Night Terrors in Children
Learn how to recognize them & how to STOP them
by Steve Silvestro, MD @zendocsteve
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I remember the first time my son had night terrors.
He was almost 3 and try as we might, he had dropped his nap a few months earlier. The only time he would sleep in the daytime would be in the car on the way to pick my daughter up from preschool a couple days a week.
Then, seemingly out of nowhere, he started waking up every few nights around 11:30. At least we thoughthe was waking up. He would scream and cry and kick as if he were stuck in a bad dream. At first, when we went in to help him, it was as if we weren’t even there—the bawling continued no matter what we did. Worse still, the more we tried to suggest that he lie down, or reassure him that everything was OK, all he would do would be to shout out “No!“ through his tears.
The whole experience—which recurred a few times over two or three weeks—was truly heartbreaking.
Once the dad in me stepped back and allowed the pediatrician in me to take over, I put the pieces together and realized that he wasn’t having bad dreams—he was having night terrors. After that realization, we were able to not just ease our minds in the middle of the night, but to help break the cycle of his night terrors altogether.
This article/episode is going to show you how to recognize a night terror, how to tell a difference between night terrors and nightmares, why they happen, and how to end them so that you and your child can sleep peacefully once more.
WHAT ARE NIGHT TERRORS?
It turns out that sleeping at night involves a lot more than just closing your eyes and then waking up several hours later.
In a typical night of sleep, we go through several sleep cycles, each of which is comprised of five stages. Our brains display different types of activity in each of these stages. For example, we are most deeply asleep in Stage 4, and are most likely to dream in Stage 5.
Usually, we transition between stages smoothly and without any problems. But in a child about to experience a night terror, the transition between the fourth and fifth stages is disrupted. The result is something that is similar to sleepwalking, but much more emotional for parents to witness.
WHAT DO NIGHT TERRORS LOOK LIKE?
The reason that night terrors are given such a scary name is that a child experiencing a night terror looks as if she’s truly afraid of something.
During a night terror, a child might moan, call out, or even scream. She might sit up or thrash about in her bed. In keeping with the thought that it looks like they’re afraid, kids might sweat, with their hearts beating quickly and eyes open wide with a look of fear on the face.
Again, it can sometimes be unsettling to watch as a parent because it seems like your child is truly suffering.
The more distressing part of a night terror is that no matter what you do, it will often seem like your child isn’t responding to you. Or, he might respond, but not really, not in the way he might if he were awake. This was what happened with my son—before we realized these were night terrors and we’d try to reassure him, he would just shout “No!” to everything we said and continue to cry.
This inability to respond to you seems odd, but remember: during a night terror, your child isn’t really awake—he’s just having a disrupted transition between the normal stages of sleep.
The hallmark of a night terror is that after a few minutes, your child will fall back asleep on her own without any intervention from you. And, perhaps best for her, she won’t remember the experience when she wakes up in the morning.
HOW DO YOU TELL THE DIFFERENCE BETWEEN A NIGHT TERROR & A NIGHTMARE?
So as I mentioned above, a night terror is a disruption in the sleep cycle, usually between the fourth and fifth stages of sleep.
A nightmare, on the other hand, is simply a bad dream.
Night terrors usually take place earlier in the night—typically about 2-3 hours after a child falls asleep. Nightmares often occur closer to the morning. I will usually tell my patients’ parents that night terrors usually happen before 1AM, whereas something after 1 or 2AM is more likely to be a nightmare.
A child who has a bad dream might remember it and be able to tell you all about it in the morning. A child who has a night terror, on the other hand, won’t remember the experience at all—not what she did, not you coming in to calm her down, none of it. (A psychologist friend of mine says that the key is who is more upset in the morning—if your child is upset in the morning, it was a nightmare; if you’re more upset about what happened overnight, it was a night terror.)
Finally, if your child is having a nightmare, you’ll find it easier to rouse him from sleep so that you can end the dream and calm him down. He might even talk to you and make sense. With a night terror, think of it like talking to someone who is sleepwalking—it’s harder to wake your child up, and if he talks it’s less likely to be coherent.
WHAT CAUSES NIGHT TERRORS?
There has been some evidence over the years that there might be a genetic component to night terrors. In identical twins (who share all of their genes), if one twin experiences night terrors then the second twin is more likely to also experience them than if the scenario were the same for fraternal twins (who don’t share all the same genes). Also, having a close relative who had night terrors or was a sleepwalker increases a child’s likelihood of having night terrors, too.
But no matter the genetic setup, we know this:
The biggest risk factor for having a night terror is being overtired.
A night terror is more likely to occur in a child who has any of these experiences, all of which can lead to her being overtired:
- Going to bed later than usual
- Dropping naps
- Caffeine or other stimulants close to bedtime
- Other causes of sleep disturbance, such as travel
If a child’s sleep deficit persists, then you might see that night terrors recur over several weeks. When this happens, you’ll find that they often predictably occur around the same time of night.
I should also note that if you do a Google search on night terrors, you’ll find that some sources say that they can be linked to psychiatric disorders. This is true—but only for adults who have them. Adults with anxiety disorders, post-traumatic stress disorder, and other problems can sometimes experience night terrors, especially in their 20s and 30s. In kids, night terrors are most common around age 3, but have been reported as young as 18 months and as old as 12 years of age. Kids eventually outgrow them and have not been shown to have any increased risk for psychiatric problems. So, as always, don’t let a medical Google search scare you!
HOW DO YOU STOP NIGHT TERRORS?
As I said above, in the moment while a night terror is taking place, there isn’t really anything that you can do make it end then and there. Instead, the best approach for you to take during your child’s night terror is to 1). Take a breath, 2). Make sure your child is safe, and 3). Know that he will be okay.
However, there are steps you can take to prevent your child from having more night terrors in the future:
Make sure your child consistently sleeps well.
Sometimes more easily said than done, right? Well, trying a few of these tips might bring you some sleep success:
- If your child has been staying up late, try putting her down 15-20 minutes earlier than usual. We know that sleeping later in the morning doesn’t actually fix sleep deficits; the only way to do that is by going to bed earlier. A mere 15-20 minutes early might just do the trick.
- Stick to a regular, calming bedtime routine that can help your child wind down each night.
- When traveling, spend time outdoors, especially at sunset. Our eyes and brains work together to use the placement of the sun as a switch to turn production of melatonin—the sleep hormone—on or off.
Do what seems unthinkable—wake your child up.
If your child has been stuck in a rut of having night terrors over the past few weeks, then waking your child up before you go to bed might be your best bet for breaking the pattern. This isn’t something most of us parents would think to be a good idea, but drastic times call for drastic measures!
As I noted before, when kids have recurrent night terrors, they tend to always happen roughly around the same time of night. So, for the next several nights, go into your child’s room 15-30 minutes before one is “scheduled” to happen. Gently wake him up, then let him roll over and fall back asleep. There are few well-done studies on this “scheduled awakening,” but parents who try it often report that it’s effective in freeing kids from the night terror rut.
THIS TOO SHALL PASS
Like most challenges when it comes to raising kids, night terrors can cause a great deal of stress and anxiety in parents. But, also like most parenting challenges, kids tend to move on naturally in time and ultimately do just fine.
Of course, if your child’s night terrors seem to be unmanageable and continue on for months without any apparent cause, then speak to your pediatrician. Together, you can explore whether a less-common cause of sleep disturbance is the culprit.
But for the vast majority of kids, if you are able to ensure that your child gets enough sleep each night, and if you try the above tips to help end the cycle of night terrors, then you and your child should soon be on the way to sleeping peacefully once more.