Though parents wish their children sweet dreams, most kids have occasional nightmares. These scary dreams occur during REM — or rapid eye movement — sleep, and children often recall at least part of the frightening or unpleasant dream upon awakening. Some adults, too, have nightmares, though it’s less common than in kids.
For children troubled by nightmares, comfort from parents is usually all that’s needed to soothe them. “Talk to them, hug them, kiss them — give them a lot of reassurance,” suggests Dr. Marc Weissbluth, a clinical professor emeritus of pediatrics at the Feinberg School of Medicine at Northwestern University in Chicago who has studied sleep issues in children.
In addition to nightmares, another common frightful sleep problem some children face is night terrors, which usually begin within a couple hours of a child falling asleep. “It can last five to 15 minutes and the child looks panicky — very frightened,” he notes. Harrowing for parents too, a child may sit up in bed, appear wide awake with a glassy stare and be inconsolable, but he or she won’t awaken during the episode and will quickly return to normal sleep. “Because it’s not occurring during REM sleep, they have no memory of the episode, and it tends to occur mainly when kids are having fevers and when they’re overtired,” Weissbluth says. He notes that these instances tend to dissipate by adolescence.
[See: How to Promote Safe Sleep for Your Infant.]
Parents — as well as some adults who have an occasional scary dream — may rest easier knowing that nightmares and night terrors typically don’t signal serious issues affecting a person’s waking life. In cases where bad dreams persist, however, experts say these nocturnal scares could have an impact on a child’s quality of life and, in fact, be a sign of underlying medical or mental health concerns.
“There are no well-established criteria regarding nightmares as a possible red flag that would lead one to consult with maybe a child psychologist or child psychiatrist,” Weissbluth says. Parameters don’t exist indicating when persistent nightmares might be cause for having a medical consult, echoes Dr. Ranji Varghese, a psychiatrist and sleep medicine physician and medical director of Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center in Minneapolis. But if parents feel like their children’s behaviors are changing because of the nightmares, or if they sense that a child’s mood has changed or anxiety has increased either following the nightmares or leading up to them, he says, it might be worth raising the issue with a child’s primary care provider or a therapist. “If the nightmares continue, that might trigger a consultation [with] a sleep physician and ideally a pediatric sleep physician,” Varghese says.
Sometimes the fix may be exceedingly simple, like turning off scary shows or videos kids probably shouldn’t have been watching before bed anyway. Children tend to incorporate into their dreams whatever they may have experienced before bedtime, points out Dr. Suresh Kotagal, a pediatric neurologist and sleep specialist at the Center for Sleep Medicine at Mayo Clinic in Rochester, Minnesota.
If a child is frequently having nightmares for weeks or months on end — especially if they’re often awoken by the dreams more than once a night — it’s also worth taking notice, Weissbluth says. Experts advise parents talk to a child’s doctor about frequent nightmares, particularly if they have concerns about other issues as well, like that the child is more anxious than normal, having trouble paying attention during the day or abnormally distracted by the thought of having more nightmares. For adults and children who have been physically or sexually abused or exposed to other form of trauma, nightmares can be a symptom of post-traumatic stress disorder, or PTSD.
Intervention by a health or mental health professional may also be warranted if a person has been essentially repeating the same bad dream over and again for weeks or months. “Often they may be a marker for some underlying anxiety,” Kotagal says of recurring nightmares.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
According to limited research, including a 2015 study published in British Journal of Psychiatry, frequent nightmares and night terrors in childhood might be associated with an increase in psychotic experiences, like hallucinations, later on. “It is likely that in some individuals, nightmares and night terrors have little significance to later psychopathology,” the researchers wrote regarding implications of the 2015 study. “However in individuals with additional risks such as a family psychiatric history or a past trauma exposure by adults or peers, such sleep problems may have greater significance and may also highlight other unnoticed psychopathology or trauma.” But for the vast majority of kids, scary dreams aren’t related to underlying psychological or emotional issues, emphasize experts not involved in that research.
Another sleep disorder that goes bump in the night — REM sleep behavior disorder — is commonly attached to severe underlying medical issues. Typically diagnosed in adults, it often occurs before the onset of neurodegenerative disease, like Parkinson’s. Where normal muscles are paralyzed during REM sleep, so we can’t act out our dreams, that’s not the case for people with REM sleep behavior disorder. “They punch and scream and kick and flail, fall out of their bed, people have punched their partners, people have jumped out windows,” says Varghese of the Minnesota Regional Sleep Disorders Center, where the disorder was first discovered in the mid-1980s.
“In children we can also see REM sleep behavior disorder, though it’s not related to any degenerative brain disease,” Kotagal says. “When we see REM sleep behavior disorder in children, there may be underlying conditions like narcolepsy or it may be related to medications,” like the antidepressant medication selective serotonin reuptake inhibitors, or SSRIs.
Weissbluth says parents should also take note of another seemingly innocuous issue, which they might not think of as relating to nightmares: snoring. “All kids snore a little bit,” he says, such as due to allergies or common colds. “But if it’s chronic and severe, then that’s a medical problem, which should be attended to — sleep apnea — and may be associated with nightmares.” Though most commonly diagnosed in adults, he says sleep apnea is a significant and underrecognized issue in some children. So as not to miss it, he recommends parents sometimes check in on kids when they’re asleep, and talk to their doctors if they are snoring heavily.
Everything from schedule — a jam-packed three-day weekend to medications, like SSRIs — can also contribute to the presence of night terrors and nightmares. So clinicians recommend parents take a hard look at daily and bedtime routines to make sure children get ample rest and aren’t overtired.
[See: Is it Healthy to Sleep With Your Pets?]
For children wrestling with frightening dreams, therapists can help patients and parents work through underlying issues like anxiety or even re-script a child’s dreams, Kotagal notes, essentially suggesting an alternate ending. For many young children, the power of suggesting a happier ending to overcome fears, say of the monster in the closet, may be enough. “I think the parents can take control of that situation, hold the child’s hand and just get the flashlight and turn the lights off and say, ‘Look, it’s just a blanket,'” Kotagal says. “It’s not a monster.'”
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