Night terrors are a type of sleep disorder characterized by intense fear, panic, or dread during sleep. They are NREM-related parasomnias, occurring during non-rapid eye movement sleep, typically in the first part of the night. Individuals usually have no memory of the event upon waking.
Distinguishing Night Terrors from Nightmares
Night terrors differ significantly from nightmares in their sleep stage and a child’s response. Night terrors manifest during deep non-REM sleep, usually within the first few hours after a child falls asleep. The child is not truly awake and may appear terrified, but they are not processing a dream narrative. In contrast, nightmares occur during REM (rapid eye movement) sleep, the dream stage, and are more common in the latter half of the night.
Awareness and memory are key distinctions. After a night terror, children have no recollection of the event. They cannot be easily awakened or comforted during an episode; attempts to console them may even increase agitation. Conversely, a child who has had a nightmare will wake up fully, remember the frightening dream, and can be comforted by a parent.
Recognizing Night Terrors in Infants and Toddlers
While more common in preschool and early school-aged children, night terrors can occur in infants and toddlers, sometimes as early as 18 months. A developing central nervous system in young children can contribute to these “confusional arousals.” Though less frequent in very young infants, parents might notice specific behaviors indicative of a night terror.
During an episode, a baby or toddler might suddenly sit upright, scream, or cry intensely. Their eyes may be wide open with a glassy stare, yet they appear confused and unresponsive to parents’ presence or attempts to interact. Physical signs include rapid breathing, increased heart rate, sweating, and thrashing limbs. Episodes can range from a few minutes to 45 or 90 minutes, after which the child calms down and returns to peaceful sleep without remembering the event.
Understanding Triggers and How to Respond
Night terrors are influenced by several factors, often involving disruptions to a child’s sleep patterns. Overtiredness, insufficient sleep, stress, or emotional tension are common triggers. Illnesses, fevers, certain medications, or changes in routine can also increase the likelihood of night terrors.
Responding to a night terror requires a specific approach, as the child is not truly awake. Do not try to fully wake the child during an episode, as this can lead to confusion and increased distress. Focus primarily on ensuring the child’s safety, especially if they are thrashing or attempting to get out of bed. Gently guide the child back to bed or create a safe environment by clearing obstacles. Staying calm and waiting patiently for the episode to pass, usually within a few minutes, is recommended.
When to Consult a Pediatrician
Isolated night terror episodes are not a cause for concern, and children outgrow them. However, seeking professional medical advice is appropriate in certain situations. Consult a pediatrician if night terrors are very frequent (multiple times a week) or if individual episodes last longer than 30 minutes.
A medical evaluation is also recommended if the child sustains an injury during a night terror or if other concerning symptoms are present, such as drooling, rhythmic jerking, or stiffening. If parents are significantly worried, if night terrors disrupt family sleep, or if the child exhibits daytime fears or signs of stress, a pediatrician can help rule out other conditions and provide guidance.