Nightmares and night terrors

[David Baxter PhD]

Nightmares and Night Terrors
by Armin Brott, Pregnancy & Baby

There is no guaranteed way to completely eliminate nightmares or night errors, but there are things you can do to reduce their frequency.

For most adults, occasional nightmares are a normal part of life.
But that doesn't stop parents from feeling helpless when their children wake up screaming in the middle of the night. And the more frequently those nightmares happen, the more parents worry.

Nightmares and night terrors
Before we go on, let me clarify two terms people sometimes use interchangeably: nightmares and night terrors.

In reality, they're very different. Nightmares happen during the dream phase of sleep known as REM (Rapid Eye Movement). The child may wake up with a clear memory of a "long movie" that frightened him.

Night terrors, on the other hand, happen during the deeper, non-REM sleep. They usually start an hour or two after the child has gone to bed and can last anywhere from a few minutes to an hour.

Technically, the child is asleep the entire time, even though his eyes will be wide open. When it's over, though, he won't remember anything.

Nightmares are fairly common. According to one recent study, between 20 and 39 percent of kids between five and 12 have them. Only one to four percent, however, have night terrors. If your child has either one, there's no guaranteed way to completely eliminate them. But there are a lot of things you can do to reduce their frequency.

Monitor television viewing. No scary shows or videos just before bedtime.

Make sure you can always hear your child if he cries out in the night. Get a monitor if you need to. If a baby sitter stays with your child, make sure she knows how to comfort him. Get to your child as quickly as you can.

Take it easy. Really. Your child will be able to tell if you're faking and sensing your tension will upset him even more.

Reassure her in a calm, soothing voice, that it's safe to go back to sleep. Stay with her until she's settled down. Reading a story is a great way to ease her back to sleep.

Discuss the nightmare, but only if your child is open to it. If he remembers his dreams in the morning, encourage him to talk about the frightening parts and to make up a happy ending to it. But if he doesn't want to discuss it, respect his wish.

What not to do
Don't wake her if she's still asleep and crying out when you go to her room. Stay with her until she wakes up all by herself or goes back to sleep peacefully.

Don't let him sleep with you, especially after a nightmare. You may end up giving him the impression that he should be afraid of his own bed. This could also develop into a difficult-to-break habit.

Don't tell her that nightmares aren't real. They seem plenty real to her and blowing them off as trivial will only upset her more. Instead, assure her that even though nightmares are scary, all of us have them sometimes.

Despite the myths, in most cases nightmares and night terrors are not a reflection of emotional distress. Reassurance and support from you are usually enough to help your child until he outgrows the problem.

However, if the nightmares or night terrors affect your child's ability to function during waking hours, or if you suspect that they're causing any health problems, consult his doctor right away.

About the author: Hailed by Time Magazine as "the superdad's superdad," Armin Brott has written or co-written six critically acclaimed, groundbreaking books on fatherhood. His articles have appeared in The New York Times Magazine, Newsweek, American Baby, Parenting, Child, Men's Health, The Washington Post and dozens of other major publications. Armin has been a guest on hundreds of radio and television shows, including Today, CBS Overnight, Fox News, and Politically Incorrect, and his work on fatherhood has been featured in such places as Glamour, Time, The New York Times, The Chicago Tribune, Newsday, and many others. He's also the host of "Positive Parenting", a weekly radio program which airs live in the San Francisco Bay Area and is also available on the Web. A father of three, he lives in Oakland, California.

 

[vi]

Hi!
I wanted to add a suggestion on how to help with night terrors.

My son had them at around 6.

Sometimes the blood sugar could be a factor.
The recommendation was to give the child a spoonful of peanut butter at bedtime.
Basically, a protein.
It might not be the answer for everyone, but it worked for my son. He had a couple more episodes after that, but that was it.

 

[David Baxter PhD]

Interesting suggestion, Vi. Thank you.

 

[Retired]

I don't know if there are instances where side effects of medications prescribed for children might sometimes cause nightmares or vivid dreams as has been reported with some medications prescribed for adults.

Also I am intrigued by Vi's use of peanut butter. When I have found myself unable to sleep, a small amount of peanut butter helped me fall asleep. As it happens, peanut butter is one of my personal basic food groups, and never thought much about it, so I wonder about the scientific validity of peanut butter as a sleep aid...or is it coincidence :?

 

[Aggress]

I see it's an old thread but it's very interesting.

I've read some books by Jung and he says that returning nightmares predict events in the future. he also gave examples of it for example a female patient of hers had a nightmare that the santa claus gripped her stomach or something and Jung interpreted it like this: the woman had a very cold attitude towards life, and later the woman commited suicide, so she threw away her life coldly. well in the book there were more details

another example A friend of Jung's once gave him some drawings that his little girl draw to him. some of them were quite weird like devils flying in heaven and angels in hell. Later the girl died in some infectious disease. Jung said that what the girl had were the dreams of "initiation" into death or something like that

i myself had similar experiences, when dreams predicted the future: some years ago before i woke up, in a semi - conscious state, the "voice" of a darts -machine began to talk to me in that annoying machine - vioce some symbolic stuff. the next day i went to a pub where i met a girl who took me to another pub. And what i saw next to the wall was a darts - machine . Later we even played darts, but what matters is the night ended in a big mess.

So it's strange when some people connect dreams with peanut butter and other food well, maybe food can influence the intensity of dreams, but what about the meaning

What do you think?

 

[Daniel E.]

Quitting Nightmares in Kids
The Faster Times blog: Pediatrics
by Jack Maypole, MD
April 8, 2010

Nightmares are nightmarish. You can quote me as Dr. Obvious on that one, but it’s true. For younger children, whom they afflict most frequently, nightmares are the stuff of dread, of hating bedtime, and of feeling most alone, and wee and vulnerable in the world. For parents, they can be equally distressing for their sudden appearance, and their ferocious impact. Consoling a freaked out child in the predawn dark is no easy task, and the impacts can linger far past the rise of the sun. What’s more, some children may be more prone to them than others.

Recently, the mother of a healthy preschooler emailed me about her son’s growing problem with terrible dreams. Like so many children, this boy’s troubles appear to have begun with a seminal moment, with an otherwise innoccuous cameo of a dinosaur (nope, not Barney) on a children’s program. Henceforth, an indelible image was made, and thus began a troublesome ricochet for many nights to come. Tears, stories about tricks of the light and monsters in the shadows followed. Wisely, his mother deployed good goin’-to-bed ideas: a stuffed animal posse (”they’re watching me!”), nightlights and hall lights…but all that failed to quell the fear and the dreams continued. So, this good mom asked, what to do?

Here’s what we know. Nightmares occur the world round in children, regardless of culture, gender, or ethnicity. The incidence of nightmares tends to peak in children aged 3-6 years of age—with about half of kids having some kind of problem at some point. What a setup we have here: Toddler to preschool time, when nightmares peak, is known in Child Study circles as the age of Magical Thinking. (Examples? Happy magical thinking: Santa. Not so good magical thinking: Santa’s overworked reindeer coming down the chimney and kicking your butt). What’s more, young brains are ever more sensitive to their environment, without having the adult tools to assess risks and messy stuff of life (eg thunderstorms, car accidents, public speaking, going to the Department of Motor Vehicles, etc). And, as we will discuss, nightmares can arise from a combination of factors including the environment, temperament, genetics, medical conditions, and even medications. Pleasant dreams, little ones!

Approximately 7% of children with frequent nightmares have a significant family history of relatives with them. And, of note, some recent research has identified some children as being vulnerable to ‘bad dreams’ as young as 5-7 months of age. Interesting this may be, but it can be hard to tease out ‘bad dreams’ from the usual wakenings of infants and toddlers. A point to remember in any case: bad dreams may occur for a short time in healthy children. Typically, nightmares fade in a week or two, often while families feverishly work to help the kids cope, and dispel their fears.

Less appreciated by the public and, I think, by many primary care providers, is the high rate of nightmares in children with developmental or neurologic or emotional problems. They haunt children with depression (less suprising, perhaps) and are more common with kids who have ADHD (more surprising). Children on the autistic spectrum, and/or cognitive delays also appear to have higher rates of bad dreams than their peers.

Most healthy children by age 2-4 years and beyond have established sleeping 8-10 uninterrupted hours a night. Nightmares tend to occur in the wee hours of the morning or even towards dawn. For the red-eyed parent recalling the history of these events in the light of a doctor’s office, a few things are key to remember. Kids experiencing nightmares may have a limited amount of sleep talking, appear sweaty and excited, and clearly upset when they awaken from a bad dream.

Nightmares are to be distinguished from other sleep disorders, called night terrors by the sleepologists. Night terrors generally occur in children of a younger age, sometimes as early as 18 months. And, to the parents, these occasions can be even more scary than nightmares. Kids with night terrors may produce a bloodcurdling shriek that brings the family running. On entering the bedroom, parents describe these children as seeming both distressed, but still asleep. They may or may not be kicking or moving some, the won’t respond to voices, and their eyes may be open (or not), and unfocused. The best approach for night terrors is to keep the child safe, and in bed, until it runs its course. Kids with night terrors cannot recall these episodes; kids with nightmares cannot forget theirs.

Parents may be understandably worried about the appearance of either of these behaviors (and hey, rightfully so). These are good times to make an appointment with a primary care provider specifically to talk about sleep issues. It comes up more often than you might think.

I am a former sufferer of nightmares at this age. I appreciate the magnitude of the fear and the scope of the problem. Of course, in my case it was my own fault. I was paradoxically drawn to watch the creepy Chiller Theater on TV…only to be up freaking out or padding into my parents room where I slept on the floor some nights. Oh, I remember being scared, watching the shadows move on the wall. Other times, I was haunted by pictures or images from books (thanks, brothers Grimm!), or some other movie or TV show that’d get my brain running on overtime. Like many such kids, I had a perfectly happy childhood, but I had my share of dreaming of physical danger (mummies), psychological nightmares (bullies), and so on. However, I did not have my nightmares of loss of control until medical school (the old chestnut of being poorly clothed, and late for an exam. BTW: that was a dream, people!)

And, so, back to our little friend, at the top of the article. What can his family do for his persistent nightmares? This little fella’s mom helped me a great deal from the doctor’s perspective. Using parents’ observations helps the physician get a sense of triggers or stessors that can be setting off the nightmares, including their duration, intensity, and connection to events in the child’s daytime and emotional life. Along the way, I’ll want to be mindful of other potential causes and to evaluate or intervene accordingly: Illness? (fever or large tonsils causing disruptive snoring can prompt wacky and terrifying dreams); Medications? (Benadryl, Zyrtec, Prednisone and other meds may cause nightmares in some kids): Trauma? (PTSD, loss of loved ones, anxiety issues or other emotional problems may explain nightmares that are persisting or disrupting the child’s daily life).

For most kids, a few simple good ‘sleep hygiene’ ideas do the job most of the time:

–A nightlight: These are benign, I find, and work for most children who habituate to sleeping with the extra photons. Giving kids control, such as where to put the light and having them turn it on, can be extra helpful.

–Pets. For families who have them, I urge a moving of the sleeping place of the dog, cat, gerbil, or even fish to the child’s bedroom, if possile. The companionship offsets the loneliness for kids.

–Keeping the bed for sleep and changing to lighter fare: Here, families do well to take TVs and computers out of the room (stolen after hours screen time is a leading cause of sleep deprivation in younger kids to teens, and can be a source of overstimulating/scary content). And, families should avoiding the triggers that set off their offspring. For example, choose Up versus Poltergeist this weekend, ok?

–Medications or supplements? Generally, meds or dietary supplements, like Benadryl, are not a first, or even second line approach to most kids with sleep problems. While an herbal tea can actually help (chamomile, anyone?), or even some aromatherapy (mmm, lavendar), I generally recommend families talk through with their physician about their use for a whole bunch of reasons.

–Monster spray: Fill a spray bottle with water, and have your child label it accordingly. By light of day, you can go around his room, misting scarycorners, dispelling Bad Dreams and Monsters from the premises. For some imaginative kids, this does the trick.

–Talking it out. Some kids are more verbal, and benefit from working out their fears in conversation. For these children, moving in the frightening nighttime spaces while the sun is up robs them of their power. Sitting with them or playing in the closet or corners, that can end the tyranny of the dark.

–Mindfulness and relaxation: Kids as young as preschool age do very well with these approaches. Yoga, massage, or even some basic bedtime relaxation techniques can reduce stress and move a child’s focus to a happier place.

And, tonight, maybe give Lemony Snicket a pass if your little one is scrunching deeper into her pillow during a reading. Or, think twice about popping a Harry Potter flick (or Chiller Theater) into the DVD player if your audience includes someone who gets wound up from such stuff. Instead, trundle up to bed with your child, turn on the nightlight and kiss their forehead and wish for a good night. If the cry comes in the night anyway, give them the hugs and kisses they need. Remember, as sure as the sun will rise, you can give your child’s doctor a call if needed.

Sleep tight!

Jack Maypole, MD is director of Pediatrics at the South End Community Health Center and director of the Comprehensive Care Program at Boston Medical Center. He is assistant professor of pediatrics at Boston University School of Medicine.