Night Terrors in Children: A Parent's Guide to a Child Who Screams in Their Sleep

What are night terrors in children and how do they differ from nightmares? How to respond in the moment, how to prevent episodes and when to see a doctor.

It has been forty minutes since you put your child to bed. Just as you turn up the television, a blood-curdling scream comes from their room. When you rush in, you find them sitting up in bed, eyes wide open, drenched in sweat and out of breath. You want to hug them but they push you away; you say their name but they look at you as if they don't recognise you. A few minutes later they drop back onto the pillow and fall asleep as if nothing had happened. In the morning they come to breakfast cheerfully with no idea of what happened in the night. This picture is very likely a night terror. Although it is extremely frightening for the parent watching, it is a sleep event seen in childhood that, most of the time, eases by itself as the child grows. In this article we look at what happens on such a night, what you should and shouldn't do in those minutes and what can be done to make episodes less frequent.

What Are Night Terrors in Children?

From the point of view of sleep science, this picture is a parasomnia; that is, a condition that appears during sleep and involves involuntary behaviour. It happens not in the stage of sleep when dreams occur, but in deep sleep. The child's brain cannot fully wake from deep sleep and stays in a half-awake in-between zone. While part of the body is in a state of alarm, consciousness and memory carry on sleeping. This is why the child screams and looks frightened but cannot really communicate with you, and does not remember the event in the morning.

Because deep sleep is concentrated in the first third of the night, episodes usually appear within an hour or two of falling asleep. The preschool years and the first years of primary school are when they are most common. They come from the same family as sleepwalking and sleep talking; it is common for someone in the family to have these kinds of sleep traits. Many parents, when they describe the situation to their own mother, get the reply: "You were just like that when you were little."

Signs of Night Terrors in Children: How to Tell Them Apart from Nightmares

Common signs are:

• A sudden, loud scream or crying
• Suddenly sitting up in bed, sometimes leaping out of bed
• Eyes open, with a blank or terrified stare
• Rapid heartbeat, rapid breathing, sweating, a flushed face
• Not responding to comfort, even pushing away a parent who tries to hug them
• Saying meaningless or muddled words
• Falling back asleep by themselves after an episode that rarely lasts longer than a few minutes
• No memory at all of the event in the morning

In a nightmare, by contrast, the child wakes up fully, recognises you, wants to be comforted and can describe their frightening dream. Nightmares are seen more often in the second half of the night. We explained in detail how to approach a child who has nightmares in our article on when your child has nightmares. Telling the two apart matters, because while being with the child and talking helps in a nightmare, here trying to wake the child and get them talking can prolong the episode.

What Causes Night Terrors in Children?

At the root of these episodes there is usually a predisposition linked to the child's brain development. During the transition from deep sleep to lighter sleep, the brain sometimes cannot make this shift smoothly. In children with this predisposition, certain factors can trigger episodes:

Lack of sleep and overtiredness: This is perhaps the most common trigger. In children who are starting to drop their daytime nap, who go to bed late or who get up early in the morning, the need for deep sleep increases and episodes can become more frequent.

Irregular sleep times: In Turkey, holiday visits to relatives, weddings, long coach journeys to the family's home town and summer evenings of conversation that go on until midnight often disrupt children's sleep rhythm. Many families notice that the screaming nights increase precisely after these periods.

Illnesses with fever: Sleep structure changes during illness and episodes may occur.

A full bladder, noise, an unfamiliar setting: Drinking a lot before bed, the sound of a motorbike passing in the night or sleeping in a different bed while staying with others can all be triggers that break up sleep.

Breathing problems during sleep: In children who snore constantly, sleep with their mouth open or seem to stop breathing in their sleep, sleep is frequently interrupted and episodes may be more common. In this case an assessment by a paediatrician or an ear, nose and throat specialist is important.

Stress: Starting a new school, tension in the family or major changes can increase episodes. But there is an important distinction here: night terrors on their own are not a sign of a psychological problem or of trauma. Most children are perfectly happy and settled during the day.

What the Family Goes Through: Fear, Embarrassment and Misinterpretations

These minutes of the night are hard not for the child but for the adult watching. The child doesn't remember what happened; but the mother and father cannot forget that scream for weeks. Many parents, at the first episode, think their child has seen something, is in pain or that something has happened to them.

Apartment living adds another worry: what the neighbours will think when they hear the screams. Some families feel the need to explain themselves to a neighbour they meet in the lift the next morning. In the extended family, the comments multiply; explanations may be offered such as the child having been struck by the evil eye, having had a fright or having been affected by something. Although these comments usually come from love, they can magnify the family's anxiety and, when voiced in front of the child, unsettle them too.

It is reassuring to know: this picture is a recognised, named sleep event that paediatricians and sleep specialists know well. The fear the child goes through in those minutes, and that you see, is not a fear that carries over into the morning.

It is also important not to forget other children in the home. Imagine an eight-year-old older sister who is woken by the night-time screams of the four-year-old she shares a room with, and who asks in the morning, "What's happening to my sibling? Are they going to die?" Giving the older child a simple, age-appropriate explanation reassures her: "When your sibling's brain is waking up from deep sleep, it sometimes gets stuck. It doesn't hurt, and they don't even remember it in the morning. If it happens, just call us." This explanation includes the older sister in the process without expecting her to act as a night-time carer. During periods when episodes are frequent, having the siblings sleep in separate rooms temporarily can help protect both of their sleep.

What to Do, and Not Do, During Night Terrors

In those minutes your instinct is to hug your child, wake them up and ask what happened. Yet in this situation the most effective stance is to be a calm observer.

What to do

• Stay close and keep them safe. Make sure the child doesn't fall out of bed or bump into anything. This is your main task.
• Keep your voice low. If you want to talk, use short and gentle sentences: "I'm here, you're in your bed." Don't expect an answer.
• If they have got up, gently guide them back to bed. Instead of holding the child down, rest your hand lightly on their shoulder and steer them towards the bed.
• Wait for the episode to end. Most episodes end by themselves within a few minutes and the child falls asleep again.
• Note the time. Recording the time episodes begin over several nights gives valuable information later, both for prevention and for a doctor's appointment.

What to avoid

• Trying to wake the child by shaking them or speaking loudly
• Splashing water on their face, suddenly switching on the light
• Pressing them with questions such as "What happened, what did you see?"
• Forcibly picking them up and holding them tightly; this can increase the child's agitation

What should you talk about in the morning?

Usually, nothing. If a child has to listen to a detailed account of an event they don't remember, they may become anxious and start to fear sleep. Avoid accounts such as "You were screaming again last night, you scared us to death", especially in front of guests, grandmothers or siblings. If the child asks something, a short and calm explanation is enough: "You were a bit restless in your sleep last night, and I was with you."

During a night terror, don't try to rescue your child; stay beside them, keep them safe and let it pass.

How Can Night Terrors in Children Be Prevented? Steps You Can Take at Home

There is no single method that will eliminate episodes completely; however, the steps below noticeably reduce how often episodes happen in many children.

Increase sleep time. Moving bedtime about half an hour earlier sometimes makes a surprising difference. In preschool children, not dropping the daytime nap too early also reduces the pressure for deep sleep.

Keep times consistent. At weekends and on holidays too, keep bedtimes and waking times as close as possible to usual. During religious holidays and visits, full control may not be possible, but returning quickly to the rhythm in the following days helps.

Calm the evenings. Switching off screens in the hour before bed, cutting down on exciting games and keeping the routine simple with a warm bath and a short book eases the passage into deep sleep. For general sleep routines, see our article on sleep problems in children.

Add the toilet to the routine. Going to the toilet just before bed and not drinking much in the last hour prevents a full bladder from breaking up sleep.

Consider scheduled awakenings. If episodes happen at roughly the same time every night, waking the child just enough to stir them about fifteen to thirty minutes before that time and then letting them go back to sleep can, in some children, shift the sleep cycle and reduce episodes. This method requires regular application for several weeks, and it is recommended that it be planned together with a specialist.

Make the environment safe. The top bunk of a bunk bed is not suitable for a child who has these kinds of episodes. Keep the balcony door and windows locked at night, use a safety gate in homes with stairs and don't leave hard objects around the bed that they could hit. These precautions are vital, especially if sleepwalking is also present.

When Should You Seek Professional Support?

Occasional episodes generally do not require medical intervention. However, in the following situations it is important to consult your paediatrician and, if necessary, be referred to a paediatric neurologist or a sleep specialist:

• If episodes are very frequent, for example several times a week or more than once in a night
• If during an episode the child tries to leave the house, heads towards a window or shows behaviour that could harm them
• If episodes always involve the same repeated movements, stiffening or jerking, or also occur towards the end of the night
• If the child is excessively sleepy, inattentive or restless during the day, or snores constantly
• If episodes began for the first time in adolescence, or are increasing rather than decreasing with age

Some types of seizure can look similar to night terrors. For this reason, recording an episode on your phone helps your doctor a great deal in making a differential diagnosis.

Beyond sleep, if the child is also experiencing intense anxiety, fears, reluctance to go to school or marked changes in mood during the day, or if the family is going through a stressful period, a psychological assessment can also be helpful.

How Are Night Terrors Addressed in Therapy?

This sleep event is not directly a subject for psychotherapy; a medical assessment may be needed, and in most cases changes to the sleep routine are enough. Nevertheless, a psychologist can support the family in managing the process in several ways.

In parent sessions, a sleep diary is reviewed together; the child's sleep duration, triggers and the family's responses during episodes are assessed. How and for how long methods such as scheduled awakenings should be applied is planned together.

The parent's own anxiety is also an area that needs attention. The exhaustion of a mother or father who cannot sleep for fear of being woken by a scream every night, and who keeps watch at their child's bedside, also spills over into their daytime relationship. With a cognitive behavioural approach, how this anxiety is fed and how catastrophic scenarios grow can be addressed.

If there is a clear source of stress in the child's life, for example the birth of a sibling, parental separation or a loss, these issues can be worked through using methods suited to the child's age, which in the preschool years is mostly through play. To learn more about this approach, you can visit our child and play therapy page.

Frequently Asked Questions

Are night terrors hereditary?

A family predisposition is common. There may be a history of similar episodes, sleepwalking or sleep talking in the mother, father or siblings. This doesn't mean the same problem will definitely occur; but knowing about these traits in the family makes it easier for the parent to recognise the situation.

Do night terrors harm a child's brain or development?

There is no information suggesting that these episodes harm a child's brain development. Since the child doesn't remember the episode, it is also not expected to leave a lasting fear in them. What really needs attention is preventing accidents such as falling or bumping into things during an episode.

Can a child with night terrors stay over at someone's house or go on a residential school trip?

They can; but it is necessary to explain the situation in advance to the adult who will be with the child, and to share how to behave during an episode and what safety precautions to take. Since new environments and going to bed late can trigger episodes, take care to protect their bedtime on those nights.

Do night terrors go away as the child grows?

In most children, episodes decrease as the structure of deep sleep changes, and become infrequent in the later years of primary school. If they continue into adolescence or start for the first time then, a specialist assessment is recommended.

• #night terrors
• #screaming in sleep
• #sleep disorders
• #children's sleep

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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