Toddler with Night Terrors

Dr.Laura,
My 22 month old has been waking up only at night after he is asleep screaming. He is usually fine during the day, but after he falls asleep, he wakes up later horrified about something. He wont let us touch him. We have tried putting him in bed with us and he still screams for a while, then sometimes falls asleep on one of us. It just seems to be getting worse though.
Please help!!!
Brittany

Dear Brittany,
I am so sorry to hear about your little one. This must be completely unnerving for you.
What your 22 month is experiencing sounds like Night Terrors.

Night terrors are different than nightmares. Nightmares are upsetting dreams that happen during REM (dream) sleep. Night terrors occur during Stage 4 Deep Sleep, or during the transition from Stage 4 to REM Sleep. During a night terror, the person is actually asleep — according to his brain waves — even if his eyes are open! Most of the time the person has no recollection of them.

Night terrors can occur at any age, but small children seem to suffer them most frequently. In fact, up to 15% of kids reportedly experience at least one night terror. Scientists think night terrors may be caused by over-arousal of the central nervous system, which regulates brain activity. Most children outgrow them, probably as their brains mature, although some adults do report having night terrors when under stress.

We don't know what causes night terrors, but there does seem to be a genetic component. Stanford researchers have hypothesized that there is a link between childhood sleep apnea and night terrors, so it is always a good idea to have your pediatrician check your child for sleep apnea.

There are indications that stress and over-tiredness can trigger night terrors in people who are prone to them, and sleep apnea can certainly make it hard for children to get enough rest. Although I have not seen any research on this, from parent reports it seems that children are also more likely to have night terrors when they are ill with a mild cold or fever. 

Night terrors are apparently not dangerous, but most parents find them utterly terrifying, and for that reason alone, they are worth addressing. Not to mention you'll all get more sleep if you can resolve them.

So what can you do for your son?

1. Keep calm yourself. It is likely that your son is not remembering these incidents and is not being traumatized by them. That said, of course you want to offer him whatever comfort you can, and keep him safe. While he will probably seem inconsolable, adults who suffer from night terrors say that they have been comforted by the calm, reassuring voices of those they love. And of course, if he'll let you hug him, then do so. If not, you may be able to stay close enough to gently touch him, without scaring him further.

2. Do try to minimize stress in his life for now. Night terrors are related to stress. Some parents link them to physical overwhelm, like kids being taken to loud parties or concerts. But pesonal overwhelm can also stress kids. So no toilet training or other big developmental challenges if you can help it until he gets out of this phase. Be sure he is not exposed to parental loud voices or other emotional stressors. Use “positive discipline” as opposed to spankings, yelling, timeouts or other stressful discipline. Minimize schedule changes and nights away from home.

3. Eliminate TV. (the American Academy of Pediatrics recommends that kids younger than 24 months should not watch TV because it negatively impacts brain development.)

4. Don't allow your little guy to get over-tired, which may make him more susceptible to night terrors. Be sure he has a regular bedtime routine and is getting sufficient sleep. One way to insure that is to move his bedtime a bit earlier each night. Often kids his age need to be asleep by 7pm; when they stay up later they have to summon adrenaline and other arousal hormones to keep it together. Moving to an earlier bedtime not only helps them fall asleep more easily at night, but also lessens the possibility of over-arousal.

5. Do adopt a comforting bedtime ritual that includes bath, snuggling & reading, and follow it each night, making sure that your child has an hour of “wind-down” that is soothing. No music, TV, loudness, wildness, or anything particularly arousing, and no food, since digestion seems to be the source of night terrors for some people.

6. Be aware that fevers and colds can trigger night terrors in those who are prone.

7. Do make sure that your son is not being accidentally awakened. There is some evidence that night terrors result from being awakened during Stage 4 sleep, if there is already a predisposition. If traffic or TV or telephone noises intrude on his sleep, they could be awakening him. You might invest in a white noise machine as a precaution.

8. Don't try to force your son to wake up from a night terror. That leaves a person extremely disoriented, sometimes to the point of temporary amnesia.

9. Keep your son sleeping in a crib until he outgrows his night terrors, if possible. If he has already graduated from a crib, be aware that he could easily leap out of bed during a night terror. Move anything he could trip on out of the way, be sure windows are closed and have a window guard, and use a baby gate to be sure he doesn't run out of his room and fall down the stairs.

10. Don't let your child get over-heated while he sleeps. Particularly, avoid footed pajamas. Many parents report that their child is more likely to have night terrors when overheated.

11. If your child has allergies or a cold and his tonsils are inflamed, it can make it harder to breathe, which may trigger night terrors. Ask your doctor about using benadryl until he's back to normal. Some physicians say that removing the tonsils and adenoids can immediately cure night terrors in cases where they were regularly swollen and the child was having a hard time breathing at night.

12. Reduce your child's anxiety. Anxiety is just mild fear, and all children carry some around because they are tiny powerless people in a big world.  Anxiety makes children more stressed. You can reduce your child's anxiety by getting him laughing every single day. While most adults immediately think that tickling is the best way to get kids laughing, I don't recommend tickling because it can make kids feel more powerless. Instead, do some physical play or roughhousing that gets the child laughing, like letting her push you over or chasing him around the house. Laughter actually reduces stresses hormones in the child's bloodstream. (Don't do this right before bedtime, of course, or it winds the child up. Do it before dinner or bath, or earlier in the day, so they have a chance to calm down.) There are a lot of roughhousing ideas here.

13. Reset the arousal system. I hate to wake kids for any reason, but there is evidence that you can help your child reset his arousal cycle by waking him gently fifteen minutes before the night terrors usually occur. If you can see a pattern, and the night terrors are frequent, it might be worth it. If you do this for 3 to 5 days, it will hopefully interrupt the arousal cycle and prevent the night terrors from recurring.

I wish you and your son sweet dreams.
Dr. Laura

Peaceful Parent, Happy Kids

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