It’s 2 a.m. and your child suddenly awakens screaming full blast,  seemingly unconsolable.   What is going on?   Is this  a night terror?  A nightmare?    Something else?  

Here’s a breakdown of what is going on and how to handle these nighttime scary episodes!

Night terrors

What are they? 

Occurring in about 15-20% of children up to age 9 et al 2000),  night terrors are intense, short (usually 4-10 minutes, but sometimes even longer),  episodes of screaming, intense fear and flailing that occur within the first few hours of night sleep (Shang et al 2006; Laberge et al 2000). 

During sleep cycle transitions, it is normal for children to move around, groan, cry, even wake briefly, and then fall back to sleep.  A night terror occurs when your child is stuck between sleep cycles: caught in between waking and sleeping.

During a night terror, your child can look terrified, with eyes open, and appear violent, or sleep walk, but they are actually asleep, and won’t recognize you or respond to you if you try to calm them.  Good news is children don’t remember the event upon awakening. 

Although they can be frightening and upsetting to parents, they aren’t a cause for concern, though there are some steps  you can take  to  prevent them. 

Night terrors occasionally require treatment if they cause problems getting enough sleep consistently  or  pose a safety risk.

What do night terrors look like?

During a night terror, your child may do any of the following:  

1. Sit up in bed, stare, kick, thrash, or even sleep walk.
2. Scream and shout and look terrified, and appear inconsolable.
3. Sweat, breathe heavily and have a racing pulse.
4. Be difficult to calm.  

What are some causes?

1. Sleep deprivation – Not getting enough sleep is one of the biggest causes of night terrors.
2. New environment or major life changes
3. Genetics

What steps can you take to help when terrors occur?

Witnessing your child in the midst of a night terror is, well, terrifying.  Although you will feel the natural urge to rescue your little one from apparent distress, the best advice is to stay close to keep your child safe, but do nothing else.   Remember your child is still asleep, though he may not look that way, and trying to wake him may only agitate him more.  Here are some tips that may make it easier for you to survive the scary episode or prevent it entirely.

Survive the episode:

1. Keep your child safe and stay close, but try not to touch her.  Hugging or picking your child up may actually exacerbate the episode and make it last longer.  
2. Don’t wake your child.  Remember that she is actually asleep, though she may not look that way, and once the episode is over, she will remain asleep quietly if she is not disturbed.  

Prevent it:  

1. Keep the room cool.  Night terrors (and nightmares) can be more common in overheated environments.  Aim for a room temperature of 68-70 degrees Fahrenheit and dress your child in light PJs.  
2. Ensure enough sleep.  Toddlers and preschoolers need 12-14 hours of sleep.   If you think overtiredness is the cause of your child’s night terrors, then work on depositing more hours in his sleep bank by ensuring he is napping well and bedtime is early enough to get  an additional 11-12 hours of night sleep.   
3. Wake your child completely and briefly  around the same time or slightly before the hour when previous night terrors occurred.. Then put her right back to bed.  This can reset her sleep clock and prevent a night terror completely.  
4. If your child snores or has other forms of sleep-disordered breathing (SDB), consult your doctor.  Researchers found that kids who underwent surgery for SDB were free of sleep-disordered breathing symptoms 3-4 months later. They were also free of night terrors (Guilleminault et al 2003).

Nightmares

What are they? 

Nightmares are vivid, scary dreams that occur during REM (Rapid Eye Movement) sleep, usually during the longer REM cycles that happen in the second part of the night for both children and adults.   If a child wakes soon after having a nightmare, they may remember the dream and it can disrupt their sleep — and yours.

When do nightmares start? 

Although nightmares are common at many ages, they are most common in 2-6 year-olds, when fears normally develop and imaginations are active.  Some studies estimate that as many as 50% of children in this age group have nightmares. 

Although babies may dream, since they can’t talk, it is difficult to know whether they actually experience dreams.  By age two, when imaginations, along with vocabulary, expand, nightmares can be communicated with more scary detail.  Since two-year-olds

may not be able to separate dreams from reality, they may act very fearful upon awakening from a scary dream.  By age 5, children have a better grasp of the difference between dreams and reality, though it doesn’t mean that dreams won’t be scary – they just might not need as much soothing as they did when they were younger.  

What causes nightmares?  

Although there is no specific cause of nightmares, they can be triggered by certain events, including:

1. Illness – children are more prone when they have fevers.
2. Irregular schedules – sleep deprivation and overtiredness.
3. Major life changes or a traumatic event causing stress or anxiety  – a new sibling; a new school; a move; a divorce; serious illness or accident.
4. Genetics –  Like night terrors, nightmares may also be hereditary: about 7% of children with nightmares have a sibling or parent with a history of nightmares. 

What should you do? 

If your child wakes up frightened from a scary dream in the middle of the night, respond with calm, loving, reassurance, but resist the urge to fall asleep with your child or bring your little one into your bed.  While tempting, even sleeping one night together, can quickly establish unhealthy sleep habits at this age:  they learn quickly what they prefer and it’s definitely to sleep with you!   Instead, gently coax them back to sleep and focus on helping him overcome fears by understanding more about their fears and how you can help them cope.  Here are some tips to help you understand and respond to your child with reassurance, while not creating a new sleep crutch of needing you to sleep with.

1. Offer comfort:  Acknowledge your toddler’s fear, and offer plenty of comfort and reassurance, like hugs and cuddles.   
2. Stay calm:  Remember, your child learns from your responses.  If you act upset, it can prolong the episode.  Instead, speak in calm, hushed tones, offering reassurances with your words.  Leading her in some deep breathing exercises, singing a song, or reading a book, can all help reduce anxiety.  
3. Keep it brief:  The longer you stay, the more you may inadvertently create bad sleep habits.  Crawling into their bed and staying the night may “fix” the problem short-term, but can quickly become a regular request if you overstay your welcome.  In other words, nightmares can become “faux-mares” (pretend nightmares) if your child learns to say they are scared in the middle of the night in order to get your company in bed for the rest of the night! So, offer a hug, some reassuring words, tuck them in and leave them to fall back to sleep on their own.
4. Avoid exacerbating the fear:  Although creating a “monster spray” or going on a monster hunt may work, these techniques can also backfire by feeding your child’s notion that monsters actually exist.  Instead, remind your child that monsters are not real and they are safe in their house and in their room.