Dennis Rosen, MD is the associate medical director of The Center for Pediatric Sleep Disorders at Boston Children’s Hospital and author of Successful Sleep Strategies for Kids. If you have a sleep-related question to ask, please email it to Thrive@childrens.harvard.edu.
Q: Over the last several weeks, my 6-year-old has been waking up about two hours after falling asleep. She screams and cries inconsolably for about 20 minutes, goes back to sleep and then doesn’t remember anything when we ask her about it the next morning. This has been happening three or four times per week for a few months. Any suggestions on how we can help her?
-Frazzled in Philly
A: Dear Frazzled,
What you are describing sounds like night terrors, which are quite common in young children. Unlike nightmares, which usually occur in the second half of the night, night terrors tend to happen in the first few hours after sleep onset. Another difference between the two is that while a child will likely remember some aspects of a nightmare after she awakens, with night terrors there is no recollection of them the next morning.
All sleep is not the same. Over the course of the night, we repeatedly cycle between deep, light and REM (rapid eye movement) sleep, sometimes awaking as we shift between the different sleep stages. When the transition between deep sleep and wake isn’t complete, parts of the brain wake up while others remain fast asleep.
This can lead to behaviors that reflect aspects of both the waking and sleeping state and can result in what are called “confusional arousals.” They include night terrors, sleep walking and sleep talking.
In general, anxiety, an irregular sleep schedule, insufficient sleep, illness and other physical discomfort increase the chance of night terrors and other confusional arousals.
How can you reduce the chances that your child will have a night terror? Start by keeping her on a regular sleep schedule. Put her to bed each evening—and wake her up in the morning—at a regular time, which allows for an age-appropriate amount of sleep.
You also may find it helpful to sit with her in the last few minutes of the evening as she is getting ready for sleep, and go over the events of the day to try and identify any sources of anxiety. If you do, try talking her through the problems or refocusing her attention on more pleasant and soothing topics through soft conversation or by reading a story together.
When confusional arousals do occur, it isn’t necessary to try and wake her up or to forcibly “pull her out” of them, even though it can be difficult to watch her cry or scream as she sleeps. The most important thing you can do is keep her safe by guiding her back to bed and waiting for the episode to resolve on its own.
If your child has a sleep-related issue that requires medical attention, please call our Center for Pediatric Sleep Disorders at 781-216-2570, or visit the center’s website and click the “request an appointment” button.
A study recently published in the journal Pediatrics found that 7-year-old children with regular bedtimes are less likely to display behavioral problems during their waking hours than those children without fixed bedtimes.
Interesting, but not exactly earth-shattering, news.
“I don’t think that anyone with a 7-year–old child at home will be surprised to learn that well-rested children are typically better behaved,” says Dennis Rosen, MD, associate medical director of The Center for Pediatric Sleep Disorders at Boston Children’s Hospital. “While it’s nice to have the scientific data, these findings will probably only reinforce what most parents already know.”
While the study may not hold any breakthrough revelations, it did reveal that behavioral issues in children without set bedtimes could be reduced or eliminated once bedtimes are introduced. In other words, even if your child doesn’t have a bedtime right now, it’s not too late to start enforcing one, and doing so could correct or lessen behavior problems your child may be having.
So, if behavior is becoming a concern in your house and your child doesn’t currently adhere to a regular bedtime, now might be a good time to start.
According to Rosen, consistency is key in setting up bedtimes and helping kids stick to them. To do so, he suggests the following: …
By Dennis Rosen, MD
This month marks the second anniversary of the January 2010 earthquake that devastated Port au Prince, killing more than a quarter million, injuring over 350,000, and leaving an estimated one million without shelter. Having gone there three times since then with groups from Children’s Hospital Boston to participate in the relief efforts, hardly a day goes by that I am not reminded of what I saw and lived during those weeks. Ranging from the truly horrible to inspiring and uplifting, many of the experiences were unlike any others I had had prior to setting foot in Haiti.
The first time I went was in May 2010 with a group that worked at the General Hospital along with Partners in Health. Conditions on the ground were utterly chaotic, and the disorganization made it difficult for foreign volunteers to work as we were accustomed to doing back home. This only added to our frustration at the discrepancy between the enormity of the challenges we faced and what we could (or could not do) to help. Many of those we cared for were suffering from the after-effects of injuries sustained in the earthquake, including chronic bone infections following amputations. A significant number of the children we saw were malnourished, their golden, frizzy hair and big bellies (often full of worms) helping us to make the diagnosis as soon as we saw them.
Others presented with routine medical and surgical problems which would have been straightforward in Boston but which were, in fact, very difficult to treat in Haiti because of the limited resources available and the lack of continuity of medical care. Perhaps the hardest of all was to repeatedly see children die from conditions and diseases which could have been prevented or treated back home, at little cost, and to be powerless to stop that from happening. On both the first and the second trips our teams cared for children who died from diphtheria. Previously widespread in the United States, it has not been reported here since 2003 thanks to widespread vaccination. However, diphtheria remains endemic in Haiti, and because most children do not have access to vaccinations, hundreds die from it there each year. …
A reader recently posted a question about kids who have difficulties waking up in the morning:
I am interested in the help available for those who simply cannot wake up in the morning. My brother has, since a young kid, absolutely not been able to wake up in the morning on his own. Even with very intense attempts to wake him by others, it is about an hour long procedure in itself, maybe longer. He dropped out of college because he could not get up for class with no one there to wake him, and at 21 still lives with our parents though he fears losing his job due to missed work. Doctors he speaks with simply cast him off with “oh you just need a louder alarm clock” (He has the loudest, most obnoxious one money can buy, which includes a vibrating pad for under your pillow) or “you’re just hard to wake up” (duh). Is there any help available for people like this? …