Sleep: Nightmares

What is a nightmare?

Nightmares are scary dreams that awaken a child. Occasional bad dreams are normal at all ages after about 6 months of age. When infants have a nightmare, they cry and scream until someone comes to them. When preschoolers have a nightmare, they usually cry and run into their parents' bedroom. Older children begin to understand what a nightmare is and put themselves back to sleep without waking their parents.

What is the cause?

Everyone dreams 4 or 5 times each night. Some dreams are good, some are bad. Dreams help the mind process complicated events or information. The content of nightmares usually relates to developmental challenges such as:

• toddlers have nightmares about separation from their parents
• preschoolers have nightmares about monsters or the dark
• school-age children have nightmares about death or real dangers.

Frequent nightmares may be caused by violent TV shows or movies.

How can I help my child?

• Reassure and cuddle your child.

  Explain to your child that she was having a bad dream. Sit on the bed until your child is calm. Offer to leave the bedroom door open (never close the door on a fearful child). Provide a nightlight, especially if your child has fears of the dark. Most children return to sleep fairly quickly.

• Help your child talk about the bad dreams during the day.

  Your child may not remember what the dream was about unless you can remind him of something he said about it when he woke up. If your child was dreaming about falling or being chased, reassure him that lots of children dream about that. If your child has the same bad dream over and over again, help him imagine a good ending to the bad dream. Encourage your child to use a strong person or a magic weapon to help him overcome the bad person or event in the dream. You may want to help your child draw pictures or write stories about the new happier ending for the dream. Working through a bad fear often takes several conversations about it.

• Protect your child against frightening movies and TV shows.

  For many children, violent shows or horror movies cause bedtime fears and nightmares. These fears can persist for months or years. Absolutely forbid these movies before 13 years of age. Between 13 and 17 years, the maturity and sensitivity of your child must be considered carefully in deciding when he is ready to deal with the uncut versions of R-rated movies. Be vigilant about slumber parties or Halloween parties. Tell your child to call you if the family he is visiting is showing scary movies.

When should I call my child's healthcare provider?

Call during office hours if:

• The nightmares become worse.
• The nightmares are not minimal after using this approach for 2 weeks.
• The fear interferes with daytime activities.
• Your child has several fears.
• You have other concerns or questions.