Nightmares Health Article

When to call the doctor

If a child's nightmares increase in frequency and intensity, it is important to consult a physician or pediatrician to determine if the sleep disruption is due to any injury, illness, or infection, or if it might be caused by the use of or change in medications. Disturbed sleeping patterns in children are also present in some cases of juvenile rheumatoid arthritis, autism, and fibromyalgia.

Nightmares usually diminish in frequency and intensity over time. Recurring nightmares may indicate an ongoing problem that the child is having difficulty resolving. A child who is losing sleep and whose fears persist during day-time hours may benefit from the help of a pediatric psychotherapist in developing coping strategies for the stress and anxiety expressed through the dreams.

Diagnosis

Parental observation of the child's sleeping patterns and careful record-keeping of symptoms of any sleep disruption through use of a sleep journal will usually reveal any parasomnia patterns that may require professional assessment.

Treatment

Parents or caretakers should take into account the age and developmental maturity of their child when responding to the fears and anxieties that a nightmare brings to the surface. The child's ability to understand that the nightmare is not real and that it is an event happening only within their own mind increases with age. The nightmare reflects real fears and stressful circumstances present in the child's waking life. A parent's willingness to listen to and sympathize with a child's fears provides a necessary validation of the child's experience and helps to calm the child's anxiety. Very young children who lack the verbal skills to describe the frightening dream may require more reassurances that they are safe and more time in the comforting presence of a parent or caretaker before they are ready to return to bed.

Anne Sayre Wiseman, writing in her book Nightmare Help: A Guide for Parents and Teachers, suggests that parents approach the nightmare as a dream story with a problem to be solved. Parents who act as dream guides can help their children to find their own solution to the dream problem. The parents' goal, Wiseman counsels, is to "encourage autonomy so the child learns to empower themselves at whatever level they can handle."

Alan Siegel and Kelly Bulkeley, writing in their book, Dreamcatching: Every Parent's Guide to Exploring and Understanding Children's Dreams and Nightmares, suggest four beneficial remedies to help a child cope with disturbing nightmares. "The Four R's" of nightmare relief are:

• Reassurance: Provide physical and emotional reassurance and a listening ear so the frightened child will feel safe enough to share the dream images.
• Rescripting: Discuss the dream images with the child and work together with the frightened dreamer to imagine changes in the outcome. Encourage the child to express the images through artwork, fantasy, drama, and writing.
• Rehearsal: Encourage the child to imagine how the various alternative dream endings might change and assist the child in working through the different outcomes to find those that restore a sense of control and safety.
• Resolution: Work with the child to help her discover and acknowledge the life problems and stressful circumstances that may be reflected in the nightmare.

Nightmares are a common childhood parasomnia and medication is rarely indicated. Other parasomnias, such as night terrors and night walking, may call for medication if other interventions and treatments fail to relieve seriously disruptive symptoms.

Alternative treatment

Teaching the child simple relaxation skills through guided imagery will provide a valuable self-help resource that may minimize bed-time anxiety. Older children can be encouraged to connect with an "inner guide" as a source of strength when they are awakened by frightening dreams. Inner guides may take the form of a loving voice within that the child can listen for during times of fear or a beloved animal that they may call upon as a companionable inner helper when dealing with problems presented in scary dreams.