Unlike toddler nightmares, which often feature monsters under the bed followed by a swift cry for snuggles, night terrors in toddlers happen before dreams have had the chance to occur. The result? Odd behavior that’s impervious to comfort.
“Night terrors, also called sleep terrors, are a type of sleep disturbance that occur when someone’s brain is both awake and asleep at the same time,” explains Margaret Canter, a clinical psychologist and assistant professor at the University of Alabama at Birmingham Department of Pediatrics. “During a night terror, someone may scream, cry, thrash their body, sweat, have an increased heart rate or even sit up or get out of bed and sleepwalk.”
From the causes of toddler night terrors to advice for handling them, here’s what experts have to say about night terrors in kids.
“Night terrors can create a lot of fear in others because the individual is unresponsive — due to being asleep — difficult to wake up, not easy to soothe and has no memory of the incident the next day.”
— Margaret Canter, clinical psychologist and assistant professor, University of Alabama at Birmingham
What are toddler night terrors?
Night terrors, in general, can be described as “sudden and partial arousals from sleep, often accompanied by a cry or piercing scream,” explains Kelsey Alford, a pediatric nurse practitioner, sleep specialist and owner of Nested Sleep in Leesburg, Virginia. “They are believed to result from incomplete arousal from slow-wave sleep.”
“Night terrors can create a lot of fear in others because the individual is unresponsive — due to being asleep — difficult to wake up, not easy to soothe and has no memory of the incident the next day,” adds Canter.
Night terrors usually occur within one to three hours of sleep onset, notes Alford, during the first third of the sleep and almost always in the first half of the sleep.
What causes night terrors in children?
Night terrors occur when a child is going from a deep early phase of sleep into their REM sleep, according to Dr. Brandon Smith, assistant professor at the Johns Hopkins School of Medicine in the Department of Pediatrics. “There’s an overexcitement of their nervous system that causes the ‘terror’ during the change in sleep state,” he explains. “Typically, this change in sleep states is quiet and smooth.”
As for episode triggers, the exact cause is more or less unknown, says Canter. However, she notes, the following may cause a night terror:
- Fever.
- Not getting enough sleep/being overly tired.
- Obstructive sleep apnea.
- Feeling overly stressed/anxious.
“Genetics can also play a role,” Canter adds. “Children whose parents have other sleep disorders may be more likely to have night terrors.”
What do night terrors look like?
According to Alford, in a typical night terror, “your child awakens abruptly from sleep, sits upright in bed or jumps out of bed, screams in terror and intense fear, is panicky and has a frightened expression.”
Most night terrors, she adds, usually last no more than a few minutes, but some may last up to an hour.
Other night terror symptoms, according to Canter, can be:
- Crying.
- Kicking.
- Hitting,
- Thrashing.
- Increased heart rate.
- Sweating.
- Inconsolable.
Alford notes that if a child is having frequent night terrors “there often may be a medical trigger, such as nocturnal asthma, gastroesophageal reflux, obstructive sleep apnea syndrome, periodic limb movements, restless leg syndrome and more.”
“Most kids outgrow night terrors by their teenage years. Night terror symptoms look pretty similar regardless of age.”
— Margaret Canter
Do older kids get night terrors?
Night terrors are most common in children ages 3-7 but can occur in kids ages 1-12, notes Canter. In a 2020 study published in the National Library of Medicine, it was noted that the peak age for night terrors is between 5 and 7 years of age.
“Most kids outgrow night terrors by their teenage years,” Canter says, adding: “Night terror symptoms look pretty similar regardless of age.”
Older children, Alford notes, “are more likely to develop other types of parasomnias, such as sleepwalking.”
How are night terrors diagnosed?
A medical doctor can make the proper diagnosis after taking a full medical history and performing a physical exam. “Sometimes,” notes Canter, “the doctor will recommend an EEG or a sleep study if there is a concern that something else may be going on/causing the symptoms.”
Videos and sleep logs can also be helpful to show your child’s provider,” adds Alford.
Treatment of night terrors in kids
Treatment depends on the cause of the night terror, but it is always recommended to “have your child maintain a regular sleep schedule and achieve an appropriate number of hours of sleep per night, as sleep deprivation can worsen night terrors,” Alford says. Do not try to wake your child up during an episode, but rather keep them safe in their sleep environment by sitting quietly nearby and waiting for the terror to pass.
When to see a doctor
According to Canter, parents should consult a doctor if a child’s night terrors are:
- Occurring multiple times per night or per week.
- Lasting longer than 30 minutes.
- Negatively impacting the child’s sleep to the point they are sleepy during the day.
- Causing the child to get injured.
“If warranted, the doctor will run tests to ensure that there is not an underlying cause or something else that is going on that may look like a night terror and/or treat the injury,” she says.
The bottom line
Typically kids outgrow night terrors, but “if you believe your child is experiencing them, consider seeing their health care provider for the best course of action,” Alford says.
“Although night terrors are often considered normal in children, they can be difficult to distinguish from other disorders,” she adds. “Your child’s provider can confirm a diagnosis of night terrors, rule out other issues and advise on how to best manage them.”
