Nighttime can be scary.

It's always a little scary to wake up to the sound of your preschooler crying in the night. You lurch out of bed, still half awake, and head toward the sound of sobbing. "It's OK, it's only a bad dream," you say, picking up your frightened child and holding him close. "It's not real, sweetie."

"But there was a monster," your little one tells you, tears beginning to fade.

"I know it was scary," you say, gently tucking him back in, "but dreams aren't real. They're like some of the stories we read. Don't worry. I'll stay right here until you fall asleep." The nightmare is over.  And, after a few minutes, that's exactly what your child does. The rest of the night is peaceful.

Not exactly a nightmare.

A month later, you hear crying again and head for your child's bedroom thinking it's another nightmare. "It's another bad dream," you say sleepily, reaching for him. But this time, something is different.

The first thing you notice is that your child is sitting upright in bed and screaming. His eyes are wide with terror; his pupils dilated to the size of dimes. When you try to pick him up and comfort him, he only yells louder. He even fights to get free of you. You call his name, and remind him you are there. But he doesn't seem to see you as he stares out into the distance. This goes on for 30 minutes before he finally goes back to sleep, and you're exhausted.

It's spooky. It's terrifying. And it seems to go on forever. This is called a night terror.

Nightmares and Night Terrors.

Scientists call both nightmares and night terrors "parasomnias." In most cases, neither requires special treatment by experts. Night terrors tend to affect boys more than girls, and are more common if older brothers or sisters have had them also. If your child has some nightmares or night terrors, don't worry, they are not normally harmful to children and they tend to decrease with age.

These two types of sleep problems also have some important differences. Nightmares usually start when children are between 3 and 6 years old, and they affect 10 to 50 percent of children in this age group (Anders & Eiben, 1997). Nightmares tend to increase when children are under stress, especially after traumatic experiences, and may reflect how a child views the events of the day.

Nightmares tend to occur a few hours before a child awakes, when dreaming is more intense. When awakened by bad dreams, children can often remember some details and may want to talk about them. And when you go to comfort your child during a nightmare, he or she will most likely respond well to your reassurance (American Academy of Pediatrics, 1998).

Is he or she even awake?

Night terrors are different. When your child has a night terror, he or she may not be aware of your presence. In fact, children who experience night terrors  — around six percent of preschoolers — are not fully awake during them even though their eyes may be open (Anders & Eiben, 1997). When a night terror strikes, usually just a few hours after a child falls asleep, he may sit up, struggle, moan, talk or scream. His heart may race and he may sweat. The event can last anywhere from 10 to 30 minutes. And even though the experience may seem unforgettable to you, your child will probably have no memory of waking up at all (American Academy of Pediatrics, 1998).

In most cases, nightmares and night terrors go away with time. Nightmares become less frightening as children get older, and night terrors become less frequent (Passer & Smith, 2001). In severe cases, doctors may prescribe drugs to reduce night terrors. And if regular or recurring nightmares cause serious behavioral problems during the day, some type of therapy may be recommended (Anders & Eiben, 1997).
 

Nightmare or Night Terror?                (American Academy of Pediatrics, 1998)
Nightmare	Night Terror
Scary dream awakens child.	Child awakes only partially, if at all.
Occurs in last hours of the night.	Occurs one to four hours after child falls asleep.
Child cries and is afraid.	Child sits up, thrashes, and may struggle with caregiver. Child may scream, cry or talk aloud. Eyes may be staring ahead, with heart racing.
Child is aware of caregiver.	Child is not very aware of caregiver.
Child may have trouble going back to sleep.	Child often goes back to sleep without fully awakening.
Child often remembers dream and may want to talk about it.	Child has no memory of a dream, or of waking up, screaming, or thrashing.

Helpful Parenting Tips

Until nightmares or night terrors fade with time, the best thing you can do is comfort your child through the scary times. First, take a look at the chart and determine whether your child is most likely having a nightmare or a night terror. (If it is a nightmare:)

• Reassure your child when he awakes from a bad dream. Hold him and talk with him about the dream. Stay with him until he's calm.
• Try to identify things that might be causing stress in your child during the day. Then see if you can decrease this stress, which may make your child less anxious at night.
• Avoid showing your child scary images - movies, television, or stories - before bedtime.
• Read stories together about dreams and sleep. The stories may help your child understand that everyone dreams, and that dreams are not real and he doesn't need to be frightened of them.

If your child has a night terror:

• Hold your child so he does not hurt himself if he's moving around a lot.
• Even though he may not appear to hear you, reassure him anyway. Tell him he's OK and that you're there for him.
• Realize that some children may have one episode of night terrors and others may have several. But it's not typical for night terrors to occur frequently or over a long period of time. If they do, talk with your pediatrician (American Academy of Pediatrics, 1998).

And keep in mind that while both nightmares and night terrors are upsetting, most children don't suffer from them for long. Chances are your child will grow out of them and sweet dreams will return.

References: Anders, T. F., & Eiben, L. A. (1997). Pediatric sleep disorders: A review of the past 10 years. Journal of the Academy of Child and Adolescent Psychiatry, 36(1), 9-20. Shelov, S. P. (Ed.). (1998). American Academy of Pediatrics: Caring for Your Baby and Young Child Birth to Age 5 (pp. 368-371). New York: Bantam Books. Passer, M. W., & Smith, R. E. (2001). Psychology: Frontiers and Applications (pp. 199-200). New York: McGraw Hill. Parkes, J. D., (1986, Nov. 1). The Parasomnias. The Lancet, 1021-1024. Anders, T. F., Goodlin-Jones, B., & Sadeh, A. (2002). Sleep disorders. In C. H. Zeanah (Ed.), Handbook of Infant Mental Health (pp. 326-329). New York: The Guilford Press. To order reprints of this Spotlight click here http://www.talaris.org/store.htm  The information on this Spotlight is the property of Talaris Research Institute and protected under U.S. copyright and other laws.

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