It’s always distressing to be jolted out of sleep by the sound of our baby or child screaming. I think every parent has had this experience! Our immediate instinct is to go see what’s happened- Is their hand stuck in the crib slat? Did they hit their head? Did they fall out of bed? Are they sick?
Once we get to them and check everything out and find no discernible cause for the intense crying, we begin to wonder what might be the issue. Did they have a nightmare? Night terrors? Is my child overtired or is something wrong with their sleep overall? These issues can look very similar, but all have very different root causes, typical ages and ways to handle them! It is really helpful to have a framework to understand if our child is struggling with one of these things, in order to respond and help in the best way. I’ll be going in-depth identifying the symptoms, age group, causes and protocol for handling each one.
Night Terrors
I’ve noticed an uptick in conversations about night terrors online and in moms’ groups. I have seen “night terrors” many times used as a catch-all term for any unexplained crying at night, but it’s incredibly important to not self-diagnose this condition, and to understand that night terrors are a true medical diagnosis with physical symptoms besides crying or screaming at night.
What is a night terror?
A night terror is a very intense instance of crying and screaming at night, caused by over-arousal of the central nervous system during sleep. Children may have their eyes open but they are, in fact, still asleep during a night terror. Night terrors are often hereditary (meaning other members of the family suffer from them as well).
What are the symptoms of night terrors?
-Screaming and crying
-Kicking, hitting or flailing
-Dilated pupils
-Flushed skin
-Aggressive if restrained
-Heavy breathing and racing pulse
When are children affected by night terrors?
Night terrors mainly affect children 4 years of age and older. They have been recorded in children as young as 18 months, but that is very rare. If your child is an infant, they are very likely not experiencing night terrors.
How do I know if my child is experiencing night terrors?
To diagnose night terrors, you should check with your pediatrician. A video can be helpful as well as noting any symptoms that they are experiencing *besides* the crying. Most notably, a child having night terrors will struggle to settle, and not remember the episode after or in the morning.
How should I handle night terrors?
Night terrors can understandably be extremely distressing for a parent to watch and so many parents look for ways to diffuse these as quickly as possible. It is helpful to remember that, while distressing for you, your child is unaware of them and will not even remember them in the morning. So try your best to diffuse your own stress in order to handle a night terror.
The best angle to “treat” night terrors is prevention. Because night terrors are directly linked to overstimulation of the nervous system, earlier bedtime, good sleep hygiene, a calming bedtime routine, avoiding caffeine and sugar, spending time outside, and reducing stress can all go a long way in helping parents keep their kids from experiencing regular night terrors.
If your child seems to experience a night terror at the same time each night, waking them 30 minutes prior and allowing them to fall back asleep can act as a “reset’ for their sleep cycles and may help them avoid the night terror.
If you’ve tried everything preventative and still experience night terrors, the best way to handle them is to sit quietly nearby, offer soothing if they seem to accept it, and to supervise and make sure they don’t hurt themselves. Night terrors typically pass within minutes, although some can last longer.
Definitely check with your pediatrician for guidance on this, or ask if they recommend any other interventions.
Nightmares
What is a nightmare?
Almost every person has experienced a nightmare, so this won’t be new information for you! But a nightmare is a scary or unhappy dream that can cause feelings of fear or upset during the dream and upon waking.
What are the symptoms of a Nightmare?
-Waking up crying and upset
-Speaking coherently, talking about what they are afraid of from their dream
-Asking for comfort, company and reassurance
-Anxiety at bedtime, not wanting to fall asleep for fear of repeating the dream
When are children affected by nightmares?
Children typically begin to have nightmares at a developmental stage when they have the capacity to “imagine” things. This is always when fear of the dark can come into play because their imagination is developing and they can envision things in their minds that aren’t real. This happens typically around 3 years old, but can be a little earlier or a little later. In addition, nightmares typically happen at a specific time in the night. Nightmares occur during REM sleep, and REM sleep occurs more often the last third of the night (roughly 2am and beyond).
How do I know if my child is experiencing nightmares?
-They are waking up crying and lucid
-They occur in the last third of the night
-Your child tells you they had a bad dream or begin explaining something that “happened” that’s clearly a dream. The “nice thing,” if you can call it that, about nightmares is that they happen at an age when our child can communicate, and children typically remember their dreams when they wake. This can be very helpful in diagnosing because your child will likely tell you exactly what their dream is about and what they are fearful of.
How should I handle nightmares?
Nightmares are scary! I can vividly remember my worst, recurring nightmare as a child and it’s been over 20 years since I had it (it was inspired by a Power Rangers commercial, by the way). Nightmares are certainly something requiring support and compassion from mom and dad, as they are truly frightening and can give littles anxiety about nighttime.
Nightmares also require a fine balance! We want to *validate their feelings without validating the fear.* Meaning we want to support them and comfort them without overreacting to the point where we give them the idea that there is something to be scared OF, and prevent them from conquering the fear. I sometimes work with clients in the 7-8 year range, and almost always, the story goes something like “My child started having nightmares at age 4, so one of us started sleeping in his room. Now he refuses to sleep at all and is in extreme fear if someone is not with him.” We want to support, but we want to help them move through the fear and regain confidence so that the anxiety doesn’t grow deep roots to the point where they feel that they cannot handle ever being alone.
In the moment with a nightmare, you should respond right away and comfort. Listen first, validate that feeling “Oh wow, that sounds so scary that you thought ants were crawling on your bed!” then move to reassurance, “See? There are no ants! It was just a dream, and mommy would NEVER let ants get in your bed!” Then offer physical comfort “I’ll stay here and rub your back for a bit until you’re feeling sleepy again.” This kind of co-regulation calms frazzled little nerves and allows them to feel safe and secure enough to become drowsy. Then before they fall back asleep, let them know you are heading back to bed but will check on them again soon (and do!). Some children may accept this and some may still be anxious. One of the ways I like to handle bedtime anxiety or fear of nightmares with my toddler or preschool is by “patrolling.” Rather than sleeping on their floor or another arrangement, I let them know I’ll “patrol” the hallway until they’re sleeping. I walk slowly back and forth in front of the open door, pausing longer at each end of the hallway, popping my head in if needed, as a reassurance. It’s a gentle ease-in to, in coming nights, letting them know I will “check on them in 5 minutes” or “check on them when I finish feeding the dog,” as they gain more and more confidence and let go of the fear.
Of course, if you share a family bed or don’t mind bedsharing as a long-term solution, you should do what’s best for your family! But if your ideal is helping your child gain confidence to sleep in their bed, this is my best advice for handling it.
Just like night terrors, there are definitely some preventative measures you can take as well. Like night terrors, nightmares are exacerbated by stress and overtiredness. Do your best to reduce stress and make sure your child gets adequate sleep and a reasonably early bedtime. During the day, give your child an opportunity to talk about and process their bad dream so that it doesn’t all come flooding back right at bedtime. Set expectations with them about checking on them and helping them feel secure.
Melatonin and nightmares
One more note: Last year, I had a string of preschool-age clients who were experiencing vivid bad dreams. The common thread among all of them? They were all being given melatonin at bedtime. I had never heard of this and was completely unaware, but upon further research I discovered that studies have shown a link between melatonin supplementation and nightmares in children. Melatonin, I believe, can have its place under the advisement of your child’s pediatrician, but it is something to keep in mind as I think many parents are unaware that even this “natural” supplement can have side effects that backfire.
Overtiredness and Sleep Disturbance
What is overtiredness?
Overtiredness is the physical condition of being past the point of exhaustion. This can happen over a short span of time, for instance your baby can become overtired from skipping one nap. This can also happen over a longer period of time, like losing a little bit of sleep here and there for weeks until your body is in a chronically overtired state. When we are overtired, our body can be flooded with cortisol and adrenaline and perpetuate this cycle by making it more difficult to settle down, fall asleep and stay asleep.
What are the symptoms of overtiredness?
-Cranky, crying, rubbing eyes
-Seeming tired at an earlier point in the day, but then becoming “wired” when given an opportunity to sleep.
-Waking early in the night, like 30-60 minutes after being put to bed.
-Early mornings and waking “for the day” between 4-5am.
-Frequent night wakings that go from “zero to 60,” screaming immediately instead of seeming to wake happily or just fussing.
-Wakings where your child may cry, push against you or resist being consoled, because the thing they need most (sleep) is what they are struggling so hard to achieve.
When are children affected by overtiredness?
A child can become overtired from a very early age, starting the week they are born. A newborn who skips naps or is awake for hours at a time will likely exhibit overtired symptoms such as inconsolable crying, trouble feeding, and resistance to settling or sleeping despite being exhausted.
Toddlers and preschoolers, or even older children often exhibit difficult behaviors when overtired, like lack of attention at school, tantrums, and misbehavior. In addition, they often struggle to fall asleep, sometimes taking hours to get to bed at night and usually waking early in the morning.
How do I know if my child is experiencing overtiredness?
Overtiredness can be confusing. As mentioned, children who are overtired often seem “wired” and next to impossible to get to sleep. This can lead some parents to believe that their child simply needs a later bedtime or less naps. If they are not getting the recommended amount of sleep for their age, if they are struggling to get decent sleep even with great sleep habits, or if they seem constantly unhappy during awake times, your child is likely overtired.
Overtiredness can cause many extremely upset night wakings, which causes some parents to believe their overtired baby is simply experiencing “night terrors,” when there is actually a simple fix that could greatly decrease the frequency of these distressed wakings!
How should I handle overtiredness?
Early bedtime, early bedtime, and I cannot stress this enough- early bedtime. You can put your overtired child to bed as early as 6pm. This stresses some parents out, believing that if their child is currently going to bed at 9pm and waking at 4am, that if their child goes to bed at 6pm they will wake for the day at 1am. This is simply not true. In a child that is overtired, early bedtime provides a welcome “reset” for their sleep cycles and circadian rhythm, and often helps them to sleep LATER. Even if they still wake at 4am, they got 3 additional hours of sleep and are well on their way to becoming less overtired.
In addition, making sure your child is getting enough daytime sleep and helping your child’s sleep habits in general with a good environment, calming bedtime routine, and good sleep hygiene (including independent sleep habits!) can help a child make up their sleep deficit and unwind an overtired cycle.
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I hope this helps you to feel more confident as a parent in how to understand and help your child through nightmares, night terrors, or overtiredness! Have you experienced any of these situations with your little ones?
References:
https://kidshealth.org/en/parents/terrors.html
https://www.mayoclinic.org/diseases-conditions/sleep-terrors/symptoms-causes/syc-20353524
https://my.clevelandclinic.org/health/articles/14297-nightmares-in-children
https://www.psychologytoday.com/us/blog/sleep-newzzz/201102/melatonin-not-magic-bullet-sleep
https://sciencenorway.no/forskningno-human-body-norway/is-being-overtired-an-actual-physical-condition/1555319
