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Baby Steps: Sleep Tight

Q  My son is 17 months old and has had nightmares for about two months now. He cries, screams, sweats, and kicks his legs. It's really scary. What should I do?

A In young children, it is sometimes hard to differentiate between nightmares and night terrors. Although night terrors are most common among children ages 3 to 8, that doesn't mean that they don't occur in toddlers. Night terrors involve a sudden, panicked arousal from deep sleep, generally one to four hours after drifting off. The child is often sweating, kicking, and thrashing, and his heart will be racing.

A child in the midst of a night terror will have his eyes wide open but be unresponsive. If you try to hold him, he will probably push you away. Children who awake from nightmares, on the other hand, tend to be aware of their surroundings after a few disoriented moments and are generally willing to accept comfort. After a night terror subsides, the child often drifts back to sleep and awakes in the morning without any memory of it, but children who have had a nightmare may not go back to sleep right away and may remember it the next day.

These distinctions can be difficult to make with toddlers. They are still developing verbal skills, a sense of time, and an understanding of the distinction between fantasy and reality. It is therefore very hard to get a reliable answer about their recollection of the previous night's events. Further, small children tend to express their emotions with their entire bodies¿ -- so the kicking you see may be part of his response to fear, and not the thrashing about that is associated with night terrors.

The initial response recommended for night terrors and nightmares is generally the same: Try to keep the child's routine predictable and calm and minimize overstimulating activities. Both events tend to occur during times of stress, and can be affected by viewing frightening images on television. It's important that you be calm yourself, despite how unsettling it is to see your son so scared.

In either case, a long spell of consistent, terrified nighttime awakening warrants a call to your pediatrician. Usually, night terrors are harmless, more upsetting to the parent than to the child, and gradually diminish in frequency on their own.

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