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Nightmares and Night Terrors

What are night terrors?

Night terrors are a sleep disorder in which a person quickly awakens from sleep in a terrified state. The cause is unknown but night terrors are often triggered by fever, lack of sleep or periods of emotional tension, stress or conflict. Night terrors are like nightmares, except that nightmares usually occur during rapid eye movement (REM) sleep and are most common in the early morning. Night terrors usually happen in the first half of the night. Also, night terrors are most common in preadolescent boys, though they are fairly common in children three to five years old.

The following are common characteristics of a night terror:

  • Sudden awakening from sleep

  • Persistent fear or terror that occurs at night

  • Screaming

  • Sweating

  • Confusion

  • Rapid heart rate

  • No recall of bad dreams or nightmares

  • Unable to fully wake up

  • Difficult to comfort

How to help a child during a night terror

  • Try to help your child return to normal sleep. Do not try to awaken your child. Make soothing comments. Hold your child if it seems to help him or her feel better. Shaking or shouting at your child may cause the child to become more upset.

  • Protect your child against injury. During a night terror, a child can fall down a stairway, run into a wall, or break a window. Try to gently direct your child back to bed.

  • Prepare babysitters for these episodes. Explain to people who care for your child what a night terror is and what to do if one happens.

  • Try to prevent night terrors. A night terror can be triggered if your child becomes overly-tired. Be sure your child goes to bed at a regular time, and early enough to give him or her enough sleep. Younger children may need to return to a daily nap.

In many cases, a child who has a night terror only needs comfort and reassurance. Psychotherapy or counseling may be appropriate in some cases. Benzodiazepine medications used at bedtime will often reduce night terrors; however, medication is not usually recommended to treat this disorder.

When to call your child's healthcare provider

While night terrors are not harmful, they can resemble other conditions or lead to problems for the child. Consult your child's healthcare provider if you notice any of the following:

  • The child has drooling, jerking, or stiffening

  • Terrors are interrupting sleep on a regular basis

  • Terrors last longer than 30 minutes

  • Your child does something dangerous during an episode

  • Other symptoms occur with the night terrors

  • Your child has daytime fears

  • You feel family stress may be a factor

  • You have other questions or concerns about your child's night terrors

In many cases, no examination or testing is needed. If the night terror is severe or prolonged, the child may need a psychological evaluation.

What are nightmares?

Nightmares are scary dreams that awaken children and make them afraid to go back to sleep. Nightmares may happen for no known reason, but sometimes occur when your child has seen or heard things that upset him or her. These can be things that actually happen or are make-believe. Nightmares often relate to developmental stages of a child: toddlers may dream about separation from their parents; preschoolers may dream about monsters or the dark; school-aged children may dream about death or real dangers.

How to help a child with nightmares

  • Comfort, reassure, and cuddle your child.

  • Help your child talk about the bad dreams during the day.

  • Protect your child from seeing or hearing frightening movies and television shows.

  • Leave the bedroom door open (never close the door on a fearful child).

  • Provide a "security blanket" or toy for comfort.

  • Let your child go back to sleep in his or her own bed.

  • Do not spend a lot of time searching for "the monster."

  • During the bedtime routine, before your child goes to sleep, talk about happy or fun things.

  • Read some stories to your child about getting over nighttime fears.

When to call your child's healthcare provider

Consult your child's healthcare provider if you notice any of the following:

  • The nightmares become worse or happen more often

  • The fear interferes with daytime activities

  • You have other concerns or questions about your child's nightmares 

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