Sleep Disturbances in Infants: Causes and Solutions - Pediatrics

Dr. Pei Rensheng reply Pediatrics

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Hello: It could be night terrors or nightmares! Has your child ever suddenly cried out loudly while sleeping, sometimes screaming and kicking, appearing very frightened? When you rush over to comfort them, they might be crying out for mom or dad but completely ignore you.
The more you try to hold them, the more they struggle.
Some children even get out of bed and move around as if they are sleepwalking.
This situation is referred to as night terrors, which is not the same as what we think of as nightmares.

What are the differences between night terrors and nightmares?
* Timing: We know that a full night’s sleep consists of several cycles, which can be roughly divided into non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep.
Typically, we dream during REM sleep, which is lighter sleep and mostly occurs in the latter half of the night.
Night terrors, on the other hand, occur during the deep sleep of NREM, usually in the first half of the night.

* Behavior: When a person wakes up from a nightmare, they may feel scared, and children might cry out in fear, but they are usually easier to soothe with a hug or a pat from a parent.
However, children experiencing night terrors are difficult to calm down; they cry and scream, and may even resist physical contact from their parents.
Sometimes, a child might call out for their mother while pushing or hitting her, as if the person trying to comfort them is a stranger.

* Memory: People who wake from a nightmare generally remember some fragments of the dream the next morning, at least knowing they had a dream.
In contrast, children who experience night terrors have no recollection of the event the following morning.
So, if night terrors are not nightmares, what are they? Night terrors typically occur in children aged three to seven, with a higher prevalence in boys.
They often happen within the first third of the sleep period, during which the child may appear very frightened and confused, crying and thrashing about.
They may also sweat, breathe rapidly, have an increased heart rate, and dilated pupils.
Some may even get out of bed and move around as if sleepwalking, but all of this occurs unconsciously, and the child usually does not recognize their surroundings or the parents who come to comfort them.
Currently, there is no clear medical explanation for the causes of night terrors.
However, it is generally estimated that most children will gradually change their sleep habits after the age of three, with a significant reduction in daytime napping, or even stopping it altogether.
At the same time, the child's nervous system may not immediately adapt to this change.
When transitioning from deep sleep to the next stage of sleep at night, the brain may not adjust properly, leading to night terrors.
Therefore, night terrors typically occur two to three hours after the child falls asleep.
During a night terror, the child is still in deep sleep, so despite their loud cries, their eyes may be open, but their brain is asleep, which is why they resist comforting from their parents; they cannot see them.
Because they are still asleep at this time, they will have no memory of the episode the next morning.
What can parents do? Most children who experience night terrors will gradually overcome this sleep disorder as they grow older, and parents do not need to take any special actions.
Night terrors usually last 10 to 20 minutes, after which the child will return to sleep.
Furthermore, the next morning, they will have no recollection of what happened, and parents do not need to discuss the incident with the child or their siblings to avoid adding to their psychological burden.

In general, during a night terror, children may feel a sense of being restrained or bound.
If parents try to comfort them with hugs at this time, it often backfires, as the embrace may only make the child feel more constrained.
This is why children experiencing night terrors strongly resist physical contact from their parents.
At this moment, verbal reassurance is more helpful than physical contact; parents can gently talk to the child or sing some of their favorite lullabies to help them calm down.
Of course, it is also important for parents to ensure that the area around the bed is safe to prevent the child from injuring themselves while thrashing about and screaming.
Night terrors can be triggered by illness or stress, but if there are no external causes, the most likely trigger is the child being overly tired before bedtime.
If this is the case, parents can help reduce the occurrence of night terrors by adjusting the child's daytime schedule, carefully assessing whether the child is too active during the day or going to bed too late at night, etc.
Arranging an appropriate amount of activities for the child and maintaining a stable and sufficient sleep schedule is the best way to prevent night terrors.
If parents notice that the child’s night terrors occur around the same time each night, they might consider waking the child 30 minutes before this time to use the restroom or quietly read a book together before going back to sleep, which may help avoid night terrors.
Finally, parents should be vigilant for any extreme behaviors.
For instance, if night terrors occur very frequently and severely affect the child's sleep, or if the child exhibits self-harming or harmful behaviors during night terrors, parents should seek medical attention to prevent the situation from worsening.
Wishing you health and happiness!
Dr.
Pei Ren-Sheng, Attending Physician, Pediatrics, Taoyuan Hospital, Ministry of Health and Welfare.

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Reply Date: 2016/11/30