Nightmares and night terrors

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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What is a nightmare?

Nightmares occur when your child wakes while having a bad dream. Your child might recall the content of the nightmare and be afraid to go back to sleep. A reassuring hug will often help them settle back to sleep. Nightmares can occur in children of any age and are most likely to happen during the later part of the sleep, or in the early morning hours when Rapid Eye Movement (REM) or Dream Sleep usually occurs. Nightmares can reflect worries that your child might be having during the day and it might be useful to talk to about this with them. Children can usually remember these episodes the following day.

What is the difference between nightmares and night terrors?

Night terrors occur when children are only partly aroused from deep (Stage N3) sleep so they are not quite awake, but they are not completely asleep either. They tend to start within the first 2-3 hours after bedtime and may occur at a predictable time after sleep onset. During a night terror your child’s brain remains asleep, whereas the "body" looks somehow awake and facial expressions are very emotional. Your child may scream and appear very frightened, usually not recognising the people around them. Because of this, it is best not to try and reassure your child and touching them may make the episode worse. They may try to run away or push people away. Night terrors are part of a group of Non-REM sleep arousal disorders or parasomnias. Your child may remember being frightened, but without specific dream content and will not usually remember the night terror the next morning. Night terrors tend to occur in younger children and are usually outgrown by the end of primary school age. Like nightmares, there are usually no long-term psychological effects.

What to do?

Nightmares

With nightmares, it is usually enough to reassure your child and stay with them until they are comfortably off to sleep again. The next day, it usually helps to talk about the dream and ask about any worries or fears they may be experiencing.

Night Terrors

With night terrors, your child will appear to be confused and not fully awake so your main focus should be to keep them safe. Make sure the home environment is safe as they may sometimes run around (see Home Safety Checklist fact sheet). Doors and windows should be locked and sleeping on the ground floor is encouraged.

During the episode keep them away from danger by gently restraining them– your child will usually go straight to sleep after a few minutes. Do not try to wake them, as parents / carers often report that the more they try to wake the child, the longer the episode lasts.

Can they be prevented?

Nightmares

Before bedtime, try to spend time with your child and ensure activities have a calming effect, eg. reading a book with them. Try to avoid your child watching exciting videos, inappropriate television or commencing vigorous activity prior to bed. For children 12 months and older, avoid food and drinks one hour before bedtime.

Night terrors

Things that make night terrors worse include fevers, being tired, or not getting enough sleep. If your child has night terrors, it will help them if you can ensure that they have regular bedtime and wake times (including weekends) to ensure that they get enough sleep. Fevers also make night terrors worse so if they are unwell, try and keep the fever down (see Fever fact sheet). If the night terror happens at the same time every night, episodes may be prevented by completely waking your child (for example by gently nudging their shoulder until they stir) 15 minutes before this time, then letting them drift off to sleep again. If they do stop the episodes, after 4 or 5 nights of these scheduled awakenings can you can stop the waking and see if the night terrors have stopped. However, in some children waking them like this may bring a night terror on earlier so if this happens, you should go back to the process of gently ensuring their safety without waking them.

What is the treatment?

It would be wise to see the doctor if the nightmares or night terrors are frequent, severe, disruptive, dangerous, happen at an unusual age or seem to affect your child’s performance during the day by causing sleepiness. Your doctor may want to rule out another medical disorder related to sleep.

If there is an underlying cause this may have to be treated before the night terrors will stop. Even if there is not another condition present, additional measure that may be required include hypnotherapy (which has been shown to be effective) or medication if the events are extremely distressing, frequent, injurious, or if they have a negative impact on your child’s daytime behavior and performance.

Sleep disorders are very common in childhood and most of the time there are no underlying medical conditions. Your local doctor and Paediatrician are very familiar with these problems and can offer help.

Remember:

  • Nightmares are bad dreams that often relate to worries your child may have so talking about these worries with your child can help them go away.
  • Night Terrors usually happen one or two hours after falling asleep and can be very frightening for parents and carers. Do not try to wake your child, but gently keep them out of harm’s way until it passes. Keep the home environment safe.
  • Make sure your child gets adequate sleep by keeping regular bedtime routines and regular and wake-up times
  • If episodes are very severe or frequent, your doctor may need to check for an underlying medical condition such as sleep apnoea. 
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The Children's Hospital at Westmead
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Sydney Children's Hospital, Randwick
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Hunter New England Kids Health
www.hnekidshealth.nsw.gov.au

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