If you've got a toddler, you should know about two common sleep problems: nightmares and night terrors.



It was only 11 p.m. when my son, then 2, woke up screaming. I raced into his room -- and stopped cold. Matt was sitting up, eyes wide open, shrieking. When I touched him, he became even more agitated. I panicked. Was he having a seizure? Yet just as suddenly as the strange episode had started, it ended. Matt stopped screaming, lay down, and closed his eyes. When I bent over him to check, he was sleeping peacefully. The next morning, he remembered nothing.

What my son had experienced, I later learned, is called a night terror. If your child has never had one, you're lucky: This disorder affects thousands of children yearly. Yet even a regular nightmare, which all kids have, can leave parents bewildered. Both night terrors and nightmares, though not unheard of in infants, grow more common at age 2. Knowing how to cope with them will help you and your toddler sleep easier.

Terrors: The Unscary Truth

Night terrors belong to a class of sleep disorders called parasomnias, which occur when someone is partially roused from deep slumber. Though your little one's eyes may be open, he's not awake. "He isn't responding to his environment," says George J. Cohen, M.D., editor of the American Academy of Pediatrics' Guide to Your Child's Sleep (Villard, 1999). "A night terror isn't a dream. It happens during deep sleep, when a child is not dreaming, and he doesn't come fully awake," adds Jodi Mindell, Ph.D., an associate professor of psychology at St. Joseph's University, in Philadelphia, and author of Sleeping Through the Night (HarperCollins, 1997). No one knows for sure whether a child in the midst of a night terror is actually feeling distressed, especially because sufferers can't remember the episode the next day.

Unsolved Mysteries

What causes this odd phenomenon of being caught between slumber and wakefulness? It's not usually possible to figure it out, although in certain uncommon instances it's related to a medical condition called obstructive sleep apnea (see "All About Apnea," right). As for timing, night terrors "usually happen an hour or two into sleep," Dr. Cohen says. Symptoms include screaming, an appearance of fearfulness, and withdrawal when touched. And though a child who's having a nightmare is easily comforted by being awakened and held, a toddler experiencing a night terror is almost impossible to rouse. Because waking him is so difficult, don't even attempt it. Instead, just stand by until the episode is over, keeping your child from falling if she flails about or starts to walk around (sleepwalking can be a related parasomnia).

Unfortunately, there's no foolproof way to prevent night terrors. But you can put safeguards in place in case of recurrence (a wise idea, especially if there's a history of the problem in your family). If your child still sleeps in a crib, you're in luck; there's little chance he can do himself harm by falling out. If your child is already sleeping in a big-kid bed, though, you'll need to take some extra steps to protect him. If his room is on an upper floor, put a gate across the stair landing. Clear the floor, lay down pillows to buffer falls, and raise the bar on your child's bed, if there is one. Consult your pediatrician if terrors start coming nightly or semiweekly. Luckily, the episodes almost always taper off steadily in early childhood, becoming unusual by the time a child is 8 or 9 years old.

Just a Bad Dream

Nightmares have some important distinctions from night terrors. For starters, they usually happen later

at night, during the second half of sleep. "They're a phenomenon of REM, or rapid-eye-movement, sleep, the period when we're dreaming," Dr. Cohen says. And, he adds, their causes are less elusive: "They stem from life events that a child finds frightening or difficult." These experiences may be as seemingly minor as encountering a dragonfly or as major as the death of a loved one.

Nightmares are also easier to handle than night terrors. "Parents should wake their children," Dr. Cohen advises -- doing so ends the nightmare at once. To minimize recurrence, cut out fairy tales and games involving scary make-believe in the evening, Dr. Mindell recommends. If your child still has a nightmare, hold and stroke her once she's awake. Encourage her to describe the dream if she's already somewhat verbal (a simple word like "spider!" speaks volumes), and reassure her that she's perfectly safe. Sometimes it helps to pick up your child and walk with her and to offer her a glass of water or warm milk. But be careful about allowing her to sleep in your bed with you; she may conclude that there really is something to fear or develop it as a habit.

If your family is coping with a traumatic event such as a divorce, head off related nightmares by comforting your child before bedtime. Address anything else your child has expressed apprehension about too. For imaginary fears (of ghosts, for instance), explain that the dreaded thing is "just pretend." If the anxiety centers on something real, such as a dog, make the object more familiar -- say, by reading a book that's filled with friendly dog pictures. Dr. Mindell suggests filling a clean spray bottle with water and spritzing frightening places (like under your child's bed) with this homemade "monster repellent."

Finally, be on the alert for recurring nightmares. "They may be the first indication that something in a kid's life is upsetting him," Dr. Mindell says. Though the problem could be something major, like school-yard bullying, it's far more likely to be minor -- such as a fear of the big noise that the dishwasher makes.

Copyright© 2004. Reprinted with permission from the September 2001 issue of Parents magazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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