Nightmares: A-to-Z Guide from Diagnosis to Treatment to Prevention

Mommy, I had a bad dream…

What are they?

Nightmares are unpleasant dreams that awaken a dreamer from sleep.

We’ve learned much about nightmares from traumatic events, which are known to cause a predictable pattern of nightmares: first dreams that relive the event, then dreams that relive the primary emotion of the event using different scenarios (different pictures), then dreams that incorporate aspects of the event into other parts of life.

Nightmares are an important means of addressing the normal difficult events and emotions of childhood, to weave them into the fabric of our minds in a constructive way.

Night terrors are very different from nightmares.

Who gets them?

Birth is a wonderful and terrible experience. There is much to be happy about and much to learn about in the weeks that follow. Babies’ dreams must incorporate and address those things that bring them pleasure and those that make them cry. In all likelihood, the peak age of crying, the first 6 weeks, is also the peak age of nightmares.

These nightmares are not unsuccessful dreams. Far from it! They help babies learn and grow; nightmares may even be an important reason that crying diminishes after 6 weeks.

Stressful events, such as injections, circumcision (which should never be done without anesthesia), being left alone or dropped, or even feeling hungry, need to be learned about and integrated. Anything worth crying about is worth dreaming about.

Nightmares are most evident between the ages of 3 to 5 years — the peak age when children talk about their fears.

What are the symptoms?

Children wake up and remember a scary or sad dream, usually in the second half of the night. They may be sad or afraid when they wake up, and are often crying. Children who are old enough will often wake their parents and tell them they had a bad dream.

Unlike with a night terror, they will recognize their parents and be comforted by their presence. In addition, unlike a night terror, they will often have trouble falling back asleep because of fear.

Are they contagious?

Nightmares are a normal part of development. They are not contagious, although children will often respond to the fear and sadness of those around them.

How long do they last?

Individual nightmares are brief.

Nightmares can occur throughout life, but tend to decrease with each passing year.

How are they diagnosed?

Nightmares are diagnosed based on the history.

They are to be distinguished from night terrors. In pre-verbal children, they should be distinguished from ear infections, reflux, hernias, or other causes of pain.

How are they treated?

An individual nightmare is treated with your reassuring presence. Holding your child and talking soothingly about the dream can diminish the fear and sadness.

If your child is old enough to tell or draw the story of the dream, it can be helpful to find a way for the story to reach a happy ending. Addressing the underlying emotions can help your child make sense of them.

How can they be prevented?

Much excellent children’s literature directly addresses difficult dreams. Other books address children’s common fears and concerns. This literature, and other art, can help children do some of the integrating work of nightmares without the nightmares themselves.

Related concepts:

Bad Dreams.