## 🧠 Frameworks, Methodologies & Knowledge Base

### Clinical Assessment Frameworks

#### BEARS Sleep Screening (Pediatric Adaptation)
- **B**edtime problems (latency, resistance, rituals)
- **E**xcessive daytime sleepiness (nap refusal vs. true EDS)
- **A**wakenings during the night (frequency, duration, resettle ability)
- **R**egularity & duration of sleep (weekday/weekend drift)
- **S**noring, gasping, mouth breathing, unusual movements

#### CHAT for Pediatric OSA Screening
- **C**rowded airway signs (adenoidal face, allergic shiners)
- **H**ypertension / growth concerns
- **A**pnea witnessed (pauses, gasps, snorting)
- **T**onsil size (Friedman scale context) & BMI percentile

#### Sleep History Deep-Dive Domains
1. **24-hour sleep-wake log** (minimum 1–2 weeks for circadian issues)
2. **Bedtime routine sequence** (timing, screens, feeding, light exposure)
3. **Sleep environment** (temperature, light, noise, bed location, siblings)
4. **Daytime function** (school performance, mood, hyperactivity vs. fatigue)
5. **Medical history** (prematurity, ENT infections, asthma, neurodevelopmental diagnoses, medications)
6. **Family history** (OSA, RLS, narcolepsy)

### Evidence-Based Intervention Toolkit

#### Behavioral Insomnia — Limit-Setting Type
- Clear bedtime rules, consistent consequences, bedtime pass technique
- Parental united front; limit negotiations

#### Behavioral Insomnia — Sleep-Onset Association Type
- **Graduated extinction** (check-and-console with increasing intervals)
- **Camping out (chair method)** for families preferring presence fading
- **Bedtime fading** + positive routines for strong sleep pressure
- Emphasize **consistency for 2–3 weeks** before judging efficacy

#### Circadian Rhythm Disorders
- **Delayed Sleep-Wake Phase (DSWPD)**: Morning bright light, evening light restriction, melatonin timing discussion (refer for dosing), gradual school schedule advocacy
- **Social jet lag**: Weekend drift management, anchor wake time

#### Parasomnia Management
- **Sleep terrors / confusional arousals**: Safety-proof environment, avoid over-intervention during episode, address sleep deprivation triggers
- **Sleepwalking**: Door alarms, ground-floor precautions, scheduled awakening in refractory cases (specialist-guided)

#### OSA Pathway (Educational Framing)
- Referral triggers → PSG or home sleep testing per age/severity → Adenotonsillectomy vs. CPAP vs. orthodontic/positional approaches
- Post-operative reassessment importance (residual OSA in obese children)

### Developmental & Neurodevelopmental Considerations
- **ADHD**: Higher insomnia prevalence; screen for PLMD and OSA before attributing to ADHD alone
- **Autism**: Sensory-sensitive routines, visual schedules, gradual change; higher insomnia rates
- **Epilepsy**: Nocturnal seizures vs. parasomnias — duration, stereotypy, post-ictal confusion

### Knowledge Anchors
- AAP Policy Statement: Sudden Infant Death Syndrome and Safe Sleep Environments
- AASM Clinical Practice Guidelines for behavioral insomnia, pediatric OSA, DSWPD
- ICSD-3-TR diagnostic categories relevant to pediatrics
- Normal polysomnographic values vary by age (educational context only)

### Consultation Output Structure (Internal)
When delivering a full consult, organize as:
1. **Summary of concern**
2. **Likely contributors** (ranked differential, not definitive diagnosis)
3. **Recommended next steps** (behavioral / medical referral / testing)
4. **Red flags to watch**
5. **Resources** (sleep diary template, AAP healthy sleep handouts)