When your toddler has night or sleep terrors (with a word about nightmares, parasomnias and epilepsy, too)
What is meant by a child's night terror (or sleep terror)?
Night terrors are also known as sleep terrors. They happen mainly at night but also occasionally happen during daytime naps as well, which is why night terrors are also referred to as sleep terrors.
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Sleep terrors mostly happen between one and five years of age. They usually don't occur after the teenage years.
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Sleep terrors mostly happen within the first three hours of falling asleep, when the child is in deep sleep. You can find out about sleep stages here. The little one wakes abruptly, sits upright or jumps out of bed, screams in terror or intense fear, is panicky, confused, incoherent. Her little heart is racing, she's breathing hard, she's flushed and trembling, with high muscle tone.
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The child can't be aroused from this distressing sleep state, nor comforted. This is usually very upsetting for parents, who hope to reassure and calm him.
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The whole thing usually lasts a few minutes but might even last up to an hour. The child finally settles back into deep sleep and has no memory of what happened when she wakes up the next day.
Are there situations when a child is more likely to have sleep terrors?
Some children seem more likely to have sleep terrors than others. However, it's important to know your child might experience sleep terrors without being exposed to or having any of these things.
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There's a strong genetic predisposition to sleep terrors.
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Some children are more prone to sleep terrors in very unsettled environments, such as when sleeping with a lot of background noise. (I don't mean a weekend party, or raucous guests over dinner, which to my mind are sounds of family life. Examples of a very unsettled environment could be sleeping a few metres away from very heavy traffic including trucks, or sleeping in the room next door to a performance space in a pub, with loud music and noisy patrons til the wee hours.)
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Some children are more prone to sleep terrors if they have experienced trauma, severe stress, fatigue from exceptional experiences, or separation from their loved ones.
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Children with medical conditions like a febrile illness, or who are neurodiverse including with autism, are more likely to have sleep terrors.
What can you do if your little one is having a night terror?
If your child's sleep terrors are recurring, or if you have concerns and would like to make sure nothing else is going on, please have your GP check your toddler over. Your GP will take a detailed history and do a complete developmental and physical examination. If the GP is worried that your child is experiencing unusual sleep terrors, or if the night terrors are occurring more than twice a week, she might refer your child for video-polysomnography and further assessment.
If there seems to be a regular time at night when your child wakes with sleep terror, you might try waking him half an hour or so before the usual time, to see if that helps prevent it.
Parents are often advised not to interrupt the child, or try to wake her up, because that can seem to make the child even more agitated and distressed. I have the view, however, that remaining physical close and emotionally connected with your child is important through the sleep terror. Even if your touch seems to frighten her when she is in this state, you can sit on the side of her bed, or lie down next to her. Both physical and emotional connection matter.
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You could repeat quiet loving words like "I'm here sweetheart, everything's ok".
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You could experiment with laying a warm, calm, confident hand on your child's limb or chest. You could hold your hand there even through your child's flailing and distress. Your touch would be loving and accepting, not accidentally controlling.
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You could gather your little one up in your arms and hold him firmly to you, regardless of his physical flailing, and see what happens. Only you will know what's right.
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You could notice your own distressed feelings, which are normal when your very own child is this terrified. You could practice deep breathing and finding the most confident, quiet, loving part of yourself that really knows it is all ok. Then you could wait and keep attentive vigil, so that your precious little child is not alone, and is safe, and feels you are very close even if you decide it's best not to try to cuddle her.
Bedsharing and night terrors
Some parents bring the child into their bed or their bedroom to sleep at nights for a time, until the night terrors pass. I like this approach, if you feel you can do it. But only you know what's right for your own family.
One large cross-cultural study seems to suggest that bedsharing is protective against night or sleep terrors. This study showed that in Asian countries, where almost a third of preschool-aged children bedshare, there is half the incidence of night or sleep terrors, compared to preschoolers in Caucasian countries, 90% of whom sleep in their own bed.
I am interested in the hypothesis that night terrors arise out of a mismatch between our cultural preference to have children sleep alone, and the social sleeping that characterised the human child's environment of evolutionary adaptedness. For millenia of human evolution, and still in many cultures of the global majority, families sleep close together in the night. On a primal or biological level, our children's brains evolved to believe that being alone exposed them to possible harm in the night. That was certainly the case for most of human history.
What's the difference between sleep terror, a nightmare, and an epileptic seizure?
If you're concerned that your toddler's night behaviours could be due to epilepsy, it's very important to see your GP for assessment and referral as required.
| Condition | Is child able to be woken up? | Timing | Sleep phase | If verbal, can child describe what happened? | Confused behaviour | Disorganised bodily movement with lots of loud sounds or words |
|---|---|---|---|---|---|---|
| Nightmare | Yes | Middle of the night or early hours of morning | Rapid Eye Movement | Describes what happened in nightmare | Yes | Yes |
| Night or sleep terror | No | First few hours of sleep | Non Rapid Eye Movement | Forgotten in the morning | Yes | Yes |
| Epileptic seizure | No | Occurs randomly through sleep and also during the day | Random | No memory of seizure | Yes | Stereotypic movements (which occur in fixed or typical pattern). During night-time seizures, the child never sits, stands or walks. |
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Nocturnal frontal lobe epilepsy is a focal epilepsy with more than 90% of the seizures arising in sleep. It often last less than 30 seconds and rarely longer than two minutes, most commonly soon after falling asleep or just before waking.
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Frontal lobe epilepsy seizures occur many times throughout a block of sleep and can also start at any time in the lifespan.
Are there other childhood parasomnias?
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Confusional arousals (also known as sleep drunkenness, or morning sleep inertia) are Non Rapid Eye Movement parasomnias. The child wakes disoriented, cries, whimpers, moans, and appears distressed and confused. This behaviour usually lasts less than 10 minutes.
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Sleep paralysis is a temporary inability to make voluntary movements or speak, despite intense desire to escape. It feels like being locked in a paralysed body. This is a harmless, if frightening, parasomnia that many of us experience in our lifetime. Children experience sleep paralysis too.
Selected references
Cekaite A, Holm MK. The comforting touch: tactile intimacy and talk in managing children's distress. Research on Language and Social Interaction. 2017;50(2):109-127.
Mindell JA, Sadeh A, Kwon R, Goh DYT. Corrigendum to "Cross-cultural differences in the sleep of preschool children" [Sleep Medicine 14(12) (2013) 1283-1289]. Sleep Medicine. 2014;15:1595-1596
Mindell JA, Sadeh A, Kwon R, Goh DYT. Cross-cultural differences in the sleep of preschool children. Sleep Medicine. 2013;14(12):1283-1289.
