Is my toddler having nightmares?


Our son Sean is two.  He used to sleep well, but the past few weeks have been terrible.  We think he might be having nightmares.  He wakes up screaming and when we rush to his room he’s sobbing and clings to us like a little monkey.  But he doesn’t stop crying for quite awhile, and he sometimes pushes us away while we are trying to comfort him.  He doesn’t remember anything in the morning but his vocabulary is pretty limited, so I don’t even think he can tell us what’s bothering him. What should we do?

Sean may be having nightmares, or he may be having night terrors. Both can occur in two year olds, and the best approach is somewhat different for each, but there are some things that you can during the daytime that will be  helpful in both situations. 

The biggest difference between what we call nightmares and night terrors is the time of the sleep cycle in which they occur.  A nightmare is what we sometimes call a “bad dream”.  All dreams occur during a lighter stage of sleep called REM (rapid eye movement) sleep. Typically, the dream is so upsetting to a child that he wakes up, crying, distressed and often visibly frightened, wanting parents to comfort him.  A night terror, on the other hand, occurs during deep sleep.  A child may scream and cry, but when parents go in, he does not seem to be fully awake, and comforting usually doesn’t help, or makes the crying worse.  Once he’s awake, he’ll be calmer and doesn’t seem frightened or upset. Nightmares usually occur in the second half of the night, and night terrors are more common in the first half of the night. They are more likely to occur when a child is overtired or has skipped a nap. From your description, I think Sean is having night terrors. Compare the following descriptions to see for yourself:

Night Terrors.  A child who is having a night terror will awaken her parents by the sounds of her crying, screaming, and thrashing about.  When her parents rush in to her, she will continue to cry, seemingly unaware of their presence.  Her eyes may be wide open but she will have a glazed, staring expression.  If her parents try to comfort her she will act as though they aren't there or even push them away.  If they manage to wake her from her screaming, she may look at them in dazed confusion, because she will have no memory of having been crying.  If she sees her parents looking at her in horror, for no apparent reason, she may then begin to cry, not knowing why they are so upset.  

A night terror is a very frightening experience for parents, but it is not frightening for a child.  That's because a night terror takes place at a very deep stage of sleep.  Even though it is very hard for a parent to watch a child cry or scream this way and to feel as though there is no way to help, it is truly better if parents can let the night terror run its course.  Your child will continue to cry, perhaps for five minutes, perhaps for as long as a half an hour.  She will then go back to sleep without difficulty. You don’t have to do anything at that point or talk about it the next day, because  it’s over!

Sometimes night terrors occur several times a week and are a result of being overtired or over stimulated during the day. Make sure that your child gets a nap if he still needs one (he does, for sure, at age two) and that you don’t have days overflowing with activities and no down time, even if he seems to be having fun.

•  Nightmares: A nightmare is a dream in which something occurs that frightens a child, usually enough to cause her to awaken, crying or calling for help.  When you go to her, she is awake, crying or asking you to hold and comfort her. After you comfort her, letting her know that she has had a "bad dream" but that you are there, she probably will relax and settle down, but she may not want you to leave..  

Unless sleeping with your child is very disruptive to your own sleep, there is no harm in letting her spend the rest of the night with you, either in her room or yours.  Most children will not develop a night waking pattern if parents respond in this way to an occasional nightmare.  Nightmares, unlike night terrors, do not usually take place night after night.  If they do, it’s important to figure out if something is bothering your child beyond the usually stresses of everyday life.

In my experience, nightmares can be the result of watching television or videos that are made for children but still have images or sound effects that are frightening.  If the stories include adventures in which a child or parent figure is lost, most young children will be disturbed, even if they don’t seem to be bothered while watching.  At night, they think or dream about the shows they have seen and replay them as nightmares. It’s best to limit young children to the shows that are designed for very young children. A good guideline is that if the storyline matches the stories your child enjoys in picture books it’s age appropriate.

Children may have nightmares or night terrors when they are coping with stressful events during their daytime hours.  The stress may be easy to identify, such as a parent traveling or being less available. Sometimes the stresses are more subtle, such as a change in teachers at child care, or transition from a vacation.  Even if you can't eliminate the cause of stress, it’s usually helpful to your child if you spend more time with him in the evening, pay more attention to maintaining bedtime rituals, and make sure that daytime routines are as regular as possible.

Meg Zweiback, R.N., CPNP, is a family advisor and infant sleep consultant in Oakland, California