Narcolepsy Symptoms, Diagnosis, and Treatment in Children

A sleepy or inattentive child is cause for concern. The critical period of development that stretches from early childhood through adolescence sets the stage for a lifetime of success. This relies on a rested and receptive mind.

Problems with attention such as occur in attention deficit hyperactivity disorder (ADHD) may be familiar, but there are other sleep problems that might similarly compromise your child’s ability to learn. How does narcolepsy affect children? How is it diagnosed and what are the treatments available? Learn more about narcolepsy and how it might unexpectedly affect your child.

University student dozes after class
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Although often considered among adults, narcolepsy actually has two peaks of incidence. Narcolepsy first appears in childhood and adolescence, becoming evident on average around the age of 14.7 years (and then later peaking again at age 35). In fact, more than half of people with narcolepsy report the onset of their symptoms before the age of 20 years.

The younger age of onset is linked to a family history of the disease. In addition, the symptoms that characterize the disease tend to be more severe in those who develop the disease earlier.

Even though the disease may develop at a relatively young age, there is often a delay in the diagnosis of narcolepsy. The symptoms may be overlooked or misinterpreted. This may result in a delay in the appropriate recognition of the condition an average of 10.5 years after symptom onset.


One of the earliest symptoms suggestive of narcolepsy in children is excessive daytime sleepiness, reported in 65.5% of cases as the first symptom. This is somewhat unusual among the sleep disorders in children. Unlike adults who may seem sleepy, children may become hyperactive or irritable when their sleep is compromised. In the case of narcolepsy, however, excessive sleepiness (or hypersomnolence) may be problematic.

Aside from excessive sleepiness, there are other characteristic features of narcolepsy. One of them, cataplexy, is quite unique. People with narcolepsy often exhibit a sudden loss of muscle tone in response to emotional stimuli. For example, surprise might result in a buckling of the knees and sudden collapse. Though this symptom may occur in 60% of people with narcolepsy, children do not often present with cataplexy.

Some studies suggest that there may be problems with metabolism in children with narcolepsy. Metabolism is controlled by a part of the brain called the hypothalamus, with dysfunction here also linked to narcolepsy. This may result in overweight or obesity. Children may gain weight at the onset of their narcolepsy symptoms.


A careful assessment by a pediatrician, especially one who is knowledgeable in sleep disorders, is the first step toward diagnosing narcolepsy. Additional sleep studies may also be used to diagnose the condition.

The standard sleep study is called a polysomnogram. When considering narcolepsy, it is often paired in children over age 8 with another study called multiple sleep latency testing (MSLT). These tests can be useful to rule out other sleep disorders, including sleep apnea or periodic limb movement syndrome. They may identify a change in the sleep architecture, revealing a lowered threshold for falling asleep and initiating rapid eye movement (REM) sleep.

There are a few other tests that can be used to identify children with narcolepsy. An examination of cerebrospinal fluid (CSF) typically reveals very low to undetectable levels of a chemical messenger, or neurotransmitter, called hypocretin-1. Testing for the human leukocyte antigen DQB1-0602 also may be performed (though this antigen is often present in those who do not have the disease, making it less useful).


As with adults who have narcolepsy, the treatment options in children with narcolepsy include stimulants to minimize daytime sleepiness, as well as agents meant to disrupt REM sleep.

Treatment options include Xyrem (sodium oxybate) or Xywav as well as stimulants such as methylphenidate (Ritalin or Adderal).

In addition, it can be helpful to suppress REM sleep with medication, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). As narcolepsy ultimately seems to be due to a problem regulating sleep states, which results in REM sleep inappropriately intruding upon wakefulness, these medicines are helpful. These medications are typically reserved for cases when the other features of narcolepsy are present, including cataplexy, hallucinations, and sleep paralysis.

Finally, sodium oxybate (sold as Xyrem) has been found to be modestly effective in reducing both excessive daytime sleepiness as well as cataplexy in children.

If you are concerned that your child may have excessive daytime sleepiness and other associated problems suggestive of narcolepsy, you can start by speaking with your pediatrician about your concerns. Further testing can be arranged to determine whether narcolepsy may underlie your concerns, which might prevent a delay in diagnosis and help your child during this critical period of development.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Y. Dauvilliers, J. Montplaisir, N. Molinari, B. Carlander, B. Ondze, A. Besset, M. Billiard. Age at onset of narcolepsy in two large populations of patients in France and Quebec. Neurology. Dec 2001, 57 (11) 2029-2033; doi:10.1212/WNL.57.11.2029

  2. Thorpy MJ, Krieger AC. Delayed diagnosis of narcolepsy: characterization and impact. Sleep Med. 2014;15(5):502-507. doi:10.1016/j.sleep.2014.01.015

  3. Zeman A, Britton T, Douglas N, et al. Narcolepsy and excessive daytime sleepiness. BMJ. 2004;329(7468):724-728. doi:10.1136/bmj.329.7468.724

  4. Cleveland Clinic. Narcolepsy in children.

  5. National Institute of Neurological Disorders and Stroke. Narcolepsy fact sheet.

Additional Reading
  • Dahl, R.E. et al. "A Clinical Picture of Child and Adolescent Narcolepsy." J Am Acad Child Adolesc Psychiatry 1994;33(6)834-841.

  • Durmer, J.S. et al. "Pediatric Sleep Medicine." Continuum Lifelong Learning Neurol 2007;13(3):175-179.

  • Guilleminault, C. and Pelayo, R. "Narcolepsy in Prepubertal Children." Ann Neurol 1993;43(1):135-142.

  • Ivanenko, A. et al. "Modafinil in the Treatment of Excessive Daytime Sleepiness in Children." Sleep Med 2003;4(6):579-582.

  • Kanbayashi, T. et al. "CSF Hypocretin-1 (orexin-A) Concentrations in Narcolepsy With and Without Cataplexy and Idiopathic Hypersomnia." J Sleep Res 2002;11(1):91-93.

  • Kotagal, S. et al. "A putative link between childhood narcolepsy and obesity." Sleep Med 2004;5(2):147-150.

  • Morrish, E. et al. "Factors associated with delay in the diagnosis of narcolepsy." Sleep Med 2004;5(1)37-41.

  • Murali, H. and Kotagal, S. "Off-label treatment of severe childhood narcolepsy-cataplexy with sodium oxybate." Sleep 2006;29(8):1025-1029.

  • Ohayon, M.M. et al. "How age influences the expression of narcolepsy." J Psychosom Res 2005;59(6):399-405.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.