Why do children get nightmares and night terrors?

Whoever it was who coined the phrase “sleep like a baby” has obviously never had one! Many parents may wonder why their child seems to have such difficulty with sleep issues, when other children seem to sleep like angels.

Environmental change

The arrival of a sibling, can cause your toddler to become excessively weepy and clingy, especially at bedtime. Moving into a new home, starting or changing playschool, a change of teacher or caregiver may also cause a problem. The death of a parent, grandparent, or loved caregiver, as well as divorce, may also cause sleep disturbances. Acknowledge his loss with him, and allow him time to grieve with lots of extra hugs and kisses.

If you have returned to work, expect your toddler to be a bit unsettled. Give him time to get used to his new routine. Holidays, or houseguests can disrupt the routine your child has come to know and expect. Try to keep your routine the same as always, even if you are not at home – toddlers need to know what is coming next, and become very confused when things change.

Medical and health issues

Any medical issues need to be addressed, and if you or your child have been hospitalised owing to illness or surgery, it will obviously very traumatic for all concerned – expect your routine to take at least 10 days to settle once you are home.

If your child is ill or teething expect your nights to be a bit wobbly – medicate if necessary. Certain medication can cause side-effects such as insomnia and hallucinations– so be informed before administering any new medication to your child. Always check ingredients of medicine with your pharmacist.

Worm infestation can also cause restless nights as some worms’ eggs are active at night in the anal area, causing irritation and itchiness. De-worm the whole family, including your animals, and check out playschool staff as well. Speak to your healthcare provider about the correct age-appropriate dosages.

Anaemia can cause behavioural problems and frequent night waking, so speak to your clinic sister or pharmacist about a good iron supplement.

Muscle cramps and growing pains can cause restless sleep – ask you pharmacist to recommend a magnesium supplement and give it to him at bedtime.

Inappropriate stimulation

Exposure to too much of the wrong sensory stimulation, for example excessive and inappropriate TV watching in the late afternoon and evening, can over-stimulate your child’s nervous system, impairing his ability to shut down and go to sleep. Rather play some gentle classical music, and keep the TV switched off.

Hyperactivity or sensory overload:

Neurotransmitters are the little chemical messengers which are released at each and every nerve ending as it transmits a message to and from the brain. The balance of stimulating and calming chemicals enables the sensory system to work efficiently in regulating basic automatic functions of sleeping, feeding, heart rate and breathing. In some children, usually owing to genetic factors, the concentration of the neurotransmitters is faulty, and they give irregular and inconsistent messages to the brain. This can manifest in over-active behaviour. We know too, that disturbed sleep patterns can lead to high levels of these chemicals, which cause the brain (nervous system) to be in a more aroused (alert and wakeful) and irritable state. This is largely due to stimulatory chemicals being released when the body is fatigued, and of course, sensory overload. So, the more tired the child is, the more likely he is to be hyperactive and irritable.

Nightmares

Nightmares are part of normal sleep, and are not associated with any specific emotional problems. Nightmares occur when we dream during the REM or light cycle of sleep. If your toddler has a nightmare it is likely that he has been dreaming of normal anxieties and fears, such as falling off a building, or not being able to breathe. In most instances, he may simply call out, but continue to sleep. Older toddlers (approximately four years of age) are more prone to nightmares as their imagination can become overwhelming at this stage. If you can hear that he is getting increasingly distressed, then go to him, wake him up and console and calm him.

If your child has many nightmares, keep a dim night light on in his room – he will be comforted by this. Nightmares are usually a passing phase and have no lasting effect on your child.

Night terrors

Night terrors are different to nightmares in that your child wakes up (usually screaming). He looks terrified and anxious, his heart is pounding, his chest heaving, and he is utterly inconsolable. Night terrors are not bad dreams, and actually occur when he is sleeping deeply. There is not much you can do for your child while he is having a night terror other than holding him tightly and reassuring him that you are there. You may have to wake him up in order for him to recognise you before he will calm down.  Most night terrors subside after a few minutes. However, research has shown that night terrors are common in children with abnormal sleep schedules. If your child is experiencing night terrors, try to encourage a daytime nap, move his bedtime earlier and avoid excessive stimulation and sensory overload during the day, particularly before bedtime.

Sleepwalking

Sleepwalking is unusual in toddlers, although research has shown that sleepwalking is more common if there is a family history. Some children open and close doors or dress and undress. There is no treatment, other than ensuring the environment is safe, then gently taking him back to bed, and tucking him in.

Sleeptalking

Some toddlers will mutter and mumble in their sleep – usually simple phrases like “No more!” or “Go away!” as if they were remembering an event that may have occurred during the day. Try to limit over-stimulation, particularly before bedtime. If your child sounds particularly anxious, take note of what is happening in his world during the day, and if necessary, make some changes.

Head banging and body rocking

About 5–10 per cent of children, usually boys, will bang or roll their heads before falling asleep. In most children this is a normal part of development, and should stop by the time they are four years old. This rhythmic behaviour is often due to sensory overload caused by over-stimulation and overtiredness. By moving their bodies rhythmically, the sensory system is calmed, and the children feel calmer and more grounded. Avoid overtiredness and over-stimulation by encouraging a day nap or some regular quiet time, and move bedtime earlier. Encourage your child to participate in more intensive movement and heavy work during the day (pushing a loaded toy/ wheelbarrow) and lots of outdoor play. Very rarely, head banging and body rocking are associated with underlying neurological diseases. Your paediatrician will be able to diagnose these uncommon conditions if they are present, so if you are worried, please seek medical help.

Teeth grinding:

Teeth grinding during sleep is quite common amongst toddlers, and should improve with age. It has no effect on the quality of sleep, and can occur in any stage of sleep.

Snoring:

Research has shown time and time again that children (and indeed adults too) who snore are not getting the best quality sleep. In children this can result in increased incidence of bedwetting, daytime drowsiness, mood changes, hyperactivity, headaches and impaired performance.

If your toddler has two or more of the symptoms below and is a difficult sleeper please consult your paediatrician for further advice.

  • snoring
  • difficult breathing (or stopping breathing) during sleep
  • restless sleep
  • chronic runny nose
  • mouth breathing when awake
  • frequent colds or middle ear infections
  • sweating when asleep
  • poor appetite
  • difficulty in swallowing
  • excessive day-time sleepiness
  • excessive hyperactivity (not age appropriate).

Structure and routine, early to bed and teaching him healthy sleep habits will result in a happier family and a better behaved and more well- adjusted toddler.

Suggested further reading: 

Sleep SenseFaure,M& Richardson, A:  Metz Press:  2007

Toddler Sense:  Richardson, A:  Metz Press:  2011 (new edition)

Baby Sense:  Richardson, A; Faure, M:  Metz Press:  2010 (new edition)

 

By Sr Ann Richardson

Sr Ann Richardson is the author of Toddler Sense and also co-authored Baby Sense and Sleep Sense. She is a qualified nurse and midwife and has worked in the midwifery and paediatric fields for 30 years. For more information from Sr Ann Richardson go to www.toddlersense.com or email her at info@toddlersense.co.za