Nightmares vs. night terrors in toddlers and young children

Toddler NightmaresWe all need the refreshing effect of sleep for a better next-day. But nothing is more worrying than if the calmness of the night is broken too often by the sounds and screams of someone we love. Night terrors and nightmares are not uncommon among toddlers and young children. Most children may have them after the age of three when a child is quite active and acquiring various skills. Fortunately, it is not a reason to worry in most cases, as a vast majority of cases are nothing more than a short-term problem. Night terrors and nightmares are not the same, but before we look into the difference, let us understand a bit more about healthy sleep for a child.

Understanding sleep

Sleep has various phases. It starts with drowsiness and then progresses to light sleep. The next phase is the so-called deep sleep stage without any eye movements (also called NREM), and later at night most of us advance to the so-called dream sleep stage or sleep with rapid eye movement (also called REM sleep). All of these phases have a particular role in physical and mental health, and disturbances in any of the stage may have a negative impact on long-term health.

It is also vital to understand that toddlers and young children need to sleep longer as compared to adults because of their fast-developing brains. It is during these early years that neurons in the brain change their interconnections to retain the maximum understanding about interacting with the environment. Toddlers and young children usually need more than 9 hours of sleep, and even 12 or more is considered normal.

As the children grow, sleep hygiene is something that must be taken care of. Due to various distractions, children may not go to bed at a fixed time, or may not get enough sleep. Thus, it is essential that caregivers or parents make sure that young children get enough sleep and routine is followed

Understanding night terrors

Night terrors, along with sleepwalking, are classified as a parasomnia, a term that encompasses abnormal occurrences in sleep. However, night terrors or sleep terrors are far more common than walking while asleep. Night terrors usually happen in the NREN stage of sleep, which are the early hours of sleep. It is often a noisy event. The child may scream, make strange movements without being aware of them, kick, fall from the bed, and, in rare cases, may even walk or break something.

These so-called attacks of night terrors may last from a minute or two to much longer (maybe even for half an hour). During bouts of night terrors, the child is extremely difficult to awaken, and even when they are finally awoken, the child is confused. Usually, a toddler or child does not remember anything about it the very next morning.

Identifying the exact cause of night terrors may be difficult. It could be due to stress, the child being over tired, a lack of enough sleep (due to fever, a breathing problem, or any other reason), medications, or a mood disorder.

Understanding nightmares

Nightmares are bad and frightening dreams or experience that wake up a child, usually late at night. They are different from night terrors, as they happen in the REM or dream phase of sleep. Moreover, nightmares do not last long.

Nightmares occur in children due to the exposure to some frightening experience. It could be a real experience, or even just something they saw on television.

Help a child in night terrors and nightmares

Helping a child with nightmares may not be that difficult. It is extremely rare for nightmares to last long; moreover, in most cases, a child can remember the experience. Thus, the solution is cuddling a child and making them feel safe. It is vital to identify the reason behind such nightmares so that they can be avoided in the future.

Night terrors may be more difficult to overcome, as in many cases the reason may not be identifiable. It may become difficult if they continue for a long duration, and, in some conditions, they may continue to be a problem for years.

The solution lies in helping your child to return to normal sleep as soon as possible. Avoid shouting or scolding, as it may only make things worse. Make sure that the surroundings are safe for your child so he or she does not get hurt during the fit of night terrors. Try to identify the causes of night terrors, like medications, lack of sufficient sleep, or any other significant changes in lifestyle.

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Seeking medical advice

If nightmares or night terrors continue for an extended period of time and occur often, it is not a bad idea to seek medical help, as night terrors have been shown to be associated with mood disorders in adult life. Further, a medical specialist will make sure that these night terrors are not due to some organic disease of the internal organs or the brain. In some cases, fits or seizures of neurological causes may be confused with night terrors.

Pharmacological treatment of such disorders is reserved for severe and refractory cases. In such cases, a doctor may prescribe sedatives or hypnotics to improve the sleep pattern. It is not rare to prescribe antidepressants for severe cases of night terrors.

About the author:
Dr. Preet Bhinder (M.D.)Dr. Preet is a family physician. He has been practicing medicine for last 15 years and often sees children with various sleep and emotional disorders. He understands the traumatic effects of such conditions on the entire family. He is also a passionate writer.

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1 comment

  • A clear distinction between the two. I always wondered about that. Thanks for clearing that up.

    Jeff on

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