Sleep disorders occur in 35 to 45 percent of children ages 2 to 18 years, with peak incidence in children ages 3 to 6 years.
Nightmares occur sporadically in many children and are frightening events for the entire family. Nightmare disorder is characterized by repeated episodes of a frightening or unpleasant dream that disrupts the child’s sleep. The child’s reaction often interrupts the parents’ sleep as well. On awakening from a nightmare, a child is alert and aware of the present surroundings, but the sleep disturbance causes distress and impairment in everyday functioning.
Nightmares are often confused with the parasomnia known as night terrors, which, as noted earlier, are episodes of extreme panic and confusion associated with vocalization, movement, and autonomic discharge. Children with night terrors are difficult to arouse and console and do not remember a dream or nightmare.
Other considerations include:
- Nightmares are not associated with specific physical findings.
- Heart rate and respiratory rate may increase or show increased variability before the child awakens from a nightmare. Mild autonomic arousal, including tachycardia, tachypnea, and sweating, may occur transiently upon awakening.
- Approximately seven percent of individuals who have frequent nightmares have a family history of nightmares.
- Nightmares are more common in children with mental retardation, depression, and CNS (central nervous system). An association also has been reported with febrile illnesses.
- Medications may induce frightening dreams, either during treatment or following withdrawal. Withdrawal of medications that suppress REM (rapid eye movement) sleep can lead to an REM rebound effect that is accompanied by nightmares.
- Nightmares may result from a severe traumatic event and may indicate post-traumatic stress disorder.
Management of nightmares is based on reassurance. Although all stressors cannot be removed from a child’s life, parents can attempt to make bedtime a safe and comfortable time. Parents should be encouraged to spend time in the evening reading, relaxing, and talking with the child.
If the child has a recurring nightmare, it may help to have parents encourage the child to imagine a good ending. Psychological evaluation is indicated when nightmares occur more than twice a week over several months. Medications are neither helpful nor indicated.