Nightmares and Night Terrors in Children

Question: We have a 29-month-old daughter who has been having night terrors lately. She often wakes up in the middle of the night screaming. Needless to say, my wife and I haven't been getting much sleep and we're going into work exhausted. Please, can you provide some answers?

Answer: One of the most common concerns of parents is sleep disturbances, including nightmares and night terrors. Let's discuss nightmares first. Nightmares occur quite commonly in young children. Typically, a child with a nightmare wakes up completely, is very anxious, and usually remembers the content of the dream vividly. Typically, childhood nightmares require no specific treatment, except for reassuring the frightened child.

Occasionally, when nightmares become more frequent or occur on a regular basis, it may be a sign of stress in the child's life or environment. Also, the content of the bad dream or nightmare may be a clue to what is stressing the child. Therefore, extreme situations of persistent nightmares may warrant evaluation of the child's family/social environment and psychological state.

Night terrors occur less commonly and are different from nightmares. Typically, children with terrors are out of control, but still awake. They may be sitting up in bed, appear frightened, staring with eyes wide open. They may also be sweating, breathing heavily, and complaining of seeing peculiar things or objects that are not really there. This period of "terror" may last for up to several minutes and then the child will usually go back to sleep.

What distinguishes night terrors (which occur in less than 5% of children) from nightmares is that the child does not recall the dream or event leading to the night terror, and in many cases, does not recall that anything at all happened during the night.

Although the exact cause of night terrors, nightmares, and other sleep disturbances is not understood, they are thought to be a result of waking up during a certain stage of the normal sleep cycle. Night terrors occur during the Stage 4 or non-REM sleep period. Nightmares, on the other hand, occur during another stage or during REM sleep. Night terrors are generally infrequent and usually stop on their own without specific treatment.

In rare cases where night terrors are frequent and/or associated with sleep walking, specific medications may be required: Again, this occurs very rarely. To summarize, most children outgrow both nightmares and night terrors. Knowing this fact is a relief to many parents.