Nightmares in Children

What are nightmares in children?

Nightmares in children are scary or frightening dreams that usually wakes them up. These dreams usually occur in the last third of the night, when we have more rapid eye movement (REM) sleep. They can involve fear or anxiety, and other emotions like anger, sadness, embarrassment or disgust.

For children, nightmares seem very real to children and they may have trouble returning to sleep after a nightmare. Some kids may also resist bedtime because they want to avoid bad dreams.

What causes nightmares in children?

The exact cause of nightmares isn’t known. They’re more likely when kids are overtired or experiencing stress. Children who have experienced traumatic events may have frequent nightmares. Some medications may also cause nightmares or disturbing dreams.

Which children are more likely to get nightmares?

Most children experience at least one nightmare. Chronic or very frequent nightmares happen less often.

Nightmares in children can happen at any age, but they usually start between the ages of 3 and 6, and decrease after age 10. After age 12, girls are more likely than boys to have nightmares.

Types of nightmares differ by developmental stage. Younger kids are likely to have nightmares about being separated from their caregivers or seeing a monster. Older kids are likely to have nightmares related to scary movies, or upcoming stressors like starting a new school.

Can I reduce my child's risk of having nightmares?

Steps to take to reduce your child's likelihood of nightmares include:

• Make sure they get enough sleep. Kids often need more sleep than they regularly get (check out recommendations from the American Academy of Sleep Medicine for optimal hours for each age group). Enough sleep can cut down on the number and intensity of nightmares.
• Keep the bedtime routine light and happy. In the 30 to 60 minutes before bedtime, don’t let your child watch scary movies or TV shows, or read frightening bedtime stories. Try to avoid material that may be upsetting.
• Talk about the nightmare during the day. Work to see if there is a theme to the nightmares – especially if they are occurring frequently. The dreams may be about school, worry about family or other issues that are bothering them. Work to identify stressors in your child's life, and talk about them.
• Comfort and reassure your child. This is a time when comfort and cuddling is appropriate. Stay with your child for a short period of time following the nightmare. Most will still be tired and able to return to sleep soon. Other tips:
  • Encourage your child to go back to sleep in their own bed. Avoid excessive attention or pampering. But let your child snuggle with any favorite soft toy or security blanket through the rest of the night.
  • Avoid keeping bright lights on in the bedroom, but a night light can bring comfort.
  • Consider leaving the bedroom door open to show your kids that home is safe and you’re close-by.
• Work out ways to overcome nightmares. Together you and child can find creative ways to help them outgrow nightmares. Read stories about getting over nighttime fears. Draw pictures of nightmares and then tear them up and throw them away as a symbolic gesture. Whatever creative solution you think may work is worth trying.

Strategies for overcoming nighttime fears

Fear of the dark, monsters in the closet or simply anxiety about going to bed – all are relatively common in young children at some point during their childhood. How you, as a parent or any caregiver, address your child's fears and offer reassurance will affect their ability to fall and stay asleep.

Some tips to help your child overcome nighttime fears:

• What is your child afraid of? Begin by identifying the fear. Listen to your child. Ask open-ended questions that allows them to tell you what makes them scared at bedtime. Don’t make fun of your child's fears. What may seem funny or trivial to you is very real to your child.
• Reassure your child's safety. If your child has a hard time being separated from you, be reassuring, but then tuck your child back into their own bed, not yours! Be gentle yet firm about staying in bed.
  • If your child calls out, ask again what’s wrong, then assure them everything is OK, they’re safe, nothing will bother them — and that they can sleep comfortably alone in their bed all night. This helps them to trust their own bed is a safe place. It’s better to comfort your child in their own room than to let them leave their bedroom and sleep elsewhere.
  • Another option is to promise you’ll regularly check in on them, beginning at two to five minutes, then every 10 minutes, then every 15 minutes, etc., until they’re asleep. Show you’re there to watch over them and they’re not alone.
• Work on building up your child's self-confidence and coping skills. During daytime hours, work on activities that help build self-confidence. For example, have your child talk about their bedtime fears and experiences. You may be able to discuss alternative ways to respond to these fears or cope with them that may help your child feel less afraid at night.
• Don’t forget positive reinforcement and/or reward programs. This can take the shape of a sticker program (turned in for a favorite treat). Breakfast treats, small toys or other special prizes are just a few ways to reward your child. Use positive phrases: "You are doing a great job of staying in bed." And remember to encourage your child to discuss their fears with you in the daytime.

Sleep terrors

Some children who have nightmares may also have sleep terrors, which differ from nightmares. Sleep terrors are most likely to happen during the first third of the night when child is in a deep sleep. They are not awake during these episodes. Sleep terrors usually last five to 10 minutes and can be very alarming. Your child may shout, scream, kick and flail, sit up suddenly and appear terrified. Despite the intensity of sleep terrors, children don’t remember it happening in the morning, unlike a nightmare.

Don’t try to wake, calm or soothe a child during a sleep terror because it increases the risk of another episode later in the night. Sleep terrors are very distressing to caregivers, but the child isn’t aware that they’re happening. Remember that the child is actually still asleep. Don’t talk with your child about sleep terror in the morning. This may make them more anxious that something frightening is happening at night without them knowing.

If your child seeks comfort and shows clear signs of being awake — speaking in a way that you can understand them or walking with their eyes open — then they probably had a nightmare. You may help soothe them back to sleep. If the child isn’t showing those signs, then wait before responding because they may stay asleep through the sleep terror.

When should I call my child’s doctor?

Consider calling your doctor if:

• Your child's bedtime fear and anxiety continue, are severe, or grow worse.
• Your child's fears began after a known traumatic experience or event and persist well after the event is over.
• Your child's fear interrupts daytime activities.
• Your child's nightmares are very distressing and repetitious or psychological issues are involved. In such cases, psychological techniques like desensitization and relaxation strategies may work. In adolescents, guided dream imagery training may help.