Night terrors in children — also known as “sleep terrors” — are sometimes confused with nightmares. Both cause distress and disrupt sleep, and though terrors are less common than nightmares, they are hardly unusual…especially among toddlers.
What’s the difference between nightmares and night terrors, and what can be done about these conditions? Here is an evidence-based overview of each problem, with some tips for coping.
Nightmares are frightening dreams associated with REM (rapid eye movement) sleep. Kids switch back and forth between REM and non-REM sleep during the night, but spend ever-longer stretches of time in REM during the last few sleep cycles. For this reason, nightmares are more likely to occur during the early morning hours.
How can you tell if your child has frequent nightmares? That’s not always easy to tell, especially if your child is too young to articulate his or her anxieties, or has trouble remembering the content of dreams.
But overall, nightmares are very common. Most studies estimate that at least 70% of young children have nightmares at least sometimes, and the incidence of nightmares peaks in later childhood — around the age of ten years (Gauchat et al 2014). Moreover, it’s not unusual for kids to think about their bad dreams during the day. In one study, children between the ages of 7 and 9 ranked “scary dreams” as one of their top three sources of intense worry (Muris et al 2000).
So it’s likely your child will experience nightmares at some point. And when kids have particularly disturbing or frequent nightmares, it can affect both their sleep and their daytime functioning.
For example, in a study of more than 6,000 primary school children, kids who reported frequent nightmares were at higher risk for insomnia, hyperactivity, mood problems, and poor academic performance (Li et al 2011). And in other research, adolescents who experienced regular nightmares (at least one per week) were more likely to suffer from an array of psychological difficulties, including anger, attention problems, hopelessness, anxiety, and symptoms of depression (Liu et al 2022; Yang 2022).
Yes, in fact nightmares are a classic symptom of post traumatic stress disorder. Kids are more likely to experience frequent and intense nightmares if they have lived through traumatic events, such as abuse, domestic violence, natural disasters, or the death of a loved one (Secrist et al 2019).
Chronic stress may play a role (Nielsen et al 2019). So too may sleep loss, as well as medications that interfere with REM sleep (Moore et al 2006). In addition, viewing television may have a small, but measurable impact on the frequency of nightmares, and of course scary media content can make its way into a child’s dreams (Muris et al 2000; Stephan et al 2012).
As you might expect, experts advise parents to reassure children after a nightmare — let kids know they are safe; encourage them to share the frightening content of their dreams; and remind them that dreams aren’t real. This may include turning on the light, and showing your child that there aren’t any threats in the room.
In addition, psychologists remind us to be mindful of our own, emotional reactions to a child’s distress. In particular, it’s important to avoid mirroring our children’s anxieties back at them, or otherwise act upset. Kids pick up on these feelings, and get the wrong message. Mom is emotional too. So I must be right about my fear. The threat is real!
So while it’s important to be sympathetic and sensitive, it’s also important to project a sense of calmness and confidence. For more about this — and additional, evidence-based tips, see my article about reducing nighttime fears in children.
Beyond these basics, there are other, research-based strategies. For example, studies of adults suggest that people with chronic nightmares can reduce their nighttime anxieties by using relaxation techniques, and by talking over the content of their nightmares and fears with a therapist. This includes “rescripting” the nightmare — or re-imagining it with a safe, happy ending. In experiments, rescripting has reduced the severity and frequency of nightmares (Davis et al 2011). It may also reduce the distress that dreamers feel during nightmares (Rhudy et al 2010).
We need more research to determine how effective these methods are for nightmares in children. Most of the studies that do exist are of limited value because the sample sizes are small. But the results suggest that the techniques are helpful for children as well as adults (Simard and Nielsen 2009; St-Onge et al 2015; Fernandez et al 2012; Lewis et al 2015; Kopcsó et al 2022). And I’ve found a couple of evidence-based programs that parents can try at home — “Uncle Lightfoot” and the “Dream Changer” technique.
Can a book help parents guide children through effective therapies for dealing with nighttime fears? Researchers have tested this idea with a couple of experimental studies.
In both, parents were assigned to read a book to their children — Uncle Lightfoot, Flip that Switch: Overcoming fear of the dark (academic version) by Mary Coffman. In addition, the families engaged in the book’s activities, which were designed to help children to confront and dispel their anxieties, and rescript frightening aspects of their dreams. Did it work? The results look good. After 4-5 weeks, kids displayed improvements in their anxiety levels, and better coping skills for getting through the night (Lewis et al 2015; Kopcsó et al 2022)
If you’re interested in trying this program out for yourself, an edition of Uncle Lightfoot, Flip That Switch: Overcoming Fear of the Dark (Second Edition) is available for purchase from Amazon.com. (Any purchases made using this link will earn a commission for Parenting Science.)
What if we could “change the channel” when we’re having a bad dream? Well, obviously it isn’t that simple. But perhaps just imagining it could help children feel less helpless or stressed at night…and possibly inspire some beneficial “rescripting” too. Recently, researchers tested the idea in an experiment, and kids managed to reduce the frequency of their nightmares (Bourboulis et al 2022). To learn more about this approach, see my article, “The ‘Dream Changer’ technique for reducing children’s nightmares.”
Like nightmares, night terrors in children are distressing and disruptive. But night terrors differ from nightmares in several important ways.
Typical symptoms of night terrors include the following (Leung et al 2020):
This might sound pretty exotic if you haven’t coped with night terrors before. But the condition is surprisingly common, especially among very young children. In studies tracking large cohorts of children over time, the age of highest prevalence is around 18 months. More than one third (35-37%) of toddlers this age experience sleep terrors (Nguyen et al 2008; Petit et al 2015).
Children tend to grow out of it, but lots of kids still have night terrors during the primary school years. Studies estimate that between 11-20% of children aged 9-10 years experience night terrors (Shang et al 2006; Laberge et al 2000; Petit et al 2015, Kim et al 2017). By the teen years, kids are less likely to experience terrors (Leung et al 2020).
Clinical studies suggest that most episodes last no more than 10 minutes. However, in some cases, they may continue for up to an hour (Leung et al 2020). Medical experts recommend that you consult with your doctor if your child’s night terrors tend to last longer than 30 minutes (see below).
Scientists don’t really know, but it’s clear that something is going off the rails during deep, non-REM sleep. According to one theory, night terrors represent a failed attempt to transition between NREM3 and REM sleep.
In addition, there is evidence that night terrors run in the family, and that genetic factors may make individuals more susceptible (Hublin et al 2001; Nguyen et al 2008; Petit et al 2015; Leung et al 2020: Mainieri et al 2021). And sleep terrors have been linked with a variety of physical, psychological, and environmental conditions (Crisp et al 1990; Petit et al 2006; Guilleminault et al 2003; Kim et al 2017; Leung et al 2020) — conditions which have in common the potential for disrupting deep, non-REM sleep. These include:
Sleep terrors have also been associated with television. Kids who have televisions in their bedrooms are more likely to suffer from both night terrors and nightmares (Brockmann et al 2016). In part, this may reflect the fact that children with bedroom televisions are at greater risk for sleep loss and tiredness. In addition, if kids are falling asleep with the television on, the noise could be interfering with sustained deep sleep.
Finally, Sean Boyden and his colleagues have floated the hypothesis that solitary sleep during infancy increases a child’s risk of developing night terrors. But currently there is no empirical evidence supporting this speculation (Boyden et al 2018).
There’s no doubt that some night terrors are related to emotional problems, and so – for some children – these sleep disturbances may be indication that a youngster is at higher risk. For instance, in a study tracking more than 300 children from the age of 12 months, researchers found that toddlers who had experienced night terrors before the age of three were more likely to show signs of internalizing problems (such as depression or anxiety) when they were five (Laganière et al 2022).
But it’s important to remember that terrors are quite common in this age group. Most toddlers experiencing night terrors did not go on to show symptoms of internalizing problems when they were five. The best approach? If your child is suffering from frequent night terrors, it makes sense to watch for signs of anxiety or depression, and discuss these with your pediatrician.
If you suspect your child suffers from sleep terrors or night terrors, consult your doctor. It’s important to rule out other conditions that could be causing your child’s symptoms — conditions like nocturnal seizures, panic attacks, or post traumatic stress disorder. It’s also crucial to make sure your child isn’t at risk of self-harm during the night. In general, experts advise parents to talk with their pediatricians if they observe any of the following:
In addition, it’s important to determine if your child’s night terrors are associated with snoring or other forms of sleep-disordered breathing (SDB). SDB can be dangerous, but it is treatable. And if you treat your child’s breathing disorder, you might also reduce or eliminate her sleep terrors (Guilleminault et al 2003). Experts have developed a number of treatments for SBD, including orthodontic approaches and myofunctional therapy (Huang and Guilleminault 2017; Villa et al 2017).
Boyden SD, Pott M, Starks PT. 2018. An evolutionary perspective on night terrors. Evol Med Public Health. (1):100-105
Brockmann PE, Diaz B, Damiani F, Villarroel L, Núñez F, Bruni O. 2016. Impact of television on the quality of sleep in preschool children. Sleep Med. 20:140-4.
Bourboulis S, Gradisar M, Kahn M. 2022. The “Dream Changer”: a randomized controlled trial evaluating the efficacy of a parent-based intervention for childhood nightmares. Sleep. 45(4):zsac004.
Crisp AH, Matthews BM, Oakley M, and Crutchfield M. 1990 Sleepwalking, night terrors and consciousness. BMJ 300: 360-362.
Davis JL, Rhudy JL, Pruiksma KE, Byrd P, Williams AE, McCabe KM, Bartley EJ. 2011. Physiological predictors of response to exposure, relaxation, and rescripting therapy for chronic nightmares in a randomized clinical trial. J Clin Sleep Med. 7(6):622-31.
DeMarni Cromer L, Pangelinan BAF, and Buck TR. 2022. Case Study of Cognitive Behavioral Therapy for Nightmares in Children With and Without Trauma History. Clinical Case Studies. 21(5): 377–395.
Durand VM. 2002. Treating sleep terrors in children with autism. Journal of Positive Behavior Interventions, Vol. 4: 66-72.
Fernandez, S., Cromer, L. D., Borntrager, C., Swopes, R., Hanson, R. F., & Davis, J. L. 2012. A case series: cognitive-behavioral treatment (exposure, relaxation, and rescripting therapy) of trauma-related nightmares experienced by children. Clinical studies 2(1).
Frank NC, Spirito A, Stark L, and Owens-Stively A. 1997. The use of scheduled awakenings to eliminate childhood sleep walking. Journal of Pediatric Psychology 22: 345-353.
Gauchat A, Séguin JR, Zadra A. 2014. Prevalence and correlates of disturbed dreaming in children. Pathol Biol (Paris). 62(5):311-8.
Giannakopoulos G and Kolaitis G. 2021. Sleep problems in children and adolescents following traumatic life events. World J Psychiatry. 11(2):27-34.
Guilleminault C, Palombini L, Pelayo R, Chervin RD. 2003. Sleepwalking and sleep terrors in prepubertal children: what triggers them? Pediatrics. 111(1):e17-25.
Huang YS and Guilleminault C. 2017. Pediatric Obstructive Sleep Apnea: Where Do We Stand? Adv Otorhinolaryngol. 80:136-144.
Hublin C, Kaprio J, Partinen M 2001. Parasomnias: Co-occurrence and genetics. Psychuatr Genet 11: 65-70.
Kim DS, Lee CL, Ahn YM2. 2017. Sleep problems in children and adolescents at pediatric clinics. Korean J Pediatr. 60(5):158-165.
Kopcsó K, Láng A, Coffman MF. 2022. Reducing the Nighttime Fears of Young Children Through a Brief Parent-Delivered Treatment-Effectiveness of the Hungarian Version of Uncle Lightfoot. Child Psychiatry Hum Dev. 53(2):256-267.
Laberge L, Tremblay RE, Vitaro F, and Montplaisir J. 2000. Development of parasomnias from childhood to early adolescence. Pediatrics. 106(1 Pt 1):67-74.
Laganière C, Gaudreau H, Pokhvisneva I, Kenny S, Bouvette-Turcot AA, Meaney M, Pennestri MH. 2022. Sleep terrors in early childhood and associated emotional-behavioral problems. J Clin Sleep Med 18(9):2253-2260
Lewis KM, Amatya K, Coffman MF, Ollendick TH. 2015. Treating nighttime fears in young children with bibliotherapy: evaluating anxiety symptoms and monitoring behavior change. J Anxiety Disord. 30:103-12.
Leung AKC, Leung AAM, Wong AHC, Hon KL. 2020. Sleep Terrors: An Updated Review. Curr Pediatr Rev. 16(3):176-182.
Li SX, Yu MW, Lam SP, Zhang J, Li AM, Lai KY, and Wing YK. 2011. Frequent nightmares in children: familial aggregation and associations with parent-reported behavioral and mood problems. Sleep. 34(4):487-93.
Liu J, Zhou G, Wang Y, Ai Y, Pinto-Martin J, and Liu X. 2012. Sleep problems, fatigue, and cognitive performance in Chinese kindergarten children. J Pediatr. 161(3):520-525.e2.
Liu X, Liu ZZ, Liu BP, Jia CX. 2022. Nightmare frequency and psychopathological problems in a large sample of Chinese adolescents. Soc Psychiatry Psychiatr Epidemiol. 57(4):805-816.
Mainieri G, Montini A, Nicotera A, Di Rosa G, Provini F, Loddo G. 2021. The Genetics of Sleep Disorders in Children: A Narrative Review. Brain Sci. 11(10):1259.
Moore M, Allison A, and Rosen CL. 2006. A review of pediatric nonrespiratory sleep disorders. Chest 130(4): 1252-1262.
Moreno MA. 2015. Sleep Terrors and Sleepwalking: Common Parasomnias of Childhood. JAMA Pediatr. 169(7):704.
Muris P, Merckelbach H, Gadet B, and Moulaert V. 2000. Fears, worries, and scary dreams in 4- to 12-year-old children: their content, developmental pattern, and origins. J Clin Child Psychol. 29(1):43-52.
Nielsen T, Carr M, Picard-Deland C, Marquis LP, Saint-Onge K, Blanchette-Carrière C, Paquette T. 2019. Early childhood adversity associations with nightmare severity and sleep spindles. Sleep Med. 56:57-65.
Nguyen BH, Pérusse D, Paquet J, Petit D, Boivin M, Tremblay RE, Montplaisir J. 2008. Sleep terrors in children: a prospective study of twins. Pediatrics. 122(6):e1164-7.
Petit D, Touchette E, Tremblay RE, Bolvin M, and Montplaiser J. 2006. Dyssomnias and parasomnias in early childhood. Pediatrics 119: e1016-e1025.
Petit D, Pennestri MH, Paquet J, Desautels A, Zadra A, Vitaro F, Tremblay RE, Boivin M, Montplaisir J. 2015. Childhood Sleepwalking and Sleep Terrors: A Longitudinal Study of Prevalence and Familial Aggregation. JAMA Pediatr. 169(7):653-8.
Rhudy, J.L., Davis, J.L., Williams, A.E., McCabe, K.M., Bartley, E.J., Byrd, P.M., & Pruiksma, K.M. 2010. Cognitive-behavioral treatment for chronic nightmares in trauma-exposed persons: assessing physiological reactions to nightmare-related fear. J Clin Psychol.66(4):365-82.
Schredl M and Göritz AS. 2018. Nightmare themes: an online study of most recent nightmares and childhood nightmares. J Clin Sleep Med. 14(3):465–471.
Schredl M, Fricke-Oerkermann L, Mitschke A, Wiater A, Lehmkuhl G. 2009. Factors affecting nightmares in children: parents’ vs. children’s ratings. Eur Child Adolesc Psychiatry. 18(1):20-5.
Secrist ME, John SG, Harper SL, Conners Edge NA, Sigel BA, Sievers C, Kramer T. 2019. Nightmares in Treatment-Seeking Youth: the Role of Cumulative Trauma Exposure. J Child Adolesc Trauma. 13(2):249-256.
Shang CY, Gau SS, Soong WT. 2006. Association between childhood sleep problems and perinatal factors, parental mental distress and behavioral problems. J Sleep Res. 15(1):63-73.
Simard V and Nielsen T. 2009. Adaptation of imagery rehearsal therapy for nightmares in children: a brief report. Psychotherapy. 46:492.
St-Onge M, Mercier P, De Koninck J. 2009. Imagery rehearsal therapy for frequent nightmares in children. Behav Sleep Med. 7(2):81-98.
Stephan J, Schredl M, Henley-Einion J, and Blagrove M 2012. TV viewing and dreaming in children: The UK library study. International Journal of Dream Research. 5(2): 130–133.
Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. 2017. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath. 21(4):1025-1032.
Yang XF, Liu ZZ, Liu SJ, Jia CX, Liu X. 2022. Nightmare distress as a mediator between frequent nightmares and depressive symptoms in Chinese adolescents. J Affect Disord. 296:363-369.
Content of “Nightmares and night terrors in children” last modified 2/2023. Portions of the text derive from an earlier version of this article, written by the same author.
Image credits for “Nightmares and night terrors in children”
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