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Afraid and confused: understanding childhood parasomnias

Filed in
  • Parasomnias
  • nightmares

Sleep Education Archive  |  Jul 10, 2007
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Parasomnias are sleep disorders that involve undesirable events and experiences. They occur during sleep, as you fall asleep or as you wake up. These sleep-related behaviors are very common in children and for the most part are a normal part of childhood.

Parasomnias begin to appear as a young child’s brain and body continue to grow and develop. This type of sleep problem often occurs in children who are healthy and happy. In the vast majority of children these sleep-related behaviors tend to go away without treatment as the child enters the teen years. These behaviors are considered a disorder when they occur repeatedly over more than three months and disrupt the lives of the child and/or the family.

Parasomnias often cause a child to appear confused or afraid. In many cases, these episodes disturb the parent or sibling much more than the child. Usually the child never becomes completely awake. He or she often has no memory of the event when morning comes.

In almost all cases a parasomnia is unrelated to any kind of mental problem in children. There are some common factors that can trigger episodes of parasomnias. These factors include:
  • Sleep deprivation
  • Stress
  • New surroundings
  • Fevers
When parasomnias are recurrent over time there are other sleep disorders that can be the trigger. These include:
Although parasomnias tend to be common and harmless, they can be a severe problem for some children. Parents should contact a sleep specialist if a sleep problem greatly disturbs their child.

These are five parasomnias that are common in children:

1. Nightmares

Nightmares are the parasomnia that is most disturbing to a child. They involve dreams that seem very real. The action in these dreams tends to involve some kind of danger or threat. Dream content will depend on the age and development of the child.

Nightmares occur more often in the last half of the sleep period. A child responds to a nightmare by waking up suddenly. He or she quickly becomes alert and usually responds by crying. Unlike other parasomnias, nightmares cause the child to seek comfort from the parent.

The child often is able to recall clear details of the nightmare. But a young child may have a hard time describing the dream. He or she may be afraid to go back to sleep. The child may ask to stay with the parent for the rest of the night.

It is very common for children to have nightmares. They tend to begin having nightmares between the ages of three and six. The frequency of these disturbing dreams peaks between the ages of six and 10. Most children then begin to have nightmares less often. Some children will continue to have frequent nightmares as teens and adults.

A nightmare disorder may develop if a child has frequent nightmares that wake him or her from sleep. This disorder can cause anxiety, sleep loss and daytime problems. In some children nightmares may be a sign of post-traumatic stress disorder. This problem occurs when the child experiences a traumatic or stressful event. In his or her dreams the child may re-enact the event.

2. Sleep terrors

Sleep terrors, also called “night terrors,” have features that are similar to nightmares. They also involve intense feelings of fear. Yet sleep terrors are much less disturbing to the child. He or she rarely wakes up fully during an episode. Unlike nightmares, sleep terrors tend to occur in the first half of the night.

For a parent or caregiver, sleep terrors may be the most disturbing childhood parasomnia. The child sits up in bed and makes a loud, piercing scream or cry. The child has a look of intense fear on his or her face. Other physical signs also may occur. These include:

Sweating
Rapid breathing
Rapid heart rate
Wide-open eyes
Muscle tension
Sleep terrors tend to pass in less than five minutes. A child who is having an episode often resists being comforted. It usually is better if the caregiver does not try to wake the child. If left undisturbed, he or she returns to sleep quickly.

Sleep terrors are not as common as nightmares. They occur in up to six percent of children. Episodes tend to emerge in children between the ages of four and 12 years. A child usually stops having episodes as he or she enters the teen years.

3. Sleepwalking

Like sleep terrors, sleepwalking occurs most often in the first half of the night. A child tends to be fairly calm and quiet during an episode of sleepwalking. After sitting up in bed, he or she gets up and begins to walk around. The child may walk toward a light or into the parents’ bedroom. Although the child is still asleep, his or her eyes are wide open. The eyes have a confused, “glassy” look to them.

Sleepwalkers can move about well without running into anything. Sometimes a child may walk down a flight of stairs, toward a window or out a door. This can put the child at risk. But injury or harm to a child during sleepwalking is rare.

A child can be hard to awaken while sleepwalking. Typically an episode ends within five to 15 minutes. Sometimes the sleepwalking may end with the child in an unusual place. Once he or she is awake, the child is likely to be very confused. With no memory of the event, he or she does not understand what is happening. The child may be frightened if the caregiver displays strong fear or panic. In some cases the child may return to bed and continue sleeping without ever becoming alert.

Sleepwalking is very common in children. It can begin as soon as a child is able to walk. Almost one out of every five children sleepwalks. A child is more likely to sleepwalk if one or both parents have a history of the disorder. Episodes of sleepwalking peak between the ages of eight and 12 years. In most children sleepwalking ends as the child enters the teen years.

4. Confusional arousals

Confusional arousals also occur in the first half of the night. The child sits up in bed with a bizarre, confused look on his or her face. The child may appear to stare unresponsively at the caregiver.

An episode also may include confused speech, yelling, and thrashing in bed. It can be very hard to awaken the child. Some symptoms of confusional arousals may be similar to sleep terrors. But confusional arousals do not involve the symptoms of intense fear that are common in sleep terrors.

Trying to comfort the child may make him or her even more agitated. Episodes tend to end in five to 15 minutes. But in some children they may last as long as 30 to 40 minutes. Although the episodes may frighten parents, the child normally has little or no memory of the event.

Confusional arousals occur in almost one out of every five children. Young children who have confusional arousals often sleepwalk when they are older. Confusional arousals tend to be harmless to the child. They occur less often in children after the age of five years.

5. Bedwetting

Bedwetting, known as “sleep enuresis,” is a common problem of childhood. Urinating is a reflex for infants when they are asleep and awake. This occurs up to about 18 months of age. From 18 months to about three years of age, a child learns to delay urination when the bladder is full.

First the child learns to do this while awake. At a later age, he or she learns to do this while asleep. The developmental maturity of the child will help determine the age at which he or she gains this skill.

Most children should be able to control their bladders during sleep by the time they are about five years of age. Thus bedwetting is not considered a sleep disorder unless it occurs at least twice a week in a child who is at least five years of age. A child who has been staying dry may begin to wet the bed after a period of stress. This includes such things as a parental divorce or physical abuse.

Bedwetting also can result from a problem or infection in the urinary. In some children it can be related to a problem in the body’s production of a hormone called “vasopressin.” The body normally increases the amount of vasopressin during sleep. This hormone reduces the amount of urine that the kidneys produce. If the child’s body does not produce more vasopressin, he or she will have more urine than the bladder can hold overnight.

Bedwetting occurs in about 10 percent of six-year-old children. It is less common as children get older. Boys are more likely than girls to have a problem with bedwetting. A child also is more likely to struggle with bedwetting if a parent or sibling wet the bed as a child.

Bedwetting can embarrass the child. How well the child’s family deals with the problem is very important. Their reaction will determine to a great extent how severe it becomes. Although bedwetting tends to go away as the child ages, some children will need medical help.

13 Comments

  1. 1 Susan Morrow 07 Aug
    My daughter is 5 and sleeps with me and always has. She just started about 2 weeks ago saying she can't sleep when we come to bed. I have increased her melatonin and still it doesn't help. She will lay in the bed for 6-8 hours before she finally just can't go anymore. I think she has Adhd and possibly Asperger's too. Just hate to have her put on meds but this is wearing me out. I am not a young mama anyway, I will be 45 in 2 weeks. Does anyone have any pointers or suggestions? Thanks 😊
  2. 2 American Academy of Sleep Medicine 27 Jul
    Hi Amanda, we recommend talking to a sleep specialist. You can find a list of sleep centers near you here. Also, you can find more information about bedwetting here.
  3. 3 Amanda 25 Jul
    My child is 8 years old turning 9 next February and still in night time nappies recently we have seen a peditriacan/ urologist and he told him to go toilet 5-6 times a day to empty the bladder and also stop all drinks at 4:30-5pm every night go toilet before bed and to wake him up at 10pm to go toilet because he's just not getting up to go by himself..When my partner and I wake him up to go to the toilet at 10pm he is in an absolute daze and doesn't know what to do with himself we even give him 10 minutes to wake up properly and then tell him off you go and then he try's to take he's pyjama pants down in the bedroom and we say no and does it again and then no again go toilet and then he finally goes to the toilet and comes back still dazed and then like he waits for us to tell him to jump in to bed hmm🙄🤔 Honestly don't know what to do anymore he is on a waiting list for an IQ test at he's school and a language assessment been 12 months extremely hard with covid atm..hopefully get some answers soon also I've always thought he may have slightly mild austim but I could be wrong please someone help us!!!?😢
  4. 4 Rosy 14 Jul
    Hi there, 
    I am concerned my 4 and soon to be 5 has been doing something different during nap or bedtime no often but regularly maybe once every 2 weeks he gets up and starts to scream and cry saying he is afraid and to take that away. This last time I talked to him and he responded that his brain was scaring him making things appear big and small very scary the episode only last like 5 mins or so. Please if anyone has experienced this with their child let me know I will def bring it up to his pediatric.
  5. 5 Eric Fine 03 Jul
    I have a 9 step daughter that shows signs of mild autism and has history of sleep walking but rarely does it. The past two nights she has been sleep walking into our bedroom with dialated pupils and carries on a semi understandable conversation then like a switch flips and become scared frantic yelling mommy is a zombie mommy is a zombie ont the first night. Then the next night does the same thing but this time she thinks mommy is haveing a siezure. I know in about 1 1/2 years ago she witnessed her mommy having a siezure. Could this be “night terrors”? Or multiple parasomnias at one time. 
  6. 6 Michael 29 May
    My daughter is 6 years old and we noticed that in she starts sweating she will wake up and look at one side like she is seeing something and cries. I always comfort her picking her up and hugging her telling Daddy and Mommy is her. She do this like 3 times a week. Is it normal. Now we put her beside us and i bought a big bed so that we will sleep together. Four of us including her 9 year old sister.
  7. 7 Sarah 30 Apr
    My son is 5 yrs old and the it is 3 yrs old for the pass month they both always sit up in the bed for several minutes blank looks or try to get off the bed and head to the door. This is for a few minutes and I gently lay them back down and tell them mommy's hear close back your eyes...  This usually works all the time.  Last night though my 5 yr  old got up sat on the bed I think with his eyes open facing me...  Before I could turn around to comfort him he started punching me non stop...  I finally got hold of him and he stopped for a second then continued after 3 mins I hugged him again telling him mommy's here and he layed down and went back to bed. In the morning I asked him about getting up not punching but as always he doesn't remember?  Is this normal or considered night terrors or confusion arousals ?
  8. 8 Edward 30 Apr
    My 10 year old son wakes up yelling and crying and has this look on his face like he is just scary I put him back to sleep and when he happens to snap out of it I ask him if he knows what he was doing and he does not know of what he did ?? Any suggestions?
  9. 9 Emily 15 Apr
    Emma Hite...my son has the same thing. Doctor said he was fine. After several tries at the neurologist they said it looked like he had benign rolandic epilepsy. Be consistent with the doctors. You know more about your child than they do. And with my son it only happens while asleep. BEst of luck
  10. 10 Ami 03 Apr
    Emma, my son sounds very similar to your child, he is 5 soon to be 6 teeth grinding taking/shouting in his sleep constantly moving around in bed  eyes half open snoring sits up in bed with a confused face im hoping he will grow out of it because I don’t know if he will ever get to sleepover at friends or families apart from his grandparents as they know his behaviour.  we put a camera in his room to see what he does sometimes he wakes up and stares into the corner of the room crying and my husband is the only one that can settle him down which is scary to watch him cry so much and rub his eyes as if he as seen or seeing a monster.
  11. 11 Emma Hite 10 Mar
    HI- IM searching for anything here. My son who is 6 has for the past year been having on and off episodes where just as he falls asleep (within the first 10 min or so) will start rapid jaw chattering, eye movement and face contorting-- as if he is having a seizure. He has a lot of drool when he sits up too. When i talk to him, ask him if hes awake, its hard for him to talk to me, a blank stare and then he reaches for my face--which is creepy.  I tell him IM here, and he wakes up- but is super tired. he knows who we are, where he is. and can actually walk up the steps to his bunk and falls back to sleep. HE remebembers it every time when i ask him about his " dreams" he corrects me-- says its not a dream mom, its that thing that keeps happening with my jaw.  I have noticed teeth grinding, and really bad sweating when he sleeps, but my husband just thinks hes being a boy. he sweats a lot when he has the episodes too. I just dont see him fitting into any caategory listed onlkine. DR said it isnt seizure since we are able to wake him up. i took him to a neurologist and they did some basic tests and said he was perfctly fine. Is anyone familiar with this? He will be 7 years old in October.  My husband and I are just more concerned about how he fully looks like hes having a seizure and cant breathe when he does this... but is he ok? 
  12. 12 Jingjia 28 Aug
    My child randomly wakes up at night terrified and turns on the lights, he then site down and takes a few deep breaths, after he goes back to sleep, in the morning he has little memory of this, any advice?
  13. 13 Marion 21 Aug
    My four year old daughter lovesto sleeps on top of me it's kinda frustrating but I think she's loves to sleep like that sometimes she just started this is this normal ?? 

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