Expert Advice

Nightmare or night terror?

How to tell the difference between just another bad dream and something more serious

Nightmares are more common than many parents realise about a third of three-to-five-year-olds have them. Night terrors are less common but what's the difference between just another bad dream and a night terror and what do you do if they affect your child?
It happened for a few months, a couple of nights a week. About an hour after Sandra put her four-year-old to bed she screamed. As Sandra watched, her little girl tossed and turned in a tangle of sheets and blankets.
Sometimes Stella sweated. Sometimes she sat in her bed, seemingly awake but at the same time oblivious to her surroundings. After five minutes, Stella settled again.
"It was very unnerving," says Sandra, from Melbourne. "Stella seemed to be in another world. At times she looked awake because her eyes were open, but I knew she really wasn't. Some nights she was on her hands and knees going round and round in her bed and her screams were horrible. Whatever was happening in Stella's mind was terrifying her.
"But in the morning Stella had no memory of it. Thankfully, after a couple of months, she slept again. I still have no idea why it happened."
"Nightmares happen towards the latter part of a child's sleep, towards the morning," says Jan Murray, a registered nurse and midwife at private parenting and child health centre Settle Petal on Queensland's Sunshine Coast.
"They're often associated with things that happened in the day. Little children don't understand the difference between fact and fantasy and an event that seems quite unimportant to an adult can worry a child," Murray adds. "If someone stole your toddler's lunchbox at kindergarten, or your child saw another child being hit at day care those events can play on their mind. Little children can't work those things out in their head and when they are in bed, those memories come back to trouble them." Penelope Leach, author ofYour Baby and Child, (Dorling Kindersley, $49.95) says good and bad dreams are common during lighter phases of sleep particularly in children who have an active and creative imagination.
"Almost every child sometimes has nightmares; from time to time your child may have a patch during which she has them almost every night," says Penelope. "Unless she shows signs of stress when she is awake as well, don't worry about them."
What to do
If your child wakes later in sleep and is crying, they're having a bad dream or nightmare and the best thing you can do is get to them quickly to cuddle them. They'll be awake, so they'll recognise your comforting presence.
"Just get to her quickly when she starts to cry," says Leach. "The sight, sound or touch of you will soothe her instantly back to peaceful sleep. It is only if she has time to come fully awake and be terrified by the sound of her own fear, or if the babysitter who comes to comfort her is a stranger, that the nightmare is likely to become a memorable event which may make her afraid of going to sleep."
Try and avoid nightmares by talking to your child about their day, so they have a chance to talk about events that bother them.
"Give your child a chance to talk and release the day's events. Children remember nightmares in the morning, too, so you can talk then about what was worrying them," Leach adds.
Ask your child if they had a nice sleep or tell them they seemed to have a bad dream so they can talk about it.
Night Terrors
Fifteen percent of children experience night terrors, which is where the body is awake but the mind is asleep. Night terrors occur soon after a child goes to sleep typically within the first one to two hours when they are in a deep sleep phase. Often during a night terror your child may look awake, they may even appear to stare, but they are not awake,
"Other typical signs are thrashing around in bed, panicked screaming, rapid breathing and rapid heartbeat and sweating," Leach says. "Sometimes children become sleepwalkers or talk in their sleep. Thankfully, night terrors don't last long."
So what triggers night terrors in some children? Penelope Leach says night terrors are sometimes caused by a severe physical or emotional shock such as an accident or separation from a parent. A fever can also aggravate a night terror and so can some sedative medications. Jan recommends consulting a doctor if your child has night terrors more than three times a week for a couple of weeks.
What to do
Don't try and wake your child or interrupt their dream. Stay with them and keep them safe and make sure they can't hurt themselves.
The Westmead Children's Hospital in Sydney suggests that if the night terrors happen at the same time every night you should wake your child about 15 minutes before it usually occurs. Shake them gently by the shoulder, so your child can wake and drift off to sleep afresh. This may avoid the night terror.
Creating a regular, calming routine in the lead-up to bedtime may also help. "Allow about 1.5 hours to help your child work towards bedtime," says Leach. "Switch off the television and computer, have dinner, give them a bath, read them a story and then put them to bed." Avoid over-stimulating them with TV or computer games and children over 12 months of age should also avoid food or drinks for at least an hour before going to bed.
Keep the same bedtime and the same bedtime routine. You can help create a space around your child's bed that is familiar and inviting to them by placing their favourite toys and books and pictures around them so they see their bed as a safe and welcoming corner of their world.
Mum's stories
"My four-year-old sometimes has nightmares, usually to do with something he's seen or heard during the day," says Sarah from Melbourne. "Once he overheard a story on the evening news about a boy being abducted from a shopping centre. Nicholas woke that night crying for me. I cuddled him and he calmed down and fell asleep."
"In the morning he said he'd dreamt we were shopping together and suddenly he couldn't find me. Then a 'nasty man' stole him and he never saw me again. I told him that's why I held his hand when we went shopping. We also talked about how, if he did get lost, he should go to a shop and ask the person behind the checkout for help. I've also taught him my mobile number so he could call me. He hasn't had that nightmare again."
Lucy's three-year-old, Samantha, had nightmares after she was picked on at her Sydney pre-school. She'd wake crying and screaming and would only go back to sleep if Lucy held her.
"A couple of kids picked on Sam because she wore glasses," says Lucy. "It was childish stuff they threw sand at her and called her names. Sam had nightmares for a couple of nights running about it and eventually told me she dreamed about the 'bad' things happening to her at kinder.
"I saw Sam's teacher and she got on top of the situation straightaway. The bullying stopped and so did the bad dreams. She loves little school now."
Night terrors are common in childhood, and very rarely there is an underlying medical issue. Parents should speak to their paediatrician or health professional if night terrors continue or if they have any concerns.

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