Nightmares and night terrors in children: An evidence-based guide

© 2008 - 2013 Gwen Dewar, Ph.D., all rights reserved

Night terrors in children--also known as "sleep terrors"--are sometimes confused with nightmares.

Both cause distress and disrupt sleep, and though terrors are less common than nightmares, they are hardly unusual. Particularly among young children.


What's the difference between nightmares and night terrors, and what can be done about these conditions?

Here is an evidence-based overview, with some tips for helping parents cope.

Nightmares in children

Nightmares are frightening dreams associated with REM (rapid eye movement) sleep. Because most REM sleep happens later at night, nightmares are more likely to occur after your child has been sleeping for several hours.

Does your child suffer from regular nightmares? That might not be clear if she can’t or won’t explain her nighttime anxieties. But if you suspect nightmares, you are probably right.

Most studies estimate that at least 70% of young children have nightmares at least sometimes, and the bad dreams don’t just go away during the school years.

In fact, there is evidence that nightmares peak during middle childhood and contribute substantially to kids' anxieties. In one study, Dutch children aged 7-9 rated nightmares among their worst fears (Muris et al 2000).

Moreover, research suggests that frequent nightmares can take a toll on health. In recent studies of Chinese children, kids who reported frequent nightmares were at higher risk for insomnia (Li et al 2011). They also performed a bit worse on IQ tests -- which may reflect fatigue (Lui et al 2012).

Nightmares, then, are worth taking seriously. And we should keep in mind that even young children are capable of remembering nightmares, especially if they awaken during or immediately after a nightmare ends.

What can we do about nightmares? We need to be aware of common triggers, like stress, anxiety, traumatic events, and medications that interfere with REM sleep (Moore et al 2006). And there are a number of specific, research-based tactics parents can use to help their children cope. For more information, see my article about nighttime fears in children.

Night terrors in children

Like nightmares, night terrors in children are distressing and disruptive. But night terrors differ from nightmares in other key respects:

• Night terrors are NOT associated with REM sleep. Instead, they occur when a child is partially aroused from deep sleep--usually 1-2 hours after sleep onset (Moore et al 2006).

• During a night terror--which may last for 5-10 minutes--your child isn’t fully awake. But he will appear terrified, and he may cry, scream, or mumble. He may also move around or sleep walk. Because he isn’t really awake, he will be unaware of your presence or your attempts to soothe him (Moore et al 2006).

• After he awakens, your child probably won’t remember the experience. When kids do remember something about their experiences, they report memories of having to fight or flee from frightening monsters or other threats (Guilleminault et al 2003).

• Because they can involve sleepwalking and other forms of movement, night terrors in children can be physically dangerous

This may sound rather exotic if you haven't coped with night terrors before. But the condition is surprisingly common, particularly among very young children. In one study tracking 780 children from birth, almost 37% of the kids suffered from night terrors at 18 months (Nguyen et al 2008). For older kids up the age of 9 years, the rate may be between 15-20% (Shang et al 2006; Laberge et al 2000).

What causes night terrors in children?

We don't really know.

But night terrors may run in the family (Hublin et al 2001; Nguyen et al 2008). And night terrors in children are also associated with overtiredness, anxiety, stress, and sleep-disordered breathing (Crisp et al 1990; Petit et al Guilleminault et al 2003).

Coping with night terrors in children

If you suspect your child suffers from night terrors, consult your doctor. It’s important to rule out other conditions that could be causing your child’s symptoms--conditions like nocturnal seizures, panic attacks, or post traumatic stress disorder.

In addition, it’s important to determine if your child’s night terrors are associated with snoring or other forms of sleep-disordered breathing (SDB). SDB can be dangerous, but it is treatable.

And if you treat your child’s breathing disorder, you might also cure her of sleep terrors. A recent study tracked kids with both SBD and night terrors. Researchers found that kids who underwent surgery for SBD were free of sleep-disordered breathing symptoms 3-4 months later. They were also free of night terrors (Guilleminault et al 2003).

But whether or not your child suffers from SDB, there are other important steps you can take to treat—-and perhaps prevent--night terrors:

• Make sure your child is getting enough sleep. See this article for help determining your child’s sleep requirements.

• Identify and treat your child’s anxieties. For tips about coping with anxieties may fuel night terrors in children, see my article on nighttime fears.

• Avoid late night exercise (Moore et al 2006).

• Make sure your child’s sleep environment as safe as possible. Remove heavy and sharp objects from the bedroom.

• If your child’s night terrors follow a predictable pattern each night, consider the treatment known as “scheduled awakenings.” This treatment involves waking your child up about 30 minutes before you expect him to suffer a night terror episode. Let him go to the bathroom, then return him to bed. In small clinical trials, this treatment had a lasting, beneficial effect on both sleep walking and night terrors in children (e.g., Durand 2002; Frank et al 1997).

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References

Crisp AH, Matthews BM, Oakley M, and Crutchfield M. 1990 Sleepwalking, night terrors and consciousness. BMJ 300: 360-362.

Durand VM. 2002. Treating sleep terrors in children with autism. Journal of Positive Behavior Interventions, Vol. 4: 66-72.

Frank NC, Spirito A, Stark L, and Owens-Stively A. 1997. The use of scheduled awakenings to eliminate childhood sleep walking. Journal of Pediatric Psychology 22: 345-353.

Guilleminault C, Palombini L, Pelayo R, Chervin RD. 2003. Sleepwalking and sleep terrors in prepubertal children: what triggers them? Pediatrics. 111(1):e17-25.

Hublin C, Kaprio J, Partinen M 2001. Parasomnias: Co-occurrence and genetics. Psychuatr Genet 11: 65-70.

Laberge L, Tremblay RE, Vitaro F, and Montplaisir J. 2000. Development of parasomnias from childhood to early adolescence. Pediatrics. 106(1 Pt 1):67-74.

Li SX, Yu MW, Lam SP, Zhang J, Li AM, Lai KY, and Wing YK. 2011. Frequent nightmares in children: familial aggregation and associations with parent-reported behavioral and mood problems. Sleep. 34(4):487-93.

Liu J, Zhou G, Wang Y, Ai Y, Pinto-Martin J, and Liu X. 2012. Sleep problems, fatigue, and cognitive performance in Chinese kindergarten children. J Pediatr. 161(3):520-525.e2.

Moore M, Allison A, and Rosen CL. 2006. A review of pediatric nonrespiratory sleep disorders. Chest 130(4): 1252-1262.

Muris P, Merckelbach H, Gadet B, and Moulaert V. 2000. Fears, worries, and scary dreams in 4- to 12-year-old children: their content, developmental pattern, and origins. J Clin Child Psychol. 29(1):43-52.

Nguyen BH, Pérusse D, Paquet J, Petit D, Boivin M, Tremblay RE, Montplaisir J. 2008. Sleep terrors in children: a prospective study of twins. Pediatrics. 122(6):e1164-7.

Petit D, Touchette E, Tremblay RE, Bolvin M, and Montplaiser J. 2006. Dyssomnias and parasomnias in early childhood. Pediatrics 119: e1016-e1025.

Shang CY, Gau SS, Soong WT. 2006. Association between childhood sleep problems and perinatal factors, parental mental distress and behavioral problems. J Sleep Res. 15(1):63-73.

Content last modified 6/13