Definition

• Nightmares are scary dreams that wake a child from sleep
• Occasional bad dreams are normal at all ages
• Peak age is 3 to 12 years
• Nightmares can start as young as 6 months of age

Health Information

Symptoms

• Children wake up when they have a nightmare. They usually are fully awake and not confused.
• When infants and toddlers 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 bad dreams are. They put themselves back to sleep without waking their parents.

Causes

• Everyone dreams 4 or 5 times each night. Some dreams are good, some are bad.
• Dreams help the mind process complex information and events from our daily lives.
• The content of nightmares usually relates to current developmental challenges such as:
• Infants have nightmares about separation from their parents, strangers or even learning to walk.
• Toddlers have nightmares about being left at child care, barking dogs, etc.
• 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.

Care Advice

1. Reassure and Comfort Your Child:
   • Explain to your child that she was having a "bad dream".
   • For older kids, add "you are safe and we are nearby".
   • Sit on the bed or hold your child until she is calm.
   • If they want to talk about the dream, listen for what they are afraid might happen.
   • Most children return to sleep fairly quickly.
2. Help Your Child Talk About the Bad Dream During the Day:
   • Talking about nightmares makes it less likely that they will recur.
   • You may need to remind your child of something he said to start the conversation.
   • 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, it may relate to a stressor in real life. Try to determine what that challenge is. Then, help your child find better ways to cope with it.
   • If the recurrent bad dream is about something unreal, such as a monster, help him imagine a good ending to the bad dream. Encourage your child to imagine a powerful person or a magic weapon to help him overcome the bad parts of the dream. You may want to help your child draw pictures or write a story about the new ending for the dream.
   • Working through a bad fear often takes several conversations about it.
3. How to Prevent Some Nightmares:
   • Provide a nightlight, especially if your child has fears of the dark. Having a flashlight in bed may also help.
   • Offer to leave the bedroom door open, though some children feel safer with it closed.
   • Younger children are helped by a security object (lovey).
4. Protect Your Child from Scary 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 any scary movies before 13 years of age.
   • Between 13 and 17 years, the maturity and sensitivity of teens varies. Decide carefully if your child is ready to deal with the uncut versions of R-rated movies. Remember that horror films are meant to frighten adults.
   • Be vigilant about slumber parties or Halloween parties. Tell your child to call you if the family he is visiting is showing scary movies.
5. What to Expect:
   • Bad dreams normally occur off and on again throughout life.
   • Frequent nightmares are not normal.

Call Your Doctor If

• Nightmares become worse
• Nightmares are not improved after using this technique for 2 weeks
• The fear from the bad dream interferes with daytime activities
• Your child has several fears
• You have other concerns or questions

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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