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Medical Author:

David Perlstein, MD, MBA, FAAP

David Perlstein, MD, MBA, FAAP

Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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Medical Editor:

Steven Doerr, MD

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

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Nightmares occur during REM sleep and thus are more common later in the night. The child acts scared and will often be able to remember his or her dream. Simple parental reassurance and comforting are effective.

In contrast, night terrors occur in non-REM sleep and thus, generally, within the first four hours of sleep. The child may become very violent with thrashing of the arms and legs while crying out in a confused manner. Routine comforting of the child is not helpful and the child will be confused and bewildered when awakened. Generally, the child will rapidly return to a "normal" sleep with no memory of the events in the morning.

Confusional arousals are a variant of night terrors. It is believed that the child is so deeply asleep that the normal waking pattern at the end of the sleep cycle is suppressed. The major distinguishing point between confusional arousals and night terrors is that the former gradually builds from moaning to crying out and may culminate in the child standing and yelling out apparent random words or phrases. Night terrors tend to have an acute onset with the very rapid development of thrashing and yelling (commonly for parents). Both conditions share several points that parents should consider when they encounter either situation.

• Don't try to awaken the child. They are asleep and if awakened, they will have a difficult time falling back to sleep.
• Anything that upsets the normal sleep rhythms -- such as illness, being away from home, and disrupted naps -- may trigger either pattern.

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