Levy S, et al. - In this investigation, researchers analyzed factors affecting time from symptom onset to diagnosis in childhood narcolepsy, including presence of cataplexy, infancy onset, H1N1 Pandemrix vaccine administration, and date of diagnosis after the H1N1 pandemic. The study included 42 children seen between 1996 and 2016 in a single tertiary pediatric neurology center. By 13 years old, 92.9% of children were symptomatic, with narcolepsy symptom onset occurring between infancy and 15 years, and 51.3% were diagnosed within 12 months of symptom onset, with time from symptom onset to diagnosis ranging from 3 months to 11 years. A statistically significant increased time from reported symptom onset to diagnosis was seen in patients who were reportedly symptomatic from birth. Childhood narcolepsy symptoms progress over time, and while the number of annual diagnoses in this center increased, time from onset of symptoms to diagnosis does not seem to be decreasing. An increased time for diagnosis is linked with being symptomatic from the age of < 1 year. The clinical relevance of excessive daytime sleepiness is important for clinicians to appreciate.