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Night terrors in children

Definition

Night terrors (sleep terrors) are a sleep disorder in which a person quickly wakes from sleep in a terrified state.

Causes

The cause is unknown, but night terrors may be triggered by:

• Fever

• Lack of sleep

• Periods of emotional tension, stress, or conflict

Night terrors are most common in children ages 3 through 7, and much less common after that. Night terrors may run in families. They can occur in adults, especially when there is emotional tension or alcohol use.

Symptoms

Night terrors are most common during the first third of the night, often between midnight and 2 a.m.

• Children often scream and are very frightened and confused. They thrash around violently and are often not aware of their surroundings.

• The child may not be able to respond to being talked to, comforted, or awakened.

• The child may be sweating, breathing very fast (hyperventilating), have a fast heart rate, and widened (dilated) pupils.

• The spell may last 10 to 20 minutes, then the child goes back to sleep.

Most children are unable to explain what happened the next morning. They often have no memory of the event when they wake up the next day.

Children with night terrors may also sleep walk.

In contrast, nightmares are more common in the early morning. They may occur after someone watches frightening movies or TV shows, or has an emotional experience. A person may remember the details of a dream after waking up and will not be disoriented after the episode.

Exams and Tests

In many cases, no further examination or testing is needed. If night terror episodes occur often, the child should be evaluated by a health care provider. If needed, tests such as a sleep study can be done to rule out a sleep disorder.

Treatment

In many cases, a child who has a night terror only needs to be comforted.

Reducing stress or using coping mechanisms may reduce night terrors. Talk therapy or counseling may be needed in some cases.

Medicines prescribed for use at bedtime will often reduce night terrors but are rarely used to treat this disorder.

Outlook (Prognosis)

Most children outgrow night terrors. Episodes usually decrease after age 10.

When to Contact a Medical Professional

Contact your provider for an appointment if:

• Night terrors occur often.

• They disrupt sleep on a regular basis.

• Other symptoms occur with the night terror.

• The night terror causes or almost causes injuries.

Prevention

Minimizing stress or using coping mechanisms may reduce night terrors.

References

American Academy of Pediatrics website. Nightmares and night terrors in preschoolers. www.healthychildren.org/English/ages-stages/preschool/Pages/Nightmares-and-Night-Terrors.aspx. Updated September 30, 2022. Accessed May 19, 2023.

Avidan AY. Disorders of arousal. In: Kryger M, Roth T, Goldstein CA, Dement WC, eds. Principles and Practice of Sleep Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 116.

Owens JA. Sleep medicine. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 31.

Vaughn BV, Basner RC. Sleep disorders. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 374.

Review Date: 4/28/2023

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.