When Night Terrors And Nightmares Disturb Sleep
March 19, 2004

(The Boston Globe) -- Has your child had a really bad dream lately? A nightmare so frightening that her crying frightened you, sending you to her room in a panic, expecting to find who knows what? Most likely, that wasn't a nightmare at all, but night terrors, which parents typically mistakenly identify as an extreme bad dream.

Hardly any child escapes sleep disturbances of the scary kind. Night terrors are more frightening to parents, though, while nightmares are what unravel children. Unfortunately, because nightmares are more frequent, parents can become nonchalant or dismissive, depriving a child of the help that would get everyone back to sleep sooner. With night terrors, parents sometimes make matters worse by overreacting.

"Night terrors are just that for parents: terrifying," says Children's Hospital child psychiatrist Joshua Sparrow. His son is 21 and Sparrow still remembers the night terrors he had at 2 1/2. "It woke us with a bloodcurdling shriek," he says. When he and his wife reached him, Mattias, was sitting upright but he wasn't awake.

That's partly what scares parents. "A child may look right at you and not recognize you," Sparrow says. Thinking something is seriously wrong, parents flip on lights, apply a wet face cloth, carry a child to the cold air. "Don't," advises pediatrician George Cohen, a spokesman for the American Academy of Pediatrics. "It only makes matters worse." Night terrors are the result of immature sleep patterns. Children are caught in an in-between state of sleep, he says. Because they are not awake but also not soundly asleep, they aren't able to process your presence or understand what you are doing so they flail or fight you.

"It may seem like an eternity, but if you wait it out, he'll go back to sleep on his own as suddenly as he woke up," Cohen says. What's more, a child typically has no memory of what happened. Cohen is a clinical professor at the Medical School of George Washington University and editor of "Guide to Your Child's Sleep" (American Academy of Pediatrics).

Nightmares are different. Less than 10 percent of children have night terrors; sooner or later, all children have nightmares. In a second-grade classroom at the Hosmer School in Watertown last week, 12 of 15 students had had a nightmare the night before, from a bad dream about giant-sized tomatoes turned monsters to scary dreams about bugs and siblings run amok.

Not only do children remember nightmares, but a particularly bad one can affect sleep routines for weeks or months. A 2- to 4-year-old, for instance, isn't able to understand that a nightmare is not real; she may fight going to sleep thinking that if she does, she'll go back to that scary event. The monsters in 4- to 6-year-olds' dreams embody the nasty and aggressive thoughts that fill children's waking hours. ("I hate my baby sister! I wish she would go away!") They may know the monster isn't real, but the monster's nastiness hits so close to home that "it makes them very vulnerable," says Sparrow. Even 7- to 10-year-olds, who cognitively get that a bad dream is not real, may occasionally need help to feel safe from it.

"If a youngster is frightened, you have to take away the fear," no matter what his age, how long it takes, or how often it happens, says pediatrician Richard Ferber, director of the Center for Pediatric Sleep Disorders at Children's Hospital and author of the best-seller "Solve Your Child's Sleep Problems" (Simon & Schuster).

You don't need to do more than necessary, though. "Don't start off putting on lights and talking in a normal voice," Sparrow says.

Sometimes a child needs only a whisper: "That wasn't real. Daddy is here. You can go back to sleep." Other times, only a full monster-check will do: "Nope, no monster in the closet. No monster under the bed, either." Even though young children may not grasp real versus pretend, Sparrow would tell a 3-year-old, "This is called a dream. Your mind collects all the things you did during the day and some of the feelings come back in dreams." To a 5- or 6-year-old, he might say, "Your brain didn't finish thinking about what happened today. Dreams are a way for it to do that." One way to take the sting out of a bad dream is to let a child talk about it the next morning or at night, depending on how awake she is.

"If she can put a scary experience into words, she gains control of it," says Sparrow. When he was a child, his mother would tell him, "Tell me the nightmare and it won't come back." He did that with his own children and it's a strategy he recommends in the book he co-authored with T. Berry Brazelton, "Sleep the Brazelton Way" (Perseus).

"Telling the dream to a parent makes a child feel less alone with it," he says.

Some children who wake up from a nightmare need you to stay with them in order to feel safe. While this may not be a problem on occasion, if it happens a lot parents can get frustrated, not to mention sleep deprived, and wonder if a child is really unable to get back to sleep or just developed a bad habit of needing you.

"It's never helpful to say, 'Don't be silly,' " says Sparrow. It leaves a child thinking, "Mom can't help me; she doesn't understand how scared I was." Ferber points out that being frightened is not something the typical child can fake. On the other hand, "By 4 1/2, a youngster is old enough for you to negotiate with him about what he needs to feel comfortable," he says. For instance, "Is it enough for me to stay on the same floor of the house when you go to bed? Can I check on you every 10 minutes? If it's the middle of the night, is it enough for you to call out to me and I can tell you everything is OK?" By 7, many children are able to come to your room and sleep on a blanket or mattress on the floor without waking you. Just being in your presence makes them feel protected.

If he needs you to be in his room, sit in a chair so that you're physically present without skin-to-skin contact. "The more a child becomes dependent on the rhythm of your breathing or the warmth of your skin to feel secure, the harder it is for him to be able to comfort himself," Sparrow says.

One thing parents may not realize is that everything that happens in the hours leading up to bedtime can affect sleep, says child psychologist Alan Kazdin, director of the Child Studies Center at Yale University. "Violent video games after dinner? I don't think so," he says. He would also nix any activity that revs a child up, even something as simple as wrestling with dad, if a child is anxious or sensitive by nature.

No parent can prevent a child's bad dreams; they are, after all, part of our human equipment. Steve Griffin, principal at the Hosmer School, says the feelings children have from nightmares are so powerful that he encourages teachers to let them talk about them if need be. His sympathy is more than academic. To this day, he still remembers how frightened he was from a nightmare in which the Mad Hatter from "Alice in Wonderland" chased after him with a cup of poison tea.

Copyright 2004 The Boston Globe. All rights reserved.