Before we dive deep into the cause of nightmares in children, some children have certain night-time behaviors that might be confused with having nightmares. These episodes could be night terrors or even confusional arousal.

Night terrors

During night terrors in children, your child might wake up all of a sudden and jump out of bed. They might scream because they are very scared. Their heart would almost be jumping out of their chest and they might be sweaty and breathing fast. Unfortunately, there is little to be done to calm your child down when they are having night terrors. It takes about 10 minutes to 20 minutes for the night terror to subside. Just stay with your child but do not try to wake them up. Some children actually have these terrors a couple of times a week.

Confusional arousal

This is similar to night terrors because your child might wake up from sleep and sit on their bed crying and confused. They are still in between sleeping and waking up. They are not asleep and not quite awake. Also, like night terrors, there is nothing much you can do to calm your child down. This confusional arousal episode might take as little as 10 minutes or as much as 30 minutes to be over. Stay with your child but do not try to wake them up.

These two (night terrors and confusional arousal) that we just discussed usually occur during the first part of the night. More often than not, it is frequently seen in children who are not getting enough sleep, staying up all night, and children with fever. It might be troubling seeing your child wake up a couple of times a week, crying at night while just sitting on the bed without really knowing how to calm them down. Don’t worry, these episodes are not dangerous and actually sometimes run in families. By the next day, children would forget that those episodes ever happened.

Nightmares

So what exactly are nightmares? And what is the cause of nightmares in children?

Nightmares are scary, frightening dreams that wake up children. They are so upset and scared that they don’t even want to go back to sleep. When a child wakes up from a nightmare, unlike night terror and confusional arousal, they are awake. They can run to your room for comfort and some would not go back to sleep unless they have company.

Nightmares in children happen during the second part of the night. You can console your child and calm them down when they have a nightmare.

When children fall asleep and are in deep sleep, their brain is still very active. This causes rapid eye movement (REM) and this is when they start to dream. Dreams can be very pleasant and happy dreams. Alternatively, the dreams can be bad dreams, hence, called nightmares.

Nightmares in children cause fear, sadness, uneasiness, and so on. It might feel so real to some children and so terrifying that they need the light on or even closets to be fully shut when it is sleep time. Other children might think that they heard or saw something scary in their room.

The bottom line, most children waking up from nightmares or who have had a series of nightmares might find it difficult to go back to sleep or go to sleep. As adults, we do have nightmares, but not as much as children do.

Having a nightmare is not a sign of mental illness. There is nothing wrong with having a nightmare. All children have nightmares. However, some children have more nightmares than others. Why is that?

Cause of Nightmares in Children

The cause of nightmares in children has been linked to several issues. These include:

Watching or reading or being told scary tales: Needless to say, telling your child scary stories increases the chances of them having nightmares.    

Stress: Believe it or not, children can also undergo stress. The stress of abusive homes, stress from separated homes, domestic violence, trauma, and so on.  

Fever: Fever can cause nightmares in children. Check and see if your child is having a fever.    

Poor sleep hygiene and other sleep problems: Having poor sleep hygiene will affect your child's sleep.    

Medications: Some medications are the cause of nightmares in children. Do you know which ones?

What medications cause nightmares in children?

Certain medications that are used to treat high blood pressure, lower cholesterol, and treat depression have been linked to causing nightmares in children. Did you know that even the antihistamines we give daily to our kids can also cause nightmares? Below is a general list of some medications that cause nightmares in children.

Steroids like prednisone, dexamethasone, and methylprednisolone 

Antihistamines like cetirizine and fexofenadine    

Beta-blockers like metoprolol and propranolol    

Antidepressants (Selective Serotonin Reuptake Inhibitor) like paroxetine, sertraline, and fluoxetine    

High cholesterol medications (Statins) like simvastatin, pravastatin, and atorvastatin

How can I reduce nightmares in children?

Please note that there is no cure or treatment for nightmares in children. We can only try to reduce the frequency by doing these:

1. Find out what traumatic event your child is dealing with

Did my child go through a trauma that I know about? Or going through something that I do not know about but should investigate? Did I just adopt a child that might have gone through a lot of trauma? Will therapy might help? Yes. Therapy helps if that is what your child needs. Finding the right therapist for your child can make a positive change in your child's sleep and overall health.

2. No more scary movies and scary stories

What kind of bedtime stories am I telling my child? Is it more about ghosts and haunted houses? Avoid telling your child scary stories. Also, do not let them watch scary and horror movies, especially right before bedtime.

3. Reduce stress

What might be causing stress to my child? Are parents fighting a lot or going through a divorce? Play music with them. Take them to the park to run around and distract themselves from whatever is stressing them. You can use art therapy. Children express themselves a lot by drawing. To find the cause of nightmares in children, you can get your child to draw the nightmare. By so doing, it makes the nightmare less scary. Also, you might be able to know what and who they are afraid of, if trauma-related.

4. Fever control

Is my child having a fever? What medications can I give to reduce the fever? What other at-home fever-reducing remedies can I do? If your child has a fever, he/she is fighting something - a bug (virus, bacteria, etc). Make sure you control the fever and take them to see a doctor.

5. Good sleep Hygiene

Does your child have a bad sleep habit? Is your child allowed to stay up all night or go to sleep whenever? Your child's sleep pattern/hygiene might also affect the frequency of their nightmares. Generally speaking, if your child is 2 years old to 5 years old, they should be getting 10 hours to 13 hours of sleep. The older children should be getting 8 hours to 10 hours of sleep.

Some Good Sleep Habits Are:

• Have a scheduled time for sleep and also wake them up around the same time every day.
• Cut off all TV and stop the use of all electronics before sleep.
• Avoid letting them eat right before sleep. Indigestion and discomfort from being so full might keep them awake. Also, eating triggers the brain to increase metabolism. By doing so, the brain stays active while your child is trying to sleep.
• Your child should also avoid caffeine. This is not only found in coffee and tea but even some energy drinks

Remind your child that they only just had a dream. It is not real and it will not happen.

6. Investigate if a Medication was started

Did my child just start a new medication - either over-the-counter (OTC) medication or prescription? What medication is it? Try to find out what medication that could be causing your child's nightmares. I have to say, it is surprising that simple seasonal allergy medications like cetirizine or fexofenadine, can be the cause of nightmares.

When should I contact my child’s pediatrician?

You can inform your child’s pediatrician at any time that you feel any concern at all. If your child's nightmares are happening too often and you still cannot figure out the cause of the nightmare in your child, contact your child’s pediatrician.

Contact your child's pediatrician if, in addition to having any of the nightmare episodes, including night terrors and confusional arousals, your child is:

• Bed-wetting
• Snoring loudly
• Gasping for air
• Behaving strangely
• Passing out
• Having seizure - Call 911

On the bright side, nightmares are not forever. Eventually, the frequency of nightmares decreases as your child gets old and adopts great sleeping hygiene. Also staying away from habits and behavior that can cause nightmares in your child would help heal your child now and help them in the long run.