Night Terrors vs Nightmares: How to Tell and What to Do

Telling them apart

• Night terror: happens in the first third of the night, often 1 to 3 hours after falling asleep. Your child screams, thrashes or sits up with eyes open, sweaty and breathing fast, but isn't really awake, doesn't know you're there and may push you away. Afterward they drop back to sleep quickly and remember nothing in the morning.
• Nightmare: happens later in the night or toward morning. Your child truly wakes up, crying and scared, knows you and wants comfort. They may remember the dream and take a while to settle.

Night terrors

• They come from partial waking out of very deep sleep, not from a bad dream. They look far worse than they are; your child isn't suffering the way it seems.
• Most common between about 3 and 7, though they can start around 18 months. They often run in families and usually fade by the school years.
• What to do: stay close and keep your child safe from falls, furniture and stairs. Don't try to wake them or hold them tightly; that tends to make it longer. Speak softly if it helps you, and wait. Most episodes end within a few minutes, sometimes up to 30.
• Don't quiz them about it the next day. They won't remember, and it can make them anxious.
• If they happen at the same time most nights: some pediatricians suggest scheduled waking. Gently rouse your child about 15 to 30 minutes before the usual episode time, every night for 2 to 4 weeks, then let them go back to sleep. Ask the doctor first.

Nightmares

• They become common around 2 to 3, as imagination grows, and often follow a busy, stressful or scary day, a new sibling, a move or starting childcare.
• What to do: go to them quickly, hold them, and keep it calm and brief. Use simple, sure words ("It was a dream. You're safe. I'm right here."). A night light, a comfort object or a door left open can help.
• Talk about it in the daytime, not at 2 a.m. Drawing the dream and then changing the ending, or reading books about fears, can make it smaller.
• Avoid scary shows, games and stories, especially in the hour before bed. Even content meant for older siblings can stick.

Sleepwalking

• Also comes from deep sleep, usually in the first part of the night, and is common in children from about 4 to 8.
• Gently steer them back to bed without waking them. Safety comes first: gates on stairs, locked outside doors and windows, and nothing sharp or breakable on the floor. Children who sleepwalk shouldn't sleep in the top bunk.

Overtiredness makes it worse

• Night terrors and sleepwalking happen more when children are short on sleep, sick, have a full bladder, or sleep somewhere new. A steady bedtime, enough total sleep for their age, and a dropped nap made up with an earlier bedtime all help. See the toddler sleep guide for amounts.

When to check in

Mention it at the next checkup if: - Your child snores loudly most nights, has pauses in breathing or gasps in sleep. This can be sleep apnea, which can trigger night terrors and is treatable. - Episodes are frequent (several a week), last more than about 30 minutes, or happen in the second half of the night. - Your child is very sleepy, cranky or struggling during the day. - Nightmares or fears are getting worse, come after something frightening, or affect daytime life. - Your child gets a minor bump during an episode.

Call the pediatrician the same day if an episode involves stiffening, rhythmic jerking, staring, drooling, or your child is very hard to rouse afterward, since these can be signs of a seizure rather than a night terror; call 911 if your child stops breathing, turns blue or gray, or is badly hurt.