Night Terrors in Toddlers and Older Children: Causes and Treatment

If your 4- or 5-year-old thrashes around in the middle of the night with her eyes open, looking terrified, and won’t respond to you, she may be having a night terror. Night terrors are different from nightmares and are usually not a cause for concern. Still, they can be frightening to observe for many parents. Read on to learn what night terrors are, what causes them, and how to help if your child has one.

What Are Night Terrors?

A night terror is a type of sleep behavior that may resemble a nightmare. It is considered a parasomnia—an undesired occurrence during sleep—and is more closely related to sleep walking and other sleep disruptions. Night terrors are rare, affecting only about 3 to 6 percent of kids between the ages of 4 to 12. Witnessing a night terror can be upsetting for parents, but it’s not as harmful as it might look. Unlike a nightmare, once the night terror is over, a child will go back to sleep quickly, and won’t remember it. An episode may last about 5 to 15 minutes. A night terror is usually not a cause for concern or a sign of a deeper medical issue.

At What Age Do Night Terrors Occur?

Some parents wonder if toddlers can have night terrors, but they almost always happen in older kids, usually those aged between 4 and 12. Although there have been rare cases of night terrors reported in toddlers as young as 18 months, it’s very unlikely for a toddler to experience a night terror. Some children experience only one night terror, while others experience several before these episodes stop as the nervous system matures. Keep in mind that it’s uncommon for a child to have frequent night terrors over a prolonged period of time, so if you do notice them happening often, you may want to consult your child’s healthcare provider for advice.

Signs of a Night Terror

If your child is having a night terror, he may:

• Sit upright in bed suddenly

• Scream or shout out in distress

• Breathe faster

• Have a quicker heartbeat

• Sweat

• Thrash around

• Act upset and scared

• Have his eyes open but be hard to awaken

• Calm down after a few minutes or so and then go straight back to sleep

• Have no memory of the episode once awake.

If you are sleeping in separate rooms or happen to be a deep sleeper, you may not even notice that your child is having a night terror, unless you are awoken by the sounds of screaming or thrashing.

What Causes Night Terrors in Children?

Night terrors can arise when a child’s central nervous system is over-aroused during sleep. Night terrors typically occur during non-dreaming sleep; they often take place within two hours of going to sleep and may last about 5 to 15 minutes. According to child health experts, these are some factors that could increase the likelihood of a night terror occurring:

• Your child is overtired or not getting enough sleep

• Your child is ill or stressed

• Your child is taking a new medication or sleeping in a new environment

• There is a family history of night terrors or sleep walking.

Keep in mind that night terrors are not technically dreams or nightmares (which occur during Rapid Eye Movement, or REM, sleep); instead, they are more like a sudden reaction of fear that happens as a child switches from one stage of sleep to another. Most of the time this transition is smooth, but some children may react by getting upset and frightened, leading to a night terror.

Sleep Stages and Cycles

During sleep, children as well as adults go through several sleep cycles composed of different stages. In most of the cycles, a child is switching back and forth between non-REM sleep and REM sleep, which is when active dreaming occurs. The ratio of non-REM to REM sleep will vary over the course of the night; the first stage of REM sleep is short but will get longer as the night progresses, while non-REM sleep stages will get progressively shorter. Here's a breakdown of what happens during a night's sleep:

The Difference Between a Night Terror and a Nightmare

To understand the difference between a nightmare and a night terror, check out the table below:

How to Help Your Child With Night Terrors

Night terrors can be upsetting for you as the parent, but the best way to handle an episode is to simply wait it out, and make sure your little one doesn’t hurt himself if he’s thrashing around. If your child has a tendency to have night terrors and moves around while having them, you may want to attach a toddler bed rail to stop her from accidentally falling off the bed. Avoid waking your child up from a night terror. If your child does wake up, he may be dazed and confused and will take longer to settle down and fall asleep again. Children usually fall asleep on their own within minutes of the night terror ending and won’t have any memory of the night terror at all.

Although there is no treatment for night terrors, here are a few things that might help prevent some of them:

• Try to reduce any stress in your child's life

• Create a simple and relaxing bedtime routine to help your child wind down for sleep

• Make sure your little one gets enough rest

• Don’t let your child get overtired, or stay up too late

• Try to put your child to bed 30 minutes earlier than usual if your child is typically overtired by his usual bedtime or if he’s had a very tiring day

• If your child is experiencing night terrors around the same time each night, try to wake her up about 15 to 30 minutes beforehand.

When to See Your Child’s Healthcare Provider

Most children will grow out of night terrors and don’t need medical attention. However, if the night terrors are frequent and you are worried about them, talk to your child’s healthcare provider, who may refer you to a sleep specialist if needed.

The Bottom Line

Night terrors can be terrifying to see, and you might feel helpless and worried about what’s happening to your child. The good news is that these sleep disturbances are harmless and your little one will grow out of them. Unlike nightmares or bad dreams, which can leave your child feeling anxious or scared, a night terror won't be remembered by your child once she wakes up. During an episode, don’t try to wake your child; she'll settle down and fall back to sleep on her own soon afterward. Creating a calming bedtime routine and ensuring your child isn’t overtired at bedtime could help prevent some episodes. If you’re worried about regular night terrors, you can always consult your child’s healthcare provider for advice, just to be on the safe side.

_{How We Wrote This Article The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.}