Night Terror

Aka: Night Terror, Sleep Terror, Pavor Nocturnus, Fearful Night Crier

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II. Epidemiology

  1. Prevalence
    1. Child: 1 to 6.5% (typically age 1-8 years, resolving by age 12 years old)
    2. Adult: 2.2%
  2. Male predominance
  3. More common during stress or Fatigue
  4. Hereditary

III. Findings: Signs and symptoms

  1. Timing
    1. Occurs 90 minutes into sleep (Sleep Stage III-IV)
    2. Episodes last 10-30 minutes
  2. Sudden Agitation or intense fear
    1. May sit up in bed, scream or cry and run about
    2. May see objects in room as dangerous
    3. May act out in dangerous ways
  3. Frightened, but difficult to awaken or comfort
    1. Eyes open, blank stare
    2. Will not remember episode in morning
  4. Associated signs
    1. Tachycardia
    2. Tachypnea

IV. Differential Diagnosis

  1. Seizure Disorder
  2. Nightmares
    1. Event occurs in REM Sleep in any age patient
    2. Patient is arousable and remembers event

V. Associated Conditions: Other Parasomnias

  1. Sleep Walking
  2. Confusional Arousal

VI. Management: General

  1. Reassure parents (episodes resolve without intervention)
  2. Treat as with other Parasomnias
    1. See Sleep Walking
    2. Ensure adequate sleep and consistent sleep schedule
    3. Ensure safe home

VII. Management: Children

  1. Calm your child
    1. Turn on lights so that child less confused
      1. Eliminates shadows
    2. Say soothing comments "You're alright. You're home"
    3. Speak softly and repetitively
    4. Shaking and shouting child only prolongs attack
      1. Does not awaken child sooner
    5. Hold child if it seems to comfort him
  2. Protect your child
    1. Child can fall down stairs, run into wall
    2. Attempt to direct back to bed gently
  3. Prepare baby sitters
    1. Describe Night Terror and what to do if one happens
  4. Help child discuss fears
    1. What frightens him during daytime?
  5. Consider Prompted Sleep Awakening Technique

VIII. Management: Infants

  1. Stay with your child if he is fearful
    1. Stay at crib until infant is calm
      1. Do not lift child out of crib
      2. Sit quietly in a chair in the room
    2. Consider listening to music via headphone
    3. Avoid talking after initial comforting remarks
  2. Leave briefly every 15 minutes
    1. Return after 1-2 minutes
    2. Helps habituate against Separation Anxiety
    3. Leave the door open and the night light on
  3. During the day, show love, attention, affection
    1. Hug, cuddle and comfort generously
    2. Carry about in a backpack or front sling
    3. Play separation games during the day
      1. Peekaboo
      2. Hide-and-Seek
      3. Chase me
  4. Reference
    1. Schmitt (1991), Your Child's Health [PubMed]

IX. References

  1. Carter (2014) Am Fam Physician 89(5): 368-77 [PubMed]
  2. Pagel (2000) Am Fam Physician 61(7):2037-44 [PubMed]
  3. Thiedke (2001) Am Fam Physician 63(2):277-84 [PubMed]

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