Why My Toddler Wakes Up Screaming

It was a triumph when you got your child to sleep through the night during infancy. Now toddlerhood brings a host of new issues in the form of night terrors! Our pediatrician gives advice on common sleep disturbances.

It is 11:00 PM. You have just settled into REM sleep after a long day. Suddenly your toddler wakes up screaming bloody murder. You stumble to his room to find him sitting up in his crib, eyes open, crying as if terrified by something unseen by you.

What's the Issue?

Night wakings are frustrating for parents. We all know what it is like when your infant wakes up in the dead of night for a feed and then won't resettle … at 3:00 AM, when you are at your lowest level of functioning as a parent. But now, your toddler should be a reasonable sleeper, and these night wakings take on a new flavor: scary, tiresome, and just plain yucky.

Consider the Numbers

Between one and six percent of all children have night terrors (also called sleep terrors), according to Rudolph's Fundamentals of Pediatrics—one of the "big three" doctors' textbooks. But one recent study in the journal Pediatrics (May 2007) showed that up to 40 percent of all children have at least one night terror by their sixth birthday. This seems a more accurate number from what I see in pediatric practice. Additionally, statistics say that one third of children who have night terrors will begin experiencing them in the second year of life.

Also interesting about night terrors? They're more common in boys, and children who have night terrors often have other family members who have them as well.

What Parents Can Do

Understanding night terrors may make them seem a bit less freaky, and they can be most easily explained as being caught in between wakefulness and sleep. Think of it this way: The brain disconnects from the body during sleep. That is why—thankfully!—we don't all get out of bed and act out our dreams.

Parasomnias (medical talk for sleep disorders such as night terrors) are disturbances in which there is an incomplete disconnect, so to speak. Your child may be partially awake and able to generate some motor movement, but she is mostly asleep and thus oblivious to her surroundings. Children who experience night terrors don't remember what has happened the next day—just like kids (or adults) who talk or walk in their sleep.

Night terrors can come in many varieties. The classic night terror involves sitting up in the crib, eyes wide open and screaming like there is a lion loose in the room (because that is what she might be dreaming). Kids are generally inconsolable and may even get a bit more agitated as you try to comfort them. They may hallucinate, talk gibberish, or lash out at you physically.

Night terrors can also involve talking (for those more verbal toddlers), saying nothing, or even laughing. I had one family ready to call the family chaplain for an exorcism after finding their child sitting up in bed at 10:30 PM looking at the wall and giggling with a deep voice. Yikes! (No wonder some say they are called night "terrors"—because they terrify parents.)

What the Docs May Do

Your child's doctor will likely tell you that night terrors are normal and then explain the physiology behind them. (This is a fairly common late-night discussion with a worried parent over the phone.)

What patterns do night terrors follow?

• They typically occur one to two hours into the night's sleep, or certainly in the first third of your child's night's sleep.
• The terror generally lasts less than 20 minutes and concludes with the child lying down and going into a deeper stage of sleep.
• Night terrors often occur in bunches. We tend to see more of them when kids are off schedule and their routines are disrupted—so, during holidays (when bedtimes are less rigid), just after a move to a new home, during times of illness, or even following Daylight Saving Time changes can come times of increased terrors.

How can parents handle night terrors?

The usual advice for parents of kids with recurrent night terrors is to check on your child to make sure everything is OK and to let it run its course—not always an easy task when your child seems so miserable. If you intervene, which is a parent's natural instinct, it usually takes longer to resolve and involves more agitation.

When kids are having frequent and predictable night terrors, doctors will sometimes advise waking kids 15 minutes before a night terror will likely occur. So if Will is having nightly terrors at 10:30, you might awaken him at 10:00 or 10:15 briefly and let him fall back asleep. This disrupts the sleep cycle just enough to avert the predictable sleep disturbance. Most children outgrow their night terrors before they turn 12, though a few adults still have them on occasion.