Sleep disorders in children: when to see a specialist?

Nightmares and night terrors are parasomnias. They are infantile behavioral changes that take place during sleep, characterized by motor and vegetative behaviors that occur during times of sleep and partial wakefulness.

How do nightmares differ from night terrors?

Nightmares occur in the second half of the night and in the REM phase. In these cases children wake up easily and remember what happened, often the dream itself. They recognize their parents and ask, out of fear, to be comforted, which also prevents them from falling asleep at first.

On the other hand, night terrors occur during the first half of the night, children do not recognize their parents and may even reject them. Also, many alarming physical manifestations appear, being common for the child to sit up in bed and scream, sweat, cry with a terrified facial expression and signs of intense anxiety (pupils may be dilated and tachycardia may appear). As far as sleep recovery is concerned, they fall back to sleep easily. But they do not usually wake up even with their eyes open or with efforts to do so, which is inadvisable. However, if awakened, the child is disoriented for a few minutes and with a sense of fear, there is total amnesia of what happened. Although the episodes of night terrors can be alarming for the parents since they tend to think that something serious is happening to the child or that he/she is suffering, most of the children overcome them when they grow up, being of great help the orientation of a specialist who facilitates personalized educational guidelines.

Why do they occur?

Children are very susceptible to everything that happens around them. A certain situation can provoke an elevation of their anxiety and manifest it in their dreams. If the nightmares are sporadic, and the children receive understanding and support, it will be only a passing and simple restlessness, but if it is not solved it can lead to anxious manifestations and that the nightmares are daily and frequent.

Normally, nightmares last a few weeks and are related to some external stimulus that has alarmed the child. As soon as the anxiety decreases, the nightmares also disappear in frequency and intensity.

Night terrors may be due to different factors. Sleep is an evolutionary process, so it does not reach maturity until the age of five or six. Experts affirm that these alterations usually improve with age through brain maturation.

At what age do they usually appear?

They may start between 6 and 7 months, being more frequent between 2 and 6 years of age.

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How can the child be reassured?

For nightmares

  • Try to avoid environments that may frighten the child.
  • Reduce daytime stress generated by the child’s environment.
  • Seek a calm environment before going to sleep.
  • Explain to them how the day has gone, it will help them also to comment on it and express their emotions. Or if they are very young through drawings or playing with puppets.

After the nightmare:

  • Go to their room to reassure them, take away the importance of what happened and stay with them for a while until they start to fall asleep.

In night terrors

  • Prevention is the best, try to make children go to sleep more rested and calm. Avoid any kind of screen (TV, computer, tablet or cell phone) one hour before going to sleep.
  • Before the moment of night terror there must be a conservative attitude of the parents, watching that the child does not fall out of bed or hit himself.
  • Be by his side in a discreet way because if we try to catch him he may not want to.
  • Do not try to wake him/her up.
  • The episode will subside after 4 or 5 minutes, and may persist for up to 15 minutes.

Both in nightmares and night terrors it is necessary to help the child feel calm and quiet when bedtime approaches. It is also very useful to create a pleasant routine for the child such as telling a story or listening to a soothing melody, which will help the child to be calm at bedtime. Then it is best to leave him in his room and say goodnight. In the case of young children, it is important to talk about their fears to help them overcome them. What is counterproductive is to laugh at their fears or minimize them. However, we should not feed back their fears, but explain to them that they have the strength to face and overcome them.

When to see a specialist?

It would be advisable to see a specialist in Child and Adolescent Psychiatry when we observe the following warning signs: Sleep disorders due to educational causes, fear of sleeping, insomnia, hypersomnia or obstructive apnea. Also when the child presents night terrors, sleepwalking and bruxism. And finally, when there is somniloquy, ofensa capitis and narcolepsy.