Night Terrors In Children: Signs, Causes, Risks & Prevention

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Night terrors in kids is a sleeping disorder characterized by excessive sweat, increased heart rate, and dilated pupils. It is also called sleep terror, and during an episode, you may notice your child screaming and flailing their limbs while asleep.

When a child is in this state, they may not respond to their surroundings. Fortunately, they shall fall asleep again and surprisingly won’t remember that incident the following day. Experts state that night terror is harmless and requires no medical attention. However, if repetitive, they may affect the child’s sleep and mental health.

Read on to know the causes, symptoms, complications, management, and prevention of night terrors in children.

Signs And Symptoms Of Night Terrors

Night terrors usually happen during non-REM sleep, generally during the first three to four hours after bedtime. During a night terror episode, a child may

  • Scream, shout, or cry suddenly.
  • Hit their hands and legs on the bed.
  • Sit up on the bed and look frightened.
  • Sweat profusely, breath heavily, and may have palpitations.
  • Be inconsolable.
  • Be difficult to wake.
  • Stare with the eyes wide open and the pupils dilated.
  • Look oblivious to the surroundings.
  • Sleepwalk or run outside the room.

A night terror episode may last for 45 minutes or much shorter, say five minutes, and may happen more than once a night. Night terror episodes may appear scary and unsettling to parents but are harmless to children.

Note: Night terrors are different from nightmares. Nightmares are scary dreams due to which a child wakes up fully. After waking up, the child remembers the dream and can even narrate them to their parents or caregiver. They usually happen in the second half of the night, during dream sleep. Night terrors occur in three to six percent of children and are relatively rare.

Possible Causes Of Night Terrors

In about two percent of children, night terrors are believed to occur due to genetic inheritance, meaning a child with a family history of night terrors is more likely to have night terrors. However, this relationship hasn’t been proven scientifically.

Besides this, there aren’t any known causes of night terrors in children. However, it may be triggered by risk factors such as

  • Sleep disorders, such as nocturnal asthma and obstructive sleep apnea
  • Overtiredness
  • Fever
  • Sleep deprivation
  • Sleep schedule disruption
  • Certain medications

About five percent of pre- and primary-school-aged children experience night terrors. According to the Royal Children’s Hospital, night terrors “are not usually associated with serious emotional or psychological problems. There is no link with epilepsy.” They occur in healthy children and are technically a part of normal development.

Diagnosis Of Night Terrors In Children

There are no specific tests to diagnose night terrors. Usually, a doctor talks to the child and parents/caregivers and collects details about the child’s sleep pattern and medical history. They will also inquire if the child is under any stress at home or school.

They may ask you to keep a sleep log and note

  • Where your child sleeps.
  • When the child goes to sleep and how much time they take to fall asleep.
  • At what time the child wakes up.
  • When the night terrors happen.
  • How the child behaves during the episode.
  • How much sleep the child gets after the episode.
  • How often the child wakes up at night.
  • How many naps they take, and for how long.

Based on their understanding of the case, the doctor would make the diagnosis. In some cases, they may refer you to a sleep specialist. The specialist might do a sleep study to ascertain if the child is experiencing night terrors and not nightmares or seizures due to an underlying health issue, such as sleep apnea.

Managing Night Terrors

If identified, treating the underlying cause, such as sleep apnea, can help treat night terrors. However, if there’s no known cause, the treatment aims at calming the child, putting them back to sleep, and keeping them safe during the episode. In some rare cases, doctors may use medication to treat night terrors in children.

Here are some steps you can take to help your child during a night terror episode.

  1. As soon as you reach your child’s room, turn on the lights to reduce confusion that may occur due to shadows.
  1. Do not hold your child too tight during the episode. Instead, hold their hand or arm gently.
  1. Children do not respond during a night terror. So, do not try to wake them up. Instead, help them return to sleep as calmly as possible.
  1. Even when your child does not respond, speak to them calmly and say soothing things such as, “It’s all right; there’s nothing to worry about.” “Everything is ok; you’re home in your bed.” “Mom and dad are right here; you are doing just fine.”
  1. Do not shake or shout at your child assuming that will stop the night terror episode and the child will wake up. Instead, shaking or shouting at your child may agitate the child and prolong the episode. Remember, there’s no way to shorten the episode.
  1. Some children may sleepwalk or run during a night terror episode. This may cause the child to fall down the stairway or break a window. So, to keep your child safe, follow them through and gently direct them back to bed. Also, secure their windows and doors and remove all the items from the room that may cause an injury.

Keeping a watch on the child at night can be tiresome for you, especially if you need to work the next day. In such cases, you can consider a babysitter. If you opt for one, remember to explain what night terrors are and what they should do to keep the child safe.

Note: Most children with less than two episodes per month outgrow night terrors as they grow and their nervous system matures.

Possible Complications Of Night Terrors

Prompt medical care and undeterred support from families help most children overcome night terrors. However, if the frequency of the night terror increases and its symptoms worsen, it may lead to complications, such as

  • Improper sleep
  • Extreme fussiness and irritability
  • Excessive daytime sleepiness, affecting the child’s everyday functioning
  • Injury to self and others due to sleepwalking or running during the episode

Are Night Terrors Preventable?

Since night terrors have no known causes, preventing them in all cases won’t be possible. However, you can try some tips to work on the risk factors that contribute to a night terror episode.

  1. Sleep deprivation is the most common trigger for night terrors. So, ensure your child sleeps well. Afternoon naps are a good tool to help children, especially preschoolers, to rest adequately. However, if the child refuses to take a nap, ask them to have an hour of “quiet time” in their room.
  1. Improve the child’s sleep hygiene. You could set the “early to bed” house rule and instruct the child to avoid staying up late at night. Put a relaxing routine in place where you bathe the child and read stories to them before bedtime. Doing so will offer a relaxing environment and help them sleep well. Remove television, computers, and video games from the child’s bedroom to reduce distractions at night.
  1. Stress is another major reason that can cause night terrors. So, try to keep your child happy and relaxed. Spend some time with them daily and talk to them. Try to find out if there’s something that’s bothering them or causing them stress. If the child doesn’t open up to you, seek professional help.
  1. Hot bedrooms can trigger a night terror episode. So, ensure your child’s bedroom has an appropriate room temperature with proper ventilation. Also, ensure they are dressed in comfortable, weather-appropriate nightclothes before they go to bed.
  1. Teething in young children can cause them to develop inflammation and fever, which can trigger night terrors. So, consult a pediatrician and give your child antipyretics and anti-inflammatory medications to ensure they get a restful sleep.
  1. A full bladder may trigger night terrors. So, train your child to form the habit of going to the toilet before bedtime.
  1. If your child has frequent night terrors, try the “promoted awakening technique.” In this technique, you need to note when your child gets the night terror for several nights. Once that’s known, awaken the child 15 minutes before the expected night terror time and keep them fully awake and out of bed for five minutes.

If, despite your efforts, night terrors persist, consult a pediatrician to seek a solution. Pediatric consultation becomes necessary in conditions where a child has

  • Two or more night terror episodes per week.
  • Night terror episode after head injury.
  • Night terrors with sleep talking or sleepwalking.
  • Difficulty in daily functioning.
  • Night terrors even during adolescence and adulthood.

Night terror in kids may cause them to suddenly wake up screaming or crying in the middle of the night, with excessive sweating and an increased heartbeat. It is usually harmless and has no long-term consequences. However, parents may find it challenging to handle the frequent occurrences, which can exhaust them. If night terrors become regular, causing problems in children such as sleep loss or harming their health, see a doctor. With the support of their parents and appropriate medical care, most children may overcome night terrors by the time they reach adolescence.

Key Pointers

  • Night terrors in children is a disorder that typically occurs between the first three to fours hours of sleep.
  • Random screaming, waking up scared, excessive sweating, and sleepwalking are some of the symptoms.
  • Various factors such as separation anxiety, fatigue, or existing sleep disorders could trigger night terrors.
  • The doctor may ask questions about the child’s sleep pattern to assess the condition.

References:

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Dr. Neha Bhave Salankar

(MD)
Dr. Neha Bhave Salankar is a consultant psychiatrist at Bhave Institute of Mental Health based in Nagpur. Having been a meritorious student throughout, she bagged the prestigious gold medal for medicine in MBBS as well as in MD psychiatry. She also took training in Child and Adolescent Psychiatry at National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. She is... more

Swati Patwal

Swati Patwal is a clinical nutritionist and toddler mom with over eight years of experience in diverse fields of nutrition. She started her career as a CSR project coordinator for a healthy eating and active lifestyle project catering to school children. Then she worked as a nutrition faculty and clinical nutrition coach in different organizations. Her interest in scientific writing... more