As a pediatrician, I often hear concerns from families about their child waking up crying, screaming, or completely inconsolable in the middle of the night. Sleep disruptions in children can be distressing for both kids and caregivers, especially when the cause isn’t clear. Two common culprits are nightmares vs night terrors in children, and while they may seem similar, they are quite different in origin, appearance, and how parents should respond.
What Are Nightmares?
Nightmares are vivid, disturbing dreams that typically occur during REM (rapid eye movement) sleep, usually in the second half of the night. A child experiencing a nightmare may wake up frightened and may recall parts of the bad dream in detail. These dreams often involve themes like being chased, monsters, or losing a loved one.
Common signs of a nightmare:
- Child wakes up crying or afraid
- They are alert and can talk about what scared them
- Often seek comfort from a caregiver
- May be hesitant to go back to sleep
How to respond:
- Offer comfort and reassurance. Hold them, speak calmly, and remind them that it was just a dream.
- Validate their feelings without reinforcing the fear (“That sounds scary, but you’re safe now.”).
- Keep a comforting bedtime routine to help reduce anxiety and promote a sense of security.
Nightmares are normal, especially in preschool-aged children, and usually not a cause for concern unless they are frequent and interfere with daily functioning.
What Are Night Terrors?
Night terrors (also called sleep terrors) are a type of parasomnia—unusual behavior during sleep. They typically occur during non-REM sleep, often within the first few hours of falling asleep. Unlike nightmares, children experiencing night terrors are not fully awake, and they usually don’t remember the episode in the morning.
Common signs of a night terror:
- Sudden screaming, sweating, or thrashing in bed
- Eyes may be open, but the child appears confused or glassy-eyed
- Child is difficult to wake or console
- Episode lasts anywhere from a few minutes to half an hour
How to respond:
- Do not try to wake the child. This can increase confusion and prolong the episode.
- Ensure safety. Gently guide them if they’re moving, and remove anything dangerous from the area.
- Stay nearby and wait it out. These episodes are often more distressing for the parent than for the child.
Night terrors are most common between the ages of 3 and 8, and they often resolve on their own as the nervous system matures. If your child has night terrors, be sure to let babysitters or other caregivers know.
When Should You Be Concerned?
While both nightmares and night terrors are typically harmless, contact your pediatrician if:
- Episodes are frequent or increasing in severity
- Your child is excessively sleepy during the day
- Sleep disturbances are affecting school, mood, or behavior
- There’s snoring, gasping, or breathing pauses during sleep
These signs may point to underlying sleep disorders or stressors that need further evaluation.
Tips for Preventing Nightmares and Night Terrors
- Consistent bedtime routine: Calming activities like reading, warm baths, or gentle music can help prepare the brain for restful sleep.
- Avoid screen time before bed: Especially scary or intense content.
- Keep bedtime and wake-up times consistent, even on weekends.
- Ensure enough sleep. Overtired children are more prone to sleep disturbances.
- Create a soothing sleep environment: Use a nightlight if needed and keep noise to a minimum.
As unsettling as these nighttime episodes can be, they are a normal part of development for many children. With a little understanding and a lot of patience, most kids outgrow nightmares and night terrors. As a pediatrician, I encourage you to keep the lines of communication open with your child, and don’t hesitate to reach out for support if you have concerns about their sleep.
Sweet dreams!
Read Also: 12 Tips for Teaching Children Gratitude
Sky Pittson, MD, July, 2025
Take the first step towards improving your child’s health with pediatric integrative medicine. Call The Village Doctor at (650) 851-4747 or Contact us to learn more about the practice.
