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Patient education: Night terrors, confusional arousals, and nightmares in children (The Basics)

Patient education: Night terrors, confusional arousals, and nightmares in children (The Basics)

What are night terrors? — Night terrors (also called "sleep terrors") are episodes in which children wake up suddenly at night and act very upset. They might scream and jump out of bed, as if running away from something scary. They might be sweating, breathing fast, or have a racing heart. During a night terror, you won't be able to calm your child down, even if you try.

A night terror usually lasts about 10 to 20 minutes. A child might have 2 or 3 night terrors a week.

What are confusional arousals? — Confusional arousals are episodes in which children behave in a confused way because they are in between sleeping and waking up. They sit up in bed, moan, or cry. During a confusional arousal, you won't be able to calm your child down, even if you try. These episodes usually last 10 to 30 minutes.

Night terrors and confusional arousals usually happen in the first part of the night. They are also more likely to happen in children who have a fever or are not getting enough sleep.

Although it can be scary to see your child having a night terror or confusional arousal, it's important to know that these conditions aren't dangerous. Also, your child won't remember them the next day.

What are nightmares? — Nightmares are very scary, sad, or upsetting dreams that wake a person up. After a nightmare, children often have trouble going back to bed.

Nightmares usually happen in the second half of the night.

Are there other conditions that can happen during sleep? — Yes. Another common condition is sleepwalking, which is when a child walks or talks while asleep.

Night terrors, confusional arousals, and sleepwalking sometimes run in families. Children can have 1 or more of these conditions.

If my child has any of these conditions, will they need tests? — Probably not. If these conditions don't happen very often and don't lead to other problems, your child will not need further tests.

Some children might need tests to make sure another medical problem isn't causing their night-time behavior. Doctors might order tests if children have frequent night terrors or confusional arousals, or any of the following symptoms:

Loud snoring or gasping for breath during sleep

Wetting the bed (if the child used to stay dry at night)

Seizures, which are waves of abnormal activity in the brain that can make people pass out or move or behave strangely

How can I help my child when these conditions happen? — If your child has a night terror or confusional arousal, you should stay with them until the episode stops. You should not try to wake them up. Once the episode stops, your child will go back to sleep.

If your child has a nightmare, there are things you can try that might help. You can:

Remind your child that it was only a dream and not real

Help your child think of a new, happy ending to the dream

Draw a picture or write about the dream, which often makes it less scary

Will my child need other treatment for these conditions? — Probably not. If these things are happening 1 or 2 times a month only, your child won't need any other treatment. Most children outgrow their night terrors and confusional arousals over time, but it can take 1 to 2 years.

If these conditions are happening much more often or leading to problems, talk with the doctor or nurse. Possible treatments for night terrors and confusional arousals can include:


A behavior plan called "scheduled awakening" – This involves waking your child every night (for a few moments) at a certain time.

If your child has frequent nightmares, the doctor or nurse might recommend that your child talk with a therapist.

Can these conditions be prevented? — Maybe. Children are more likely to have night terrors and confusional arousals in certain situations, such as when they do not get enough sleep or have a fever.

You might be able to prevent night terrors and confusional arousals by making sure your child gets enough sleep. To do this, try to stick to a regular sleep schedule. In general, children 3 to 5 years old should get 10 to 13 hours of sleep (including naps). Older children should get 9 to 11 hours each night, and teens should get 8 to 10 hours.

If your child has trouble falling asleep or getting a good night's sleep, here are some things you can try:

Have a set bedtime and bedtime routine for your child.

Keep your child's bedtime and wake-up time about the same every day (on school and non-school days).

Make the hour before bed a quiet time. Avoid TV or other screens and high-energy activities.

Keep your child's room quiet and dark. If your child is scared of the dark, use a night light that is not too bright.

Don't have a TV in your child's bedroom.

More on this topic

Patient education: Sleepwalking in children (The Basics)
Patient education: Bedwetting in children (The Basics)
Patient education: Nocturnal (nighttime) leg cramps (The Basics)

Patient education: Bedwetting in children (Beyond the Basics)

This topic retrieved from UpToDate on: Mar 03, 2022.
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