Nightmares and night terrors

How to know when it’s more than just a bad dream

By Russell Dorr, PA-C

Nightmares and night terrors - we all have experienced these from time to time, and have seen our children experience them as well. You may think nightmares and night terrors are one and the same, but they are different.

Nightmares are the scary dreams, the bad dreams that awaken us. For children the experience of a nightmare is just the same. This is normal, and can occur at any age from about 6 months of age on. When an infant has a nightmare they cry and scream until someone comes to them, wakes them up and comforts them. Preschoolers will usually cry and run into the parent’s bedroom. Older children begin to understand what the nightmare is and may wake their parents, or just go back to sleep.

Night terrors are different. Night terrors are a sleep disorder where the child tends to have a frightening dream during their deep sleep, and it is difficult for the child to wake from it. They occur in perhaps 2 percent of children and are usually not caused by any psychological stressors, but instead by being overtired.

Dealing with nightmares and night terrors are different. With a child having a nightmare, reassure the child, hold them and explain that they are having a bad dream. Sit on the bed with them until the child is calm; this is a time for the child to be fully awake and realize everything is OK.

Offer to leave the bedroom door open; it should not be closed on a child that has been frightened. Also having a nightlight is reassuring, especially if your child is afraid of the dark. Helping your child talk about the bad dream during the day can help. They may not remember the dream unless you can provide them with some feedback of what they said to you at the time. Sometimes the dream is about falling, or being chased, or something under the bed or in the bedroom closet. Working through that recurrent fear will probably take more than one conversation.

You should also protect your child against frightening movies, stories, television shows or video games. For many children violent or horror movies can cause bedtime fears and nightmares. And do not be fooled by other perhaps more “safe” sources. My children were frightened for years from the image of the wicked witch in Disney’s Snow White, and the many movies of the loss and separation from a parent. Of course it’s impossible to avoid all triggers, so as a parent don’t set that expectation.

Dealing with night terrors is different. Your child will be restless and agitated, but cannot be awakened or comforted. He or she may sit up, or run about screaming or talking wildly. They will not realize you are there; if their eyes are open they may not react to seeing you, and they may mistake objects in the room as dangers. Usually this will occur approximately one to two hours after the child has gone to sleep, and may last from 10 to 30 minutes. The next morning the child will not be able to remember what the terror was about, and unlike nightmares that can occur from age 6 months on, night terrors usually occur between the ages of 1 to 8.

Try to reassure your child that everything is OK, that they are home and in your own bed and that they are safe. Turn on the bedroom lights to take away shadows, and continue to talk in a calm, low, soothing voice. You can prevent night terrors by keeping your child from becoming overtired.

There are other helpful interventions for both problems. The key is being as proactive as possible to prevent them for occurring. Protect the child from frightening and disturbing stories, movies and books and see that the child is getting plenty of rest. If you have more questions, discuss them with your child’s health care provider.

Russell Dorr, PA-C works at Dartmouth-Hitchcock Merrimack Family Medicine. For more information,go to Dartmouth-Hitchcock.org