Night Terrors

What is it?

"Night terrors" are a very common form of mild sleep disorder in childhood. They are not the same as nightmares, which are bad or frightening dreams. People have nightmares at all ages, and can usually remember what they were dreaming about. Night terrors occur in children from the pre-school years until adolescence. They are most common between ages 5 and 7. Night terrors usually begin with the child whimpering or crying out a few words. The child then goes on to a few minutes of terrified screaming, during which s/he may not recognize his or her parents. During the spell, the child has a very rapid heart rate, may be sweaty, and breathe very fast. After the screaming spell, the child is usually confused and may not respond to the parents. Children with night terrors usually cannot remember anything about the event. Unlike nightmares, which often occur very late in the night or early morning, night terrors usually happen within the first few hours of sleep.

Scientists do not know the exact cause of night terrors. They seem to be related to an abnormal transition from sleep to waking, or between different levels of sleep. Children’s immature nervous system may be part of the cause of this. Children who are sick with a fever may be more likely to have night terrors. Doctors do know that establishing regular sleep habits and patterns (good "sleep hygiene") is one way to help reduce night terrors.

The first few times a child has night terrors, they usually terrify the parents as well. True night terrors are harmless except for the anxiety they cause in the family. This usually goes away with education and familiarity with the problem. The biggest concern is to be sure that the event really is a night terror, and not some other problem that could be more serious. Your doctor can usually do that by listening carefully to your description of the event. Sometimes a video of the event helps in the diagnosis, if one is available.

If your child has a night terror, go to his or her bedside to be sure s/he is ok. Please try to speak in quiet, gentle tones to the child. This can be hard to do if you are frightened yourself, so please try to remember that your child is in no danger. Children awakening from night terrors can become more agitated at first. This is a normal part of the event. It may help to remind the child that s/he is at home, in his or her own bed, with Mommy or Daddy right there. The more you can be quietly reassuring to your child the better. Some parents find that if they quietly point out things that are familiar to the child it can help – a picture on the wall, a favorite toy, etc. The whole idea is to create a soothing and reassuring environment for your child as s/he passes from the terror state into wakefulness.

Night terrors almost never require treatment with medication. Like other childhood sleep disturbances, night terrors often get better with attention to good sleep habits. Sleep is an important part of a child’s normal routine, but many people don’t pay much attention to it. Just as with a healthy diet, it’s important to help your child develop healthy habits about sleep. Here are some tips from experts on establishing habits for a good and restful night’s sleep:

• Keep a regular nap-time routine for children who still take naps. Avoid naps after late afternoon (3:30pm).
• Keep a regular evening routine (if possible). Allow time in the evening to spend with your child while s/he is still awake. Try to have the routine be enjoyable for your child – something s/he will look forward to, like story time.
• Avoid caffeine-containing foods and drinks in the evening (remember that many soft drinks and chocolate have caffeine in them)
• Make a firm and consistent bedtime. Stick to the same bedtime, so that your child goes to sleep and wakes up at the same time each day.
• Reward your child for cooperating with bedtime.
• Put your child to bed while s/he is still awake. Avoid letting your child fall asleep with you on the couch or in front of the TV.
• Avoid taking your child into your bed for sleep or to get settled.
• If your child wakes or fusses in the night, try to be as "boring" as possible – avoid making the event a big deal.
• In very severe cases in which children seem to have several night terrors every night, doctors may prescribe an anti-anxiety medication like alprazolam (Zanax® and others). This is rarely necessary. If you or your doctor feel your child needs medication, it would be a good idea to be sure you’ve talked about what other problems might be going on instead of night terrors.

Night terrors are not dangerous to children. Occasionally children have other conditions that we might mistake for night terrors, but that could be more serious. Here are a few things to look out for:

• Fever that you did not previously know about
• A child who continues to have jerky or rhythmic movements that you can’t stop with your hand
• A child who does not wake up after 10 – 15 minutes
• Vomiting
• Loss of bowel or bladder control
• Difficulty breathing or noisy breathing
• An episode of terror that lasts for more than 10 – 15 minutes
• Hallucinations or coherent fears that the child can talk about – with night terrors children cannot tell what was scaring them
• A child who becomes fearful of a particular person during the day or at bedtime
• A child with changes in daytime behavior or habits

Night terrors are just one of many common sleep disturbances in childhood. You can control most of them with good sleep hygiene and regular sleep habits. Here are some good resources about sleep in infancy and childhood:

Pearce J. New baby and toddler sleep programme, how to get your child to sleep through the night, every night. Ebury Press, 1999. ISBN 0091825911.

Ferber R. Solve your child's sleep problems. Penguin Books. ISBN 1864660783.

Quine L. Solving children’s sleep problems: a step by step guide for parents. Beckett Karlson, 1997. ISBN 1901292010.

Website of the National Sleep Foundation: "Children and sleep."

In addition to night terrors, several other conditions can cause children to seem terrified at night. Nightmares are the most common. All children have nightmares, which are scary or disturbing dreams. Children with nightmares can usually wake up to the parent’s voice, and can usually describe what they were dreaming about or frightened of. With night terrors, the child usually does not wake up right away, and rarely can remember the fear. Nightmares are not usually a big problem for children, but if your child has frequent or recurring nightmares, or seems afraid to go to sleep, please discuss this with your doctor. These could be signs of an emotional or psychological problem.

Seizures (epilepsy) can sometimes cause symptoms similar to night terrors. Children with seizures usually have fairly violent, uncontrolled movement that you can’t stop with your hand. They may lose urine or stool. They may be sleepy after the seizure, but they are not usually confused the way children with night terrors may be. If your doctor is concerned about seizures, s/he will recommend other testing, such as an EEG (brain wave scan). In some cases where it is difficult to tell what is going on, your doctor may recommend a "sleep study." This is a test in which technicians will measure your child’s vital signs and other functions, along with an EEG and video monitoring, during a night’s sleep. The sleep study can be very useful in sorting out a variety of sleep disturbances.

Caring for a child with night terrors can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.