Understanding Children's Nightmares

Children’s Nightmares

By Dr Kathleen Pfaff

One out of every four children has nightmares more than once a week. Most nightmares happen very late in the sleep period (usually between 4 and 6 a.m.). Your child may wake up and come to you for comfort. Usually, he or she will be able to tell you what happened in the dream and why it was scary. Your child may have trouble going back to sleep. Your child might have the same dream again on other nights.

Nightmares affect 20 to 39 percent of children between five and 12 years of age. Contrary to popular belief, frequent nightmares in children do not always suggest underlying psychopathology unless some type of abuse or neglect has been reported.  Nightmares are often described by creative children who demonstrate "poor boundaries" and become easily bullied, manipulated and abused. Creative children, (like creative adults), tend to dream more often then those that view the world as black and white.

The imagination of creative children can be quite extraordinary. They may wake with a very vivid and detailed story. I’ve actually made a list of children’s books I’d like to write based on some of the dreams my younger clients have told me about. Because of their sensitive nature, they can have some horrific nightmares, sometimes based on imagined fear. This child will often ask the question, “what if?” based on something that concerns him, (the little worrier).  If the parent or adult caretaker ignores the question, the child may obsess about the possible conclusions, of which can be very scary.  This same child should not be allowed to watch scary movies or play scary games of any kind before bed. They are much more vulnerable then the left brained math genius and are capable of dreaming up their own monsters without the help of outside stimulation.

Some children have a different kind of scary dream called a "night terror." Night terrors happen during deep sleep (usually between 1 and 3 a.m.). A child having a night terror will often wake up screaming. He or she may be sweating and breathing fast. Your child's pupils (the black center of the eye) may look larger than normal. At this point, your child may still be asleep, with open eyes. He or she will be confused and might not answer when you ask what's wrong. Your child may be difficult to wake and, on awakening, he or she usually won't remember the night terror.

Nightmares and night terrors don't happen as much as children get older. Often, nightmares and night terrors stop completely when your child is a teenager. Some people, especially people who are imaginative and creative, may keep having nightmares when they are adults.

A child who dreams “often” about drowning, getting killed, getting lost or being chased by a monster may be experiencing some emotional problems and parents need to seek professional help whenever reoccurring nightmares  such as these are disclosed.

However, most often, nightmares and night terrors in children are usually not caused by mental or physical illness. Nightmares often happen after a stressful, physical or emotional event which could be as simple as losing a t-ball game. In the first six months after the event, a child might have nightmares while he or she gets used to what happened in the event. If nightmares keep happening and disturb your child's sleep, they can affect your child's ability to function during the day. Talk with your doctor about whether treatment will help your child.

NOTE: A child who can’t remember any dreams, ever, may be depressed or suppressing a traumatic event. For children not to dream at all, is very rare, almost unheard of.

Common causes of nightmares in children .

  Some obvious causes of nightmares in children are stress related and are usually fear based. There are also physical events and emotional events in a child’s life that can and will trigger nightmares. To an adult the fear may seem silly or insignificant, but to the child, the fear is very real and should be treated as such.

Stress can include but not limited to; moving to a new house, changing schools, losing close friends, missing family, having to leave a pet behind, new environments of any kind, fear of rejection by peers, and other authority figures, (new principal, new coach, new teachers). Fear of failing a test or a grade. Fear of a new step-parent or added siblings. Fear of losing a parent or parent’s affection, especially if a step family moves in.

Physical trauma can include falling off a slide, getting hit with a ball, breaking a bone, getting sick or having a high fever. Any physical abuse on the child is obviously something to be alarmed about and the child will need professional help along with his/her abuser.

Emotional events include; a death of a loved one, being rejected, embarrassed or bullied at school, loss of a pet, not getting chosen for a team, moving to a new town or feeling threatened by something or someone. If a child witnesses a crime, abuse to another child or adult or to the family pet, can be traumatized and will need professional help to overcome the fears and feelings of helplessness.

The list is endless as to what a child fears, which is why communication and reassurance needs to take place often, between parents and their children. It is important that the child is helped to understand the possible cause of the nightmare and be shown how he can solve it. Teaching problem solving at a young age, prepares them for adult life.

Nightmares are also associated with the use of medication, both in children and adults. Primarily those medications that affect neurotransmitter levels of the central nervous system, such as antidepressants, narcotics or barbiturates are known to cause nightmares. Intense, frightening dreams may occur during the withdrawal of certain drugs also.

Below is a list of common meds that could cause a problem. If unsure about what drug your child is on, then consult with your physician about possible side affects of your child’s medication:

Medications that alter central nervous system neurotransmitter levels
Antidepressants
Tricyclic
Monoamine oxidase inhibitors
Selective serotonin reuptake inhibitors
Centrally acting antihypertensives
Beta blockers
Rauwolfia alkaloids
Alpha agonists
Antiparkinsonian agents
Levodopa (Larodopa)
Selegiline (Eldepryl)

Miscellaneous medications known to cause nightmares
Flutamide (Eulexin)
Procarbazine (Matulane)
Ketamine (Ketalar)
Short-acting barbiturates

Medication withdrawal associated with nightmares
Ethanol
Barbiturates
Benzodiazepines

Night terrors and sleepwalking require that you protect your child during sleep. Be sure your home is safe (use toddler gates on staircases and don't use bunk beds for these children). Talk with your doctor if your child ever gets hurt while sleeping. Your doctor may want to study your child during sleep.

Can I Prevent My Child from Having Nightmares?

Although it is normal to have a nightmare once in a while, there are some techniques you can do to help your child to get nightmares under control. (Some of these techniques work for big people too).

·        Get your child on a sleep schedule. Try to get a bedtime routine started by reading a calming, gentle story that empowers your child in a positive way. Make bedtime about the same time every night and wake up at the same time every day. Unless you're child is sick or didn't get enough sleep the night before, avoid naps during the day, (only if child is past the age of first grade).

·        Avoid scary books or movies before bedtime.

·        Avoid eating or exercising just before bedtime as this stimulates metabolism, and makes it difficult for the child to relax.

·        If your family believes in a higher power (God) then a prayer just before sleep helps tremendously. I made one up for my children and some of my clients used it too. It went something like this:

“Now I lay me down to sleep, I pray to God, my thoughts to keep, Send the angels to keep me safe all day and night, waking up to the sun, so bright”

·        If prayer is not an option for you, then try some relaxation techniques, like taking in a big deep breath in through your nose, and slowly releasing in through your mouth. Do this several times until yawning occurs. Another technique is visualization. Teach your child to use his/her imagination to visualize a safe and happy place within his mind. My children liked thinking about swinging at the park, walking under a waterfall, or floating on a raft in the pool.

·        Play soft music, no words, with sound affects if your child has a favorite nature sound. My daughter and I love the sound of rain, birds chirping, and the wind blowing through the trees. There are so many options to choose from, usually listed under New Age music or meditation. Soft music can relax racing thoughts, so the mind can quiet and fall to sleep.  

• Allow your child to sleep with a stuffed toy, a super hero figure or favorite blanket. This helps some children feel more secure.
  
• Use a nightlight in the child’s room or in the hallway just outside his/her door. Keep the door slightly open so the light can be seen. Should your child have a nightmare, the nightlight will help the child see familiar things and remember where they are whenever they wake.
  
• When I counsel children about their nightmares, I have asked them to draw a picture of the nightmare, encouraging them to make up a different ending. It could be funny, happy or empowering.
   
• Remind your child you are near by and if they get scared, they can get up and find someone for reassurance. None of us are ever too old for a hug! (Learn to know when the child actually has a nightmare and is not trying to avoid bedtime).
  
• If your child continues to have frequent nightmares, you might want to see a counselor to help your child deal with their bad dreams. Sometimes we need to talk about our nightmares to another person other then with our authority figures, especially if the monster in the Childs dream is symbolic of a parent figure.
  
• Rarely, kids with frequent nightmares may need to visit a doctor or a sleep clinic. A doctor can determine whether their nightmares are the result of a physical condition. A sleep clinic can check your brain waves, muscle activity, breathing, and other things that happen with your body while you sleep. If nothing else seems to work, your doctor may prescribe medicine designed to help your child sleep through the night. This should be your last option, after you have tried some of the ideas above, first.