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
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
• 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
• 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).
Your first paragraph ...
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Content last modified 6/13