Nightmares and Night Terrors

Nightmares are bad dreams that frighten and awaken the child. It is normal for children (after 6 months of age) to have these dreams now and then. Children respond to them differently, depending on their age. Infants usually cry or scream until someone comes in and comforts them.

What causes nightmares?

Dreams occur when the mind is processing events or information. Usually the content of the nightmare is related to developmental challenges. Toddlers may dream about separation from their parents. Sometimes dreams are related to scary TV shows.

How to help the child:

  • Provide warm reassurance and hold child
  • Stay with the child until he/she is calm. Explain that they were having a bad dream. Offer to keep their bedroom door open and turn on a night light for them. (most children go back to sleep fairly soon)
  • Encourage your child to talk about scary dreams in the daytime
  • You may need to remind the child about the subject of the dream. Help the child imagine a good ending for the dream. Sometimes drawing pictures or writing stories about a happy ending for the dream is helpful. This process may require several talk sessions.
  • Shield your child from scary TV programs and frightening movies
  • Fears from frightening movies can persist for years. Do not allow a child younger that 13 to watch them. Monitor (or check ahead of time) Halloween and slumber parties. Encourage your child to call you if a frightening movie is being shown.

Call the office (during regular hours) if:

  • Nightmares do not decrease after 2 weeks of using the above steps
  • Nightmares become significantly worse
  • Daytime activities are affected by child’s fears
  • The child has multiple fears
  • You have questions not answered above

What are night terrors?

Night terrors are described by the following:
  • Anxious, agitated child who may run around and scream or talk wildly
  • Frightened child who cannot be awakened or comforted
  • Child does not seem to understand that you are with them (their eyes are widely open, but they look right through you)
  • Child may feel that people or objects in the room are dangers
  • Terrors last about 10-30 minutes
  • Amnesia: the child will not remember the night terror the next day
  • Age: usually between 1 and 8 years of age
Night terrors are inherited and occur in about 2% of children. Usually they are not caused by psychologic stress. Being extra tired can trigger night terrors; try to assure that your child gets adequate sleep.

How to help your child

  • Try to help your child resume sleeping
  • Don’t try to waken the child (you can’t). Talk slowly and soothingly, telling the child that she/he is all right. Hold the child if it helps them (some children will resist this).
  • Protect your child from hurting himself
  • The child may run into a wall or tumble down the stairs during a night terror. Attempt to gently guide the child back into their bed.
  • Prepare babysitters for night terrors
  • Explain to anyone caring for your child about night terrors, and how to help your child
  • Try prevention of night terrors with night awakenings

One approach that has been shown to be helpful

  1. Time the period from falling asleep until the terror starts
  2. Awaken the child about 15 minutes before the normal time (time when terror starts)
  3. Keep the child awake, out of bed for 5 minutes
  4. Continue this for 7 nights in a row
This procedure was found to stop terrors in 90% of children

Call the office (during regular hours)

  • The terrors last longer than 30 minutes
  • Child does dangerous things during the terror
  • Child has significant daytime fears
  • You suspect stress in the family may be involved
  • Any questions you may have

Credit: above “condensed/paraphrased” from Schmitt, Barton, Instructions for Pediatric Patients, 1992