episodes in the first third of the night with no memory. Video helps us separate terrors, sleepwalking and nocturnal seizures.

• Snoring, mouth breathing, witnessed pauses

  The red flags for obstructive sleep apnoea. Examined for tonsillar and adenoidal hypertrophy, then attended polysomnography if clinically needed.

• Restless legs and periodic limb movements

  An urge to move the legs at night, often with a family history. Ferritin is checked and iron repletion is first-line if below 50.

• Narcolepsy and hypersomnia

  Excessive daytime sleepiness, cataplexy or sleep attacks. Requires attended polysomnography, MSLT and often HLA-DQB1*06:02 with orexin.

• ADHD, autism and sleep dysregulation

  Neurodevelopmental sleep difficulty is common. Prolonged-release melatonin (Slenyto, NICE TA753) is licensed from age two upwards.

• Red flag: growth failure or new enuresis

  Poor growth, new-onset bedwetting, morning headaches or daytime hyperactivity all raise suspicion for untreated OSA and need attended studies.

• Behavioural first, medicine second

  For behavioural insomnia we lead with sleep hygiene, routine and graduated extinction. Medication is added, not started, if behavioural work is not enough.

• Avoid long-term sedating antihistamines

  Promethazine and other sedating antihistamines are not recommended as a sleep aid in children. They lose effect and carry daytime hangover.

• Melatonin is prescribed, not casual

  Melatonin is a specialist decision with a dose, a duration and a review date. Prolonged-release Slenyto is licensed for autism and ADHD sleep from age 2.

• Iron before dopamine in restless legs

  Ferritin is checked and repleted to above 50 before any dopaminergic drug is considered. Dopamine agonists are a last resort in paediatric restless legs.

• OSA is treated, not watched

  Untreated childhood OSA is linked to hyperactivity, poor concentration, growth failure and enuresis. Adenotonsillectomy is first-line for hypertrophy.

• Attended studies in a hospital lab

  Complex paediatric polysomnography is done in a hospital sleep lab with paediatric-trained scorers. Home studies have limited value in young children.

• Safeguarding and mood screening

  Adolescent insomnia is screened for anxiety, low mood and school refusal. Where indicated we refer for CAMHS or private child psychology support.

• Medication-induced insomnia

  Stimulants for ADHD, corticosteroids and SSRIs can all disturb sleep. Timing and dose are reviewed rather than adding a sleep medication on top.

• Red flags for urgent review

  Witnessed apnoea with cyanosis, daytime cataplexy, morning headaches, or a sudden change in a child`s behaviour need review within days, not weeks.

1. 01 Header

   History, examination and screening

   Age, presenting problem, sleep-diary summary, Brodsky tonsil grade, craniofacial notes, ferritin, thyroid, ADHD and mood screen.

2. 02 Investigations

   Actigraphy or polysomnography results

   Sleep onset, total sleep time, sleep efficiency, apnoea-hypopnoea index (AHI), oxygen nadir, periodic limb movement index and video observations.

3. 03 Diagnosis

   Working diagnosis and differential

   Behavioural insomnia, DSPS, OSA, narcolepsy, parasomnia or restless legs, and any coexisting ADHD, autism or anxiety noted for the wider team.

4. 04 Plan

   Treatment, referral and review interval

   Read this first: behavioural programme, melatonin dose, ENT referral, CPAP set-up or narcolepsy medication, plus the follow-up date.