Luis Ortiz, M.D., on spotting narcolepsy symptoms in children

The signs of childhood narcolepsy can be easy for parents to miss, according to Luis Ortiz, M.D., a pediatric sleep medicine specialist at Johns Hopkins All Children's Hospital. In this video, he explains why excessive daytime sleepiness, subtle cataplexy, renewed napping and slipping grades all deserve a closer look.

Persistent daytime sleepiness, no matter how many hours a child sleeps, is the clearest warning sign of narcolepsy, Ortiz said. Parents should watch for children who fall asleep or struggle to stay awake at unusual times or in unusual places, even after what looked like a full night's rest.

“Even if they wake up feeling great, if at some random time later, they're all of a sudden asleep or struggling to stay awake, that might be a sign of narcolepsy,” Ortiz said.

Cataplexy, a sudden loss of muscle tone triggered by strong emotion, is another hallmark of the condition, but Ortiz cautioned that it rarely looks the way parents expect. Adults with cataplexy may collapse entirely; children often show something far more subtle, such as a brief change in facial expression during a moment of laughter or excitement.

“They may have an unusual face, almost like a paralysis of their face when they're laughing,” Ortiz said.

Two other behavioral shifts are worth flagging, Ortiz said. A child who hasn't needed a daytime nap in years and suddenly starts napping again may be showing an early sign of narcolepsy rather than simply going through a growth spurt or a busy stretch. A sudden, unexplained drop in grades, moving from consistent A's to B's and C's, is another red flag parents shouldn't dismiss as a motivation or attention problem without first asking questions.

Ortiz recommended parents talk directly with their child about what's happening in the classroom rather than assuming the cause. A child struggling to stay alert may not be able to follow a lesson, even if they want to and are otherwise capable of the work.