Nighttime fears in children: A guide for the science-minded
© 2008 - 2012 Gwen Dewar, Ph.D., all rights reserved
Nighttime fears are very common, and may include fears of intruders, monsters, unexplained sounds, and darkness. In this article, I review
• The evolutionary basis for nocturnal fears
• Why kids may be biologically unprepared to handle nighttime fears by themselves,
• How you can help your child overcome her fears and anxieties
If your child suffers from frightening dreams or nighttime screaming episodes, you might also want to check out this article on
nightmares and night terrors.
Nighttime fears in evolutionary and cross-cultural perspective
If you’re reading this because your child suffers from nocturnal fears, he’s fortunate in at least one respect: You know about it.
In a study of Dutch children, over 73% of kids aged 4-12 years said they experienced fear at night (Muris et al 2001).
Another study of Australian children reported that over 64% of kids between 8 and 16 admitted to nighttime anxieties or fears (Gordon et al 2007).
In both cases, many parents were unaware of their children's problems.
Why do so many of these kids report nighttime fears? And why are some parents out of touch?
Perhaps the answer is related to the practice of solitary sleep.
In most places around the world, young children sleep with other people. But in some Western countries, children are expected to sleep by themselves.
Does solitary sleep make children more fearful? It would be surprising if co-sleeping with parents didn’t reduce a child’s separation anxiety -- a panic response arising from a primitive part of brain that also processes information about physical pain (Panskepp 2000).
And it makes sense that kids might find nocturnal separation to be especially distressing. For over 99% of human history, our ancestors lived as hunter-gatherers. Among these ancestors, children left alone at night would have been extremely vulnerable to predation. Leaving a child alone at night meant abandonment and (very possibly) death. Fear evolved to keep kids close and safe.
Few modern kids have to worry about getting attacked by predators. But the tendency to be fearful remains, and some young children have trouble distinguishing fantasy from reality. These kids may have more nighttime fears as a result (Zisenwine 2012), and sleeping alone might make things worse.
In a study tracking over 900 Quebecois children from the age of two, Valérie Simard and her colleagues found that toddlers who slept in their mothers' beds were less likely to suffer from nightmares in later years (Simard et al 2008).
The correlation is suggestive, but not conclusive. Maybe kids who co-sleep have other advantages that reduce the risk of nightmares. But one thing seems clear. Whether your child sleeps along or with family members, nighttime fears and anxieties should be taken seriously.
Although the kids in the Australian study were selected from the general population (as opposed to a psychiatric practice or sleep clinic), researchers discovered that about 10% of children complaining of nighttime fears fit the criteria for an anxiety disorder.
And the study by Simard and colleagues reports strong links between anxiety and bad dreams. Seventeen-month-old kids who were rated by their mothers as anxious, difficult, or emotionally disturbed were more likely than other children to have bad dreams at 29 months (Simard et al 2008).
The researchers speculate that some children—those who are more inhibited or anxious—at are greater risk for chronic nightmares and other psychological problems. If parents treat their children’s fears at an early age, they might help their children avoid emotional problems later in life.
Addressing your child's nighttime fears may also help her get more sleep. Kids suffering from
nighttime fears may suffer from bedtime problems
and frequent night wakings.
Finally, we should keep in mind that everybody tends to overreact to emotional stimuli at the end of the day.
Experiments suggest that the amygdala -- a brain region that processes emotional events -- becomes overactive when you are tired. Negative emotions may come naturally to us at night.
Why kids need help coping with nighttime fears
Adults find it difficult to cope with fear and anxiety. When older adults go to sleep feeling lonely, threatened, sad, or out-of-control, they experience elevated levels of cortisol (a stress hormone) the next day (Adam et al 2006).
Even relatively brief, stressful experiences—
—can trigger depression when adults don’t get enough social support.
If this is the adult experience, what must it be like for a child who lacks the mature coping skills of an adult?
To deal successfully with nighttime fears and separation anxiety, a child needs
• A well-developed sense of time (“when will I see Mommy again?”)
• The ability to control emotional impulses
• The ability to distinguish appearances from reality
• The ability to reason consciously and trust rational conclusions over misleading sensory information (“that shadowy bump on the floor might look like a monster, but I know it’s really a pile of clothes”)
Most kids don’t develop these capacities until they are 5-6 years old—not coincidentally the age when the frontal lobes start to mature (Eliot 2000). The brain’s frontal lobes permit us to reason, problem-solve, and plan ahead. They also help us decide what to do with the raw emotions we feel.
The implications seem clear. When frightened toddlers and preschoolers are left to fend for themselves, they don’t know how to calm themselves down. And even after kids develop the ability to reason about their emotions, they can’t be expected to invent their own effective fear-management therapies.
Moreover, some kids are intrinsically more timid than others. These kids may be at a physiological disadvantage when it comes to confronting their own fears.
Temperamentally-inhibited children tend to have higher resting heart rates and higher levels of stress hormones. They show greater brain activity in the right frontal lobe—where fears and anxieties are processed (Eliot 2000).
And animal studies suggest that the amygdala—the brain structure that tells us when we should be afraid—is more sensitive, or “trigger-happy,” in timid children (Fox et al 2005; Eliot 2000). These kids can learn to be less fearful. But to do it, they need the sensitive, gentle encouragement of their parents.
The bottom line?
Kids need help coping with nighttime fears, and they need a helper who is sensitive to their developmental stage and individual temperament.
They need someone to reassure them, to provide them with a sense of security, and to teach them how to overcome their nighttime fears.
In short, they need responsive, rational parenting.
Helping children cope with nighttime fears: A checklist
• Always question parenting advice that encourages parents to leave distressed children alone at night. As noted above, kids lack the coping tools to work things out by themselves. And even advocates of “cry-it-out” strategies of sleep training warn that such approaches are inappropriate for young babies and children who are especially fearful or anxious (France and Blampied 1999; Owens et al 1999).
• Talk to kids about the difference between fantasy and reality, and prove to them that there is no monster in the closet. As noted above, children who have trouble distinguishing fantasy and reality may be at higher risk for nighttime fears (Zisenwine et al 2012).
• Consider sources of daily stress. Kids who suffer from daytime anxieties—about school, separation from parents, or other concerns—are more likely to fear the dark and fear sleeping alone (Gregory and Eley 2005). You may be able to reduce your child’s nighttime fears by helping him cope with daytime stress.
• Review your child’s
and sleep schedule. Sometimes parents overestimate how much sleep their children need. As a result, they send their kids to bed long before kids can fall asleep. Kids left to stew in the dark have more time to dwell on nighttime fears (Ferber 1995).
• Avoid frightening television, stories, and imagery— especially before bedtime. This includes passive exposure, which occurs when your child is present while you watch potentially disturbing material on TV. A recent study reported that 5-6 year olds exposed to adult TV programs—including the evening news—slept less overall and experienced more sleep disturbances (Paavonen et al 2006).
• Fight fear with the power of touch. Physical affection switches off separation anxiety (Panskepp 2006).
• Offer your child the comfort of a soft toy animal or doll. There is experimental evidence that this old standby really helps: In a study that randomly assigned fearful children to receive a toy "huggy puppy," kids exhibited fewer nighttime fears and sleep problems than did children in a control group. The effect was observed whether the toy was presented as a protector or as a creature needing protection (Kushnir and Sadeh 2012).
• Try to be patient. If your child’s nighttime fears are depriving you of sleep, it’s natural to feel resentment. But it’s important not to direct anger or irritation at your child. If your child feels rejected, this will only intensify his separation anxiety and make things worse.
• Respond promptly to nightmares. Assure your child that the nightmare wasn’t real, and explain that everybody has nightmares sometimes. The more quickly you break the spell of a frightening dream, the more quickly your child can get back to sleep.
• Provide your child with a night light. As you and your child works through her nighttime fears, you can switch to progressively dimmer lights (Glaze 2004).
• Be a model of calm, confident behavior. When your child comes to you in a fearful state, be warm, sensitive and responsive. Tell him you understand that he is scared, and that everybody gets scared sometimes. But don’t let sympathy turn into overprotectiveness. Many animals—ranging from birds to monkeys—are sensitive to social cues about fear (Zentall and Galef 1988). They pick up fears by watching others model them. Kids are no exception. If your child believes you are worried or anxious, he may become more fearful.
• Show your child how to relax. For instance, as you soothe a crying child, you can show her breathing exercises. In a study aimed at reducing anxiety in young children scheduled for a medical procedure, researchers taught kids how to take slow, deep breaths by having them exhale into party blowers (Jay et al 1987). These breathing exercises appeared to reduce distress in 40% of the kids.
• Counteract frightening thoughts with images of happiness, safety, and bravery. When he is fearful, help your child think of situations that make him feel happy and in control. For instance, you might encourage him to imagine he is playing with his favorite pet. You might also have your child practice telling himself that he is brave. This technique was used in the study mentioned above (Jay et al 1987).
• Teach coping skills through role playing. Many kids overcome their fear of medical check-ups by playing doctor. You can apply this approach to nighttime fears as well. During the daytime, talk about your child’s fears and discuss how she can counteract them. Help your child practice the tactics mentioned above—thinking happy thoughts, telling oneself that one is brave, rehearsing relaxing techniques, and transforming frightening imaginary creatures into something silly and non-threatening. Then try a little role playing (Jay et al 1987). If you have another adult or older child to help, the two of you can act out the parts of frightened child and helpful parent. The parent shows the child how to counter her nighttime fears, and the child tries each technique out. After this demonstration, have the child play the part of the comforting adult. You—or a favorite toy—can take the part of the fearful child.
• During the daytime, create stories with your child in which the protagonist (your child’s favorite fictional character or hero) learns to overcome his nighttime fears. This technique—called story desensitization—is designed to make children less fearful by having them confront their fears in small steps (King et al 2001). Start by telling a story that lacks any frightening elements. Then introduce something that is just a little bit scary. For instance, if your child is afraid of spiders, you might add a very small, non-threatening spider to the story (one that keeps its distance from the hero). The hero responds by successfully practicing the fear management techniques mentioned above. If this story doesn’t distress your child, you can intensify the frightening element in the next story—perhaps by making the spider come closer. In this way, you may gradually desensitize your child’s fears.
References: Nighttime fears in children
Adam EK, Hawkley LC, Kudielka BM, and Cacioppo JT. 2006. Day-to-day dynamics of experience--cortisol associations in a population-based sample of older adults. Proc Natl Acad Sci USA. 103(45):17058-63.
Eliot L. 2000. What’s going on in there? How the brain and mind develop during the first five years of life. New York: Bantam.
Ferber R. 1995. Sleeplessness in children. In R Ferber and M Kruger (eds), Principles and Practices of sleep medicine in children.
Fox NA, Henderson HA, Marshall PJ, Nichols KE, and Ghera MM. 2005. Behavioral inhibition: linking biology and behavior within a developmental framework. Annu Rev Psychol. 56:235-62
France KG and Blampied NM. 1999. Infant sleep disturbance: Description of a problem behaviour process. Sleep Medicine Reviews 3(4): 265-280.
Glaze DG. 2004. Childhood insomnia: why Chris can’t sleep. Pediatrics Clinics of North America 51: 33-50.
Gordon J, King NJ, Gullone E, Muris P, and Ollendick TH. 2007. Treatment of children's nighttime fears: the need for a modern randomised controlled trial. Clin Psychol Rev. 27(1):98-113.
Gordon J, King N, Gullone E, Muris P, and Ollendick TH. 2007. Nighttime fears of children and adolescents: frequency, content, severity, harm expectations, disclosure, and coping behaviours. Behav Res Ther. 45(10):2464-72.
Gregory AM and Eley TC. 2005. Sleep problems, anxiety, and cognitive style in school-aged children. Infant and Child Development 14: 435-444.
Jay SM, Elliott, CH, Katz, ER, and Siegel, SE (1987). Cognitive-behavioral and pharmacologic interventions for childrens' distress during painful medical procedures. J. Consult. Clin. Psychol. 55: 860-865.
King NJ, Heyne D, Gullone E, and Molloy GN. 2001. Usefulness of emotive imagery in the treatment of childhood phobias: clinical guidelines, case examples and issues. Counselling Psychology Quarterly 14: 95-101.
Kushnir J and Sadeh A. 2012. Assessment of brief interventions for nighttime fears in preschool children. Eur J Pediatr. 171(1):67-75.
Mahat G and Scoloveno M. 2003. Comparison of fears and coping strategies reported by Nepalese school-age children and their parents. J Pediatr Nurs. 18(5):305-13.
Muris P, Merckelbach H, Ollendick TH, King NJ, and Bogie N. 2001. Children's nighttime fears: parent-child ratings of frequency, content, origins, coping behaviors and severity. Behav Res Ther. 39(1):13-28.
Owens JL, France KG, and Wiggs L. 1999. Behavioural and cognitive-behavioural interventions for sleep disorders in infants and children: A review. Sleep Medicine Reviews 3(4): 281-302.
Paavonen EJ, Pennonen M, Roine M, Lahikainen AR (2006): TV viewing associated with sleep disturbances in 5-6 year old children. J Sleep Res 15: 154-161.
Panksepp J. 2001. Affective Neuroscience: The Foundations of Human and Animal Emotions. New York: Oxford University Press.
Simard V, Nielsen TA, Tremblay RE, Boivin M, and Montplaisir JY. 2008. Longitudinal study of bad dreams in preschool-aged children: prevalence, demographic correlates, risk and protective factors. Sleep 31(1):62-70.
Zentall TR and Galef BG (eds). 1988. Social learning: Psychological and biological perspectives. Hillsdale, NJ. Lawrence Erlbaum Associates.
Zisenwine T, Kaplan M, Kushnir J, Sadeh A. 2012. Nighttime Fears and Fantasy-Reality Differentiation in Preschool Children. Child Psychiatry Hum Dev. 2012 Jul 3. [Epub ahead of print]
Content last modified 11/12