Night terrors in babies - signs, causes and treatment

What are night terrors?

A night terror is a condition that typically occurs early in the night, where children wake up screaming or crying intensely, appearing to experience strong fear and panic. During a night terror, the child experiences what's known as a partial awakening—meaning they are partially awake but still in a state between sleep and wakefulness.

During the episode, the child may sit up, flail their arms, and sometimes speak incoherently. They may have a glassy-eyed stare and often seem unresponsive when parents try to wake or comfort them.

In younger babies and toddlers, night terrors may look slightly different and can be harder to distinguish from other types of nighttime crying. The child may wake up crying inconsolably and be difficult to soothe, only to fall back asleep afterward.

Typically, these episodes last just a few minutes, after which the child can usually return to a calm, deep sleep. Most of the time, they have no memory of the event the next day.

Night terrors generally happen only once per night during the first three hours of sleep and don’t usually occur during daytime naps. About 5 percent of all children experience night terrors. As a parent, witnessing your child go through a night terror can be distressing, but it’s reassuring to know that the child typically doesn’t remember the episode and that night terrors are harmless and tend to resolve over time.

Night terrors vs. nightmares

Night terrors are not believed to be caused by dreams, as they don’t occur during the sleep stage where we typically dream most intensely (REM sleep). Instead, they happen during the transition from deep sleep. If an older child is awakened during an episode, they usually do not remember a dream, or they might recall only fragments. More often, they describe a strong feeling of perceived threat or danger rather than a specific dream.

What causes night terrors?

Night terrors can have several causes, although the exact reasons they occur are still not fully understood. One significant factor appears to be the child’s development. Many children outgrow night terrors as they get older, suggesting that the maturation process plays an important role.

The environment and the child’s physical health can also influence night terrors. In some cases, episodes are more easily triggered if the child has experienced severe stress, has a fever, or has had previous sleep deprivation.

Research also points to a potential genetic link. One study found that the occurrence of night terrors was 60% if both parents had experienced them. Additionally, night terrors have been shown to be more common among identical twins than fraternal twins.

Can babies have night terrors?

Night terrors are most common in preschool-aged children, and their occurrence in children under 1.5 years old has not been extensively studied. However, many parents report experiencing night terrors in children around 1 year old, and sometimes even earlier.

Therefore, it’s possible that night terrors can occur in younger babies, even if they are less common. In many cases, these episodes may instead be another type of awakening or crying that is difficult to distinguish from night terrors in babies.

Other possible causes

In babies and young children, several factors can cause them to wake up and cry at night, and these episodes can sometimes be mistaken for night terrors. Understanding the different reasons for nighttime awakenings can help you identify the cause and provide the right kind of comfort and care.

Normal awakenings with crying and/or screaming

It’s normal for babies to wake up and cry or scream at night as a way of communicating their needs. They may be hungry, cold, have a wet diaper, or simply wake up needing comfort and security. Understanding these common reasons for nighttime awakenings can help you respond to your baby’s needs more effectively.

Active sleep

Newborn babies have sleep stages that differ from the sleep stages that develop between 2-5 months of age. Instead of the four sleep stages that older infants and adults experience, newborns have only two: quiet sleep and active sleep.

Active sleep in newborns corresponds to our REM sleep, the most active sleep stage where we often dream most intensely. During REM sleep in adults, our bodies are paralyzed to prevent us from acting out our dreams. However, in newborns, this paralysis doesn't occur. As a result, during active sleep, newborns may twitch, kick, grimace, and even scream or cry.

Despite these movements and sounds, the baby’s eyes remain closed, and they are still asleep. In fact, during active sleep, newborns are not unresponsive or difficult to wake—quite the opposite. They may easily respond to a parent's touch or voice.

Sometimes, a newborn may even wake themselves up with their movements and sounds during active sleep, becoming frightened and crying as a result.

Moro reflex

The Moro reflex is a strong, innate reflex in newborns that is triggered by sudden movements or loud noises, such as a snap in the room. When this reflex occurs, the baby reflexively flings their arms and legs out in a clinging motion and may take a sharp breath. The reflex can be triggered even while the baby is sleeping, and if it’s strong enough, it may cause the baby to wake up, become frightened, and cry. The Moro reflex is more pronounced and easily triggered in younger babies and typically disappears around 4-6 months of age as their nervous system matures.

Illness and discomfort

If a baby has a cold, ear infection, or other physical discomfort, it can disrupt their sleep and cause them to wake up crying. Addressing the underlying discomfort and providing extra comfort can help soothe your baby during these times.

Reflux

Reflux is a condition where stomach contents, including stomach acid, move up into the esophagus, causing discomfort or pain in babies, especially when they’re lying down. If this happens during sleep, it can cause the baby to wake up and cry.

If you suspect your baby has reflux, it’s important to contact your pediatric nurse or other healthcare professionals for advice. They can help you manage and reduce the symptoms, ensuring your baby is more comfortable during sleep.

Recommendations and treatment

Night terrors can be a stressful experience for parents, but it's reassuring to know that they are usually harmless and that the child typically does not remember the episode the next day.

If your child experiences night terrors, try to stay calm and let the episode pass without waking them. Instead, focus on helping your child settle back to sleep calmly.

Preventing overtiredness or overstimulation during the day can also help reduce the likelihood of night terrors. Monitoring your baby's wake windows and signs of tiredness, as well as establishing a calm and consistent bedtime routine, can make a big difference in reducing stress and tiredness.

If night terrors become recurrent or very disruptive, it's a good idea to contact your pediatric nurse or pediatrician. In some cases, talking to a doctor or child psychologist for advice and support may be helpful.

If your child is taking any medications, discussing the night terrors with a healthcare provider can help determine if they might be a potential side effect.

In certain cases, your doctor may suggest trying a method called scheduled awakenings. This involves gently waking your child 15-30 minutes before the usual time of the night terror and then helping them fall back asleep. This approach has been shown to prevent night terrors, but it should always be done under the guidance of a healthcare professional.

As a parent, it’s natural to feel helpless when your child experiences night terrors, but remember that they are harmless and that your child likely won’t remember the episode the next morning. If you have any concerns or worries, don't hesitate to reach out to your pediatric nurse or pediatrician for reassurance and support.