Night Terrors and Nightmares

Night Terrors

  1. Night terrors are a common disorder that affects about 3% of the population. It has a greater incidence in boys and there is often a positive family history.  Mostly 18 months to 6 years of age
  2. Occurs during the first stage of sleep(non-REM) thus the incidence is greatest during the first 4 hours of sleep.  Often occur many nights in a row and then stop for a period of time.
  3. Child is very agitated and will be sweating, tachycardic, tachypneic, and have dilated pupils.
  4. Child doesn't awake and is unable to be comforted, won't respond to the parents, and doesn't remember the incidence
  5. Very frightening to the parents
  6. Increased incidence during times of stress 
  7. Parents should be instructed to protect child from hurting themselves secondary to thrashing about. Also, there is an 18% incidence of sleep walking and children have left their homes. If this occurs, some mechanism must be used to awake the parents if the child tries to leave their room. 
  8. Treatment
    1. Don't wake the child during the episode.  May awake 30 minutes before expected event to attempt to break up the pattern.
    2. protect the child from injury
    3. reassure the parents that night terrors will spontaneously disappear. 
    4. Relieve any stresses if possible.
Nightmares
  1. 7-15% incidence, girls & boys, usually before 10 years of age
  2. Nightmares are frightening dreams that occur in the second half of the sleep cycle during REM. 
  3. The child awakens from sleep and has distinct memory of the dream. 
  4. Able to be comforted by the parent
  5. Increased incidence during stresses such as familial difficulties and toilet training.
  6. Treatment
    1. reassure the child
    2. don't get into long discussions about the dream. If the child wants to discuss the content, do it during the daytime. Also, don't go looking for monsters with flashlights because this may reinforce the fear.
    3. Relieve any stresses if possible.
References
  1. Blum, Nathan and Carey, William. Sleep Problems Among Infants and Young Children. Pediatrics in Review, March 1996
  2. Howard B. and Wong J. Sleep Disorders Pediatrics in Review October 2001
  3. Mason TB, Pack AL. Sleep Terrors in Childhood J Pediatrics 2005; 147:388-392