Night terrors in young children: what to do and when to worry

By Diego Román Roldán

Table of Contents for this article

General Health Psychologist (COPAO AN 12348) at Ocnos Psychology Clinic. I work from a clinical perspective focused on functional behaviour analysis, emotional regulation in children and support for families.

A young child suddenly sits up in bed, screams, sweats, looks terrified and does not recognise their parents. The scene lasts only a few minutes, but it leaves the whole household on alert. And the next morning, very often, the child remembers nothing.

This kind of episode can be extremely confusing and distressing. In clinical practice, we often see that the episode frightens the family more than the child, because parents experience it with the feeling of not knowing what is happening or how to help.

That is why the aim of this article is clear: to understand what is happening, what we can do, what is best avoided and when it is worth seeking help. From this perspective, night terrors in young children are not understood only as an isolated symptom, but within the child’s sleep, routine, family context and developmental stage.

What are night terrors in children?

Night terrors in children are episodes of incomplete awakening that occur during deep sleep, usually in the first third of the night. The child may seem awake, but they are not truly conscious or able to respond as they would when fully awake.

During the episode, they may scream, cry, move around or show an expression of intense fear. However, the next day they usually remember nothing, or very little, precisely because this is not a complete awakening like the one that occurs after a nightmare.

In practice, this helps us distinguish night terrors from other night-time experiences. A child who wakes up frightened and looks for their parents is not the same as a child who seems “present” but cannot fully connect with what is happening around them.

Night terrors are part of what are known as parasomnias: phenomena that appear during sleep and can look very striking from the outside. Although they can be very alarming, in most cases they do not mean that the child is “going mad” or that there is necessarily a serious problem behind them.

The difference between nightmares and night terrors

The difference between nightmares and night terrors is easier to understand if we look at the moment of sleep, the child’s response and whether they remember what happened.

In other words, a nightmare is more like a frightening dream; a night terror, in contrast, looks more like an incomplete awakening with a great deal of activation. This difference matters, because it completely changes the way we support the child.

Parents sometimes tell me: “My child wakes up screaming at night, but then won’t tell me what happened.” When it is a nightmare, that conversation is usually possible. When we are talking about a night terror, the child is often not available for that conversation because they have not fully woken up.

How does a child act during a night terror?

When a child has night terrors, their behaviour can be very striking. They may sit up in bed, scream or cry intensely, sweat, breathe quickly and appear very agitated.

They may also look around with their eyes open, but with an empty or confused expression, as if they were not fully there. Sometimes they push away contact, reject comfort or do not recognise their parents, even when their parents are trying to soothe them.

Afterwards, the episode usually settles and the child goes back to sleep. The next morning, many families tell me that the child remembers nothing, which can be even more confusing, because the adult has lived through an intense scene and the child wakes up as if nothing had happened.

In therapy, this part is key: we should not interpret this behaviour as intentional misbehaviour. It is not. It is a manifestation of sleep and of the physiological activation of that moment.

It is also worth knowing that the intensity of the scene does not always match the seriousness of the problem. Some very dramatic episodes happen only occasionally and leave no consequences, while other less striking episodes create a lot of family strain because they are frequent or unpredictable.

What causes night terrors?

There is not always one single cause. In fact, the most common situation is that several factors come together and make the episode more likely.

Common triggers include lack of sleep, excessive tiredness, fever, changes in routine, stress, irregular schedules, screens before bedtime and certain developmental stages.

Emotionally activating life events can also play a role: starting school or nursery, moving house, the birth of a sibling, family changes, tension at home or a stage in which the child is more sensitive for other reasons.

There may also be a family predisposition. Some families tell me that one parent also had night terrors or sleepwalking during childhood. That does not mean there is a serious problem, but it may suggest that sleep is more vulnerable in some children.

It is important to underline this: there is not always a deep psychological cause behind night terrors. Sometimes the child’s body is simply too tired, too activated or too dysregulated to move smoothly between sleep stages.

In other cases, we do not find one clear trigger on a single night, but rather a sum of small factors. A day full of emotions, a late dinner, an argument at home, more screen time than usual and a disorganised bedtime may be enough for sleep to become fragmented and for the episode to appear.

A functional behaviour analysis perspective

This is where the way I work becomes especially useful. From functional behaviour analysis, I do not focus on looking for blame, but on understanding patterns.

I observe three things: what happens before the episode, how the episode appears and what happens afterwards. In other words: antecedents, behaviour and consequences. At the same time, I look at the wider context: sleep, routines, family, school, life changes and the child’s general level of emotional regulation.

For example, if a child tends to have episodes on days when they go to bed late, after screen time and with a lot of emotional activation, the focus is not to label the child, but to adjust the system surrounding sleep. From this perspective, the question is not “what is wrong with them?”, but “what is happening around them that may be disorganising their sleep?”.

This shift in perspective often brings great relief to parents. It is no longer about guessing some mysterious cause, but about observing more precisely which factors may be maintaining the problem.

In therapy, I often help families look at sleep as a context, not as an isolated symptom. That changes the way we intervene, because it allows us to introduce small, sustainable changes instead of only acting when the episode appears.

What should you do when a child has night terrors?

The first thing is to stay calm. Although this is difficult, the adult regulates more through their calm presence than through explanations in that moment.

It is not advisable to wake the child abruptly. Nor should you shake them or try to force a response. The most useful approach is usually to protect them from injury, remove dangerous objects, speak quietly and wait for the episode to pass.

Accompanying without overwhelming is a good idea. Sometimes it is enough to stay close, watch over them and communicate safety with very few words.

It is also very useful to keep a record of what happens. Writing down the time, duration, frequency, whether there were screens, whether the child went to bed late, whether there was fever, changes at home or a particularly intense day can help detect patterns.

This record does not need to be sophisticated. A notebook, a note on your phone or a small table with the day, time, previous situation and how the episode ended is enough. Sometimes, after three or four weeks of observation, a fairly clear pattern begins to appear.

At home, I insist on this point: the aim is not to interrogate the child the next day. If they do not remember the episode, they do not need a detailed explanation or an insistent conversation about what they “did”.

What can be useful, however, is reinforcing a sense of safety before sleep. A calm message, a predictable routine and a serene adult response can help more than many explanations.

A recommended sleep routine when there are night terrors

When night terrors repeat, it is not enough to act during the episode. It is also worth looking at what happens during the afternoon and in the transition towards bedtime.

A routine does not need to be rigid or perfect. In fact, if we try to control every minute, we may create more tension. What is useful is for the child to be able to anticipate what will happen and for the body to gradually lower its level of activation.

In many cases, small sustained changes have more impact than big measures applied for two nights and then abandoned. That is why, in therapy, we usually look for routines the family can genuinely maintain.

What should you avoid during a night terror?

There are very common mistakes which, although they come from fear, can make the scene worse.

Turning on bright lights can disorganise the child even more. Shouting, arguing or trying to reason with them in that moment does not help either, because they are not in a position to process arguments.

It is also best not to hold them tightly unless there is a real physical risk. The priority is safety, not rigid restraint. And turning the episode into a family drama only increases everyone’s alarm.

The next day, it is not helpful to speak as if the child had done something wrong. There is no bad intention and no manipulation. There is a sleep episode that deserves understanding, not punishment.

Another frequent mistake is trying to “get” an immediate explanation from the child with repeated questions. If they do not remember what happened, insisting can only generate confusion or distress, and it does not provide useful information.

It is also advisable to avoid excessive anxious monitoring. If the family enters a constant state of alert, the home ends up organising itself around the fear of the episode. In the medium term, this can make sleep feel more tense than necessary.

When should you worry about night terrors?

Most night terrors are not dangerous in themselves, but it is worth seeking advice when they are very frequent, very intense or clearly affecting rest and daily life.

Assessment is also advisable if there is a risk of the child injuring themselves, if an intense fear of sleeping appears, or if there is daytime sleepiness, changes in daytime behaviour, regression or significant anxiety.

There are other signs that require medical attention: intense snoring, pauses in breathing, suspicion of night-time epileptic seizures, episodes that are very unusual or different from normal, or any neurological sign that raises concern.

When there are medical or neurological doubts, the right thing is to consult a paediatrician or neurologist. When the main issue is anxiety, fear of sleeping, family stress, disorganised routines or behavioural difficulties, child and adolescent psychology can be very helpful.

It is also worth asking for help when parents feel overwhelmed. This does not mean they are doing something wrong. It means they have spent too long carrying a difficult night-time situation, with accumulated sleep loss, anxiety and little sense of control.

In these cases, even if the child does not have a serious underlying problem, the family may still need guidance to regain calm, structure and confidence.

At what age do night terrors appear and when do they usually disappear?

Night terrors can appear in early childhood and are relatively common in young children. They are often seen during stages of sleep maturation, when the nervous system is still consolidating its night-time transitions.

In many cases, they reduce over time as sleep matures. However, I do not like promising exact ages as if all children followed the same timetable, because each case is different.

Some children stop having them on their own. Others need guidance if the episodes persist, increase or appear alongside other sleep, anxiety or behavioural difficulties.

In practice, I tend to think more in terms of evolution than a specific age. The important question is not so much “when should this disappear?”, but whether the evolution is moving towards less frequency, less intensity and less family distress.

Night terrors, anxiety, ADHD and autism

Not all children with night terrors have ADHD or autism. And not all children with ADHD or autism have night terrors. It is important to say this clearly so that we do not over-pathologise.

That said, some neurodivergent children may have more difficulty regulating sleep, transitioning into the night or tolerating certain changes. In ADHD, for example, there may be more activation, difficulty switching off and more irregular schedules. In autism, sensory sensitivity, rigidity around routines, anxiety about changes and sleep difficulties may play a role.

The key, therefore, is to assess the whole child, not just the night-time episode. A night terror is one piece of the puzzle, not the whole diagnosis.

There are also children without a formal diagnosis who show high activation, sensitivity or emotional dysregulation, and that alone can make sleep more fragile. We do not need to force everything into a label in order to intervene well.

When childhood anxiety, fear of sleeping or hyperactivation appears, it may be useful to assess whether a broader psychological intervention is needed. At Ocnos, when the case requires it, we can also integrate guidelines related to anxiety treatment, always adapted to the child’s age and family context.

Can food, emotional regulation or habits be related?

There can be a relationship, but I never like to oversimplify it. Food is not usually the sole cause of a night terror, although it can form part of the wider context.

Sometimes we see very late dinners, very busy days, screens too close to bedtime, accumulated tiredness or a child who reaches the night emotionally overloaded. All of this can make sleep more fragile.

From my clinical experience, sleep regulation, food, routines and behaviour are connected. In children with selective eating, anxiety, regulation difficulties or family tension, sleep can be one more part of the system, not the only focus.

That is precisely why I try to avoid isolated explanations. It is not about blaming dinner, screens or the child’s personality. It is about observing which combination of factors is making the night more unstable.

In some children, the night is not the beginning of the problem, but the moment when everything that has built up during the day becomes visible. That is why clinical analysis also needs to look at the afternoon, the transition home, dinner, the time for switching off and the way the family supports that lowering of activation.

How we work with night terrors in child therapy at Ocnos

At Ocnos Psychology Clinic, in Palmones, I usually work with these cases in a very practical and family-centred way. Often, the goal is not to “make the problem disappear” immediately, but to understand it, reduce its intensity and bring safety back into the home.

An example of sessions with a child who has night terrors

How long does it take to see improvements?

I do not like giving fixed timeframes. It would not be honest. Even so, in mild or moderate cases, many families notice improvements within a few weeks if they apply the guidance consistently and the context supports it.

Sometimes 4–6 sessions of family guidance and follow-up are enough. In other cases, more time is needed, especially if there is anxiety, neurodivergence, family stress, behavioural difficulties or highly disrupted sleep.

Improvement does not always mean that the episode disappears suddenly. Very often, it means that it happens less often, lasts less time, frightens the family less, interferes less and the family regains more confidence in managing it.

It is also important to review progress from several angles. It is not only about whether the episode repeats less often, but also whether the child sleeps more peacefully, whether parents are less on alert and whether the night becomes a more predictable space again.

Who treats night terrors?

The first point of reference is usually the paediatrician, especially when there are medical doubts, atypical symptoms or signs of another sleep problem.

A child psychologist can help when there is anxiety, fear of sleeping, disorganised routines, family stress, emotional regulation difficulties or behavioural impact during the day. In that case, child therapy does not focus only on the episode, but on the full context.

A child neurologist becomes relevant if there is suspicion of epileptic seizures, very unusual episodes or neurological signs. At Ocnos, when I consider it necessary, we refer or coordinate so that the assessment is appropriate.

In short, there is no single professional who “treats” all night terrors. The important thing is to assess the case properly and choose the support that fits what is happening.

Night terrors in Campo de Gibraltar

At Ocnos Psychology Clinic, in Palmones, we work with families from Los Barrios, Algeciras, La Línea de la Concepción, San Roque, Sotogrande and across Campo de Gibraltar. Many families come looking to understand why their child wakes up screaming at night and what they can do at home to experience it with less distress.

If the night has become a tense moment, it is worth seeking guidance. You can learn more about my professional profile on the page for Diego Román Roldán, or request an appointment through book an appointment. When the problem includes anxiety, fears or hyperactivation, we sometimes also work in coordination with anxiety treatment.

Reliable sources and resources

To learn more about night terrors, nightmares and children’s sleep hygiene, I recommend these reliable health sources:

These sources are useful for expanding basic concepts, understanding when to seek advice and supporting healthy sleep habits.

Conclusion

Night terrors can look very dramatic, and it is normal for parents to feel frightened. Even so, they often do not mean there is a serious problem. In many cases, they reflect immature or dysregulated sleep that needs more structure, more understanding and less alarm.

When they are frequent, intense or disrupting family life, it is worth seeking guidance. From child psychology, we can help understand the pattern, adjust routines, reduce fear around sleep and better support both the child and their family.

Frequently asked questions about night terrors in children