My child has nightmares or night terrors- should I be worried?

 

When my daughter was little, around age three, she had several nights in which she had night terrors. It is a part of childhood that most parents are not prepared for; I was not. 

 

Prevalence of Night Terrors

 

Night terrors can occur in young children, typically from toddlers up to six years old, although some may experience them until age twelve. According to the American Academy of Pediatrics (AAP), only a small percentage, about 2 to 6.5%, of children are affected, with most cases seen between ages one and four. Fortunately, these episodes usually do not cause any long-term or short-term harm. It’s important for parents to distinguish between nightmares and night terrors: while children often remember nightmares, they do not recall night terrors. The two also differ in the timing during the night and the stage of sleep in which they occur.

 

Nightmares can occur during the REM dream stage of sleep, later in the night, closer to morning hours. A child usually wakes up afraid or is easily woken by parents responding to cries or outbursts from the child. The child remembers the nightmare and, if able to speak, can talk about it or answer questions from parents. Parents can soothe the child and help them return to sleep. Most parents wonder about the episode, and if the child returns to sleep, all is well. Nightmares may have parents concerned about bedtime routines, daily stress, and any major changes in life. Simply reducing overstimulation and assuring the child that he is loved and safe can help. Calming bedtime routines that are consistent in length and bedtime itself (give or take 15 minutes) will give cues to the child that this is the time to relax and fall asleep. 

 

Night Terrors usually occur in children and toddlers up to age 6, while some may experience them until 12 years of age. They are a result of partial arousal from deep sleep that is non-REM. Parents are usually startled by them, and it is very upsetting until they learn more about them. Causes are not all clear, but there may be genetic ties, late bedtimes, overtiredness, fear, irregular sleep schedules and routines, or sleeping in a new environment. Sudden or persistent family struggles that a child may pick up on may contribute as well, contributing to stress and fears that can make them worse. Please let caregivers or others who may care for your child know so they can appropriately support the child. 

 

The characteristics of night terrors

 

The episodes occur in the first third of the night, typically 1 to 3 hours after falling asleep, while the child is in the deepest stage of sleep a non-REM, nondream stage of sleep, often before parents’ bedtime. They can last 15 to 20 minutes, with a rare few as long as 45 minutes. They stop on their own, and the child resumes cycling through sleep stages. In the deeper stages of sleep, a child is not easily awakened. Parents who have tried to wake their children find out quickly that it’s difficult and counterproductive to the episode ending.

 

During a night terror, a child may act afraid and mistake people and objects as dangers. They may look awake with their eyes open, but they are in fact asleep, scream, thrash, sit up, or even move out of their bed. They look panicked or very agitated, and they could even run around. They are not usually aware of their parents or caregivers while in this state. They cannot be consoled, and any attempt to wake them may enhance the fear or agitation and prolong the episode. Other symptoms may include, but are not limited to, crying uncontrollably, sweating, shaking, and breathing fast. 

 

Night terrors may also occur during naps. Daycare providers should be informed that they may occur and how to care for your child. School-aged children generally do not take naps, so families may not need to inform them unless a child is having difficulty in school.

 

Amnesia for night terrors is typical. The child cannot remember what happened the next morning, unlike nightmares, where a child can recall it. These events can happen with a family that may have a history of some type of parasomnia, but not always.

 

What to do when a night terror happens 

 

Stay calm. Your child will not likely remember the episode. Do not attempt to wake your child. Use a calm, soothing voice to keep them in bed or gently guide them back to bed.  Say things like “you are okay” or “you are looking for your bed” if they are out of bed. The episode will pass in a few minutes to up to 30 minutes. Rarely up to 45 minutes. If parents or caregivers interfere with the episode, it will likely last longer.

 

Keep your child safe. If your family has a history of childhood sleep concerns, follow basic safety precautions like using safety gates at points of entry, such as stairwells or even on a child’s doorway. Keep sharp objects away from the child so he does not hurt himself or others if moving about in the room. Turn on only enough light in the room to keep you and your child safe. Guide them gently back to bed. Clear objects that are hazards off the bedroom floor. Try to keep them in their bedroom. Make sure doors and windows are secured so your child remains safe and in the house. 

 

Using a calm, soft voice to guide them from an agitated state to a calm one is usually better for the child than silence. That is the short goal. Longer goals are to help him get into regular, healthy sleep habits that are appropriate for his age. There are environmental tips for improving bedtime routines and sleep near the end of this post.

 

Holding your child’s hand may help, but don’t be surprised if he pulls away. Use only gentle holding of your child. Some professionals say not to touch your child. Do keep them safe. 

 

Tips To Prevent Night Terrors

 

While these may not always prevent night terrors, here are some helpful tips:

 

• A consistent calming bedtime routine for the child’s developmentally appropriate bedtime.  
• When your family recognizes that the night terrors are recurring, try the following for seven nights:
  • The parents can wake the child one hour after the child falls asleep. Waking the child may reset the sleep stages to prevent night terrors. It is not counterintuitive to sleep training if the family is in the process of sleep training.

 

Is sleep training safe to start or continue?

 

If you are currently sleep-training your child, it is appropriate to continue this approach. Establishing and consistently applying safe, calm, healthy, and age-appropriate gentle methods can enhance bedtime routines. This practice supports adequate and restorative sleep for your child. A predictable, secure routine can foster a sense of reassurance, helping the child understand and anticipate bedtime.

 

Talking with my child about night terrors

 

If you need to talk about it with your child, don’t overwhelm him with it. It is not your child’s fault, and you could add unnecessary stress to the child.

 

When to call the pediatrician

 

When in doubt, get it checked out has always been my motto. Any of the items on the list below is a good reason to call your child’s pediatrician.

 

•  If you are unsure about your child’s health for any reason( illness, physical injury, overexertion, or stress). 
•  If your child suffers an injury during an episode. 
•  If your child has multiple night terrors a night.
• If the child is having multiple or recurring nightmares that are upsetting to him. 
• If your child’s behavior or personality is altered.  
• If your family’s routines are severely affected by the night terrors.
• If after the night terrors or recurring nightmares in one night or over several nights and your child’s personality is changing – sad days or overly angry throughout his day, lethargic beyond a normal tiredness from daily routines, over several days, etc. Any significant change is worth following up with your doctor.
• If any other sleep disorders are present: sleep apnea, snoring, or gasping for air.
• If you know your family history, and sleep disorders were experienced by a close relative.

 

How to promote healthy sleep habits (for your infant, toddler, and young children). 

 

We have an advanced list of healthy, safe environmental tips to help parents create healthy, safe sleep habits for kids on our Pocono Pediatric Sleep Consulting website.  

 

Here are a few tips to get parents started:

 

Maintain an Ideal Room Temperature

Keeping the room at a cool but comfortable temperature is crucial for restful sleep. Newborns are especially sensitive as they are still learning to regulate their body temperature. Therefore, it’s important to monitor the environment closely. Swaddled infants should not be allowed to overheat. For toddlers and young children, you should aim for a room temperature like that preferred by adults (between 64 and 70 degrees Fahrenheit). Dress your child in pajamas that are safe and comfortable for the room temperature. Both overly warm and chilly conditions can lead to frequent awakenings during the night. It’s worth noting that most baby monitors display the room’s temperature, but because they are often placed at higher locations, their readings may not accurately reflect the temperature at the height where the child sleeps, such as in a crib, toddler bed, or floor bed located lower down.

 

Use Room-Darkening Blinds or Shades, or Curtains

Room-darkening blinds, shades, or curtains are recommended to ensure a consistent level of darkness during sleep throughout the year. Reliable physical cues, such as closing curtains, pulling down shades, putting away toys, and closing closet doors, can help establish a clear bedtime routine for children. These actions minimize shadows and provide visual signals that mark the transition from day to night for infants and young children. For some families, it may also be helpful to close curtains during daytime naps as well as nighttime sleep; recommendations may vary depending on family preferences and the length of naps, as advised by sleep consultants.

 

Establish Calm and Consistent Bedtime Routines

Creating a calm and predictable bedtime routine helps children feel secure as they prepare for sleep. Activities such as taking a bath, putting on pajamas, and reading soothing bedtime stories together each night can encourage relaxation. Selecting gentle, positive books that promote bedtime is ideal. These routines allow children to unwind and transition smoothly into the initial stage of sleep.

 

Supporting Parents Through Nightmares and Night Terrors

 

By following these tips, parents of toddlers and young children can feel more knowledgeable about managing disturbances like nightmares and night terrors. Better Sleep = Better Days.

 

Developing good sleep habits in infancy and early childhood can lead to a lifetime of healthy sleep habits.

 

You can find more helpful information by joining our email list, booking a coaching session, or purchasing a full sleep training plan at PoconoPediatricSleepConsulting.com

 

 

Sources:   

• American Academy of Pediatrics
• Raising Children Network
• Children’s Hospital Colorado
• Children’s Health.com

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