What are Nightmares in Children, Frequencies, and effects?

According to the Sleep Foundation, nightmares can occur at any age, but studies suggest they are exceptionally common for young children. Roughly half of the children between the ages of 3 and 6 report frequent nightmares. The same is true for 20 percent of children ages 6 to 12. The exact cause of nightmares is not known. They are more likely when kids are overtired or experiencing stress. Children who have experienced traumatic events may have frequent nightmares. Some medications may also cause nightmares or disturbing dreams. While most children eventually outgrow their nightmares, some may develop Nightmare Disorder, a condition characterized by recurring unpleasant or frightening dreams that cause sleep disturbances. Nightmares in children are scary or frightening dreams that usually wakes them up. These dreams usually occur in the last third of the night, when we have more rapid eye movement (REM) sleep. They can involve fear or anxiety, and other emotions like anger, sadness, embarrassment, or disgust. For children, nightmares seem very real to children and they may have trouble returning to sleep after a nightmare. Some kids may also resist bedtime because they want to avoid bad dreams.

Night Terrors vs. Nightmares in Children

The National Health Service (NHS) explains that night terrors are very different from nightmares. Night terrors, outbursts during sleep that can last for several minutes, are also more common in children than adults. Nightmares are often mistaken for night terrors, which are defined as episodes of terror and panic that occur during sleep. Unlike nightmares, night terrors are often accompanied by vocalizations, autonomic symptoms, and other signs the child is acting out against the dream. Another key difference between nightmares and night terrors is timing. Night terrors primarily occur during the non-rapid eye movement (NREM) stages that precede the REM stage, whereas nightmares mostly take place during REM sleep. Children do not remember the content of night terrors when they wake up, but they may remember nightmares because nightmares are dreams whereas night terrors are not. Because they involve unusual behaviors during sleep, night terrors are considered a type of parasomnia. A single episode can last up to 90 minutes. Night terrors are most common in children ages 3 to 7, and typically begin to taper off after age 10. Roughly 30 percent of children experience night terrors, and these episodes appear to affect boys and girls in equal proportion.

How to Help Children Cope with Nightmares

For children who experience occasional nightmares, reassurance is often the most effective tactic. Parents should discuss fears and anger triggers with their children in a relaxed setting. This can help promote feelings of relaxation before bedtime, which in turn may improve their sleep quality and minimize their risk of disruptive dreams. That said, too much reassurance can have the opposite effect. Parents can encourage their children to comfort themselves after waking up from a bad dream as opposed to relying on their family members for comfort. Co-sleeping with children after a nightmare occurs or remaining in their room until they return to sleep are generally frowned upon because these practices have been linked to an increase in nighttime waking episodes for infants and young children. Parents may find more success by providing a “sleep partner” for their children, typically in the form of a doll or stuffed animal. They may tell the child that the sleep partner is scared, requiring the child to comfort it at night, or that the sleep partner is capable of protecting the child; both intervention strategies can assuage nighttime fears and improve the child’s sleep quality. Another effective technique can be to educate children about the reality of nightmares – i.e., they are just thoughts and completely harmless – in order to dispel misconceptions they may have about these dreams. Deep breathing, muscle relaxation, and other coping techniques may also help children sleep more soundly.

When to See a Doctor

Parents should consider a psychological evaluation for their child if he or she experiences at least two nightmares per week for at least six months. Additionally, frequent nightmares in children older than six years may necessitate psychological intervention. Psychotherapy may be recommended. If the child takes medication, their dosage may need to be adjusted. For some children and adolescents, frequent nightmares stem from sexual assault, abuse, and other types of trauma. Children diagnosed with pediatric post-traumatic stress disorder (PTSD) may respond well to imagery rehearsal, a type of therapy during which children “rehearse” less frightening dreams during the day in order to promote more positive dreams at night and decrease nightmares. Medications available to adults with PTSD are generally discouraged for children. Children who experience frequent nightmares may develop anxiety about sleep. They often act out by delaying bedtimes or demanding to co-sleep with their parents. Granting these requests can exacerbate the problem and solidify the child’s worries about sleeping, rather than alleviating them. A strict bedtime schedule, reward-based positive reinforcement, and other behavioral strategies are considered more effective. If these methods are not successful, a low-dose prescription of a benzodiazepine may also be recommended.

This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.