Night terrors vs nightmares in toddlers: how to tell and what to do

Night terrors and nightmares can both wake the house with screaming, but they're different events that need different responses. KidsHealth's guide to night terrors says night terrors happen in non-REM sleep, typically about 2 to 3 hours after bedtime, and that the child probably won't remember them. KidsHealth's guide to nightmares says nightmares happen in REM (dreaming) sleep and tend to come in the second half of the night, when REM periods are longer.

The simplest rule: if your child is awake, scared and wants you, it's probably a nightmare, so comfort them. If they seem awake but don't know you're there, it's probably a night terror, so keep them safe and wait. Both are common and usually outgrown. This guide covers how to tell them apart, what to do, sleepwalking safety, triggers, typical ages and when to get help. For a baby under 1 who cries out in their sleep, see baby crying in sleep.

How can I tell a night terror from a nightmare?

The NHS page on night terrors and nightmares says night terrors usually happen early in the night, sometimes more than once, and can last up to 15 minutes, while nightmares tend to happen later in the night and are bad dreams you wake up from and can remember. The Royal Children's Hospital Melbourne (RCH) in Australia describes a child having a night terror as stuck halfway between being asleep and awake, and says episodes usually last about 5 to 10 minutes.

What a night terror looks like

The RCH and the Sydney Children's Hospitals Network in Australia describe:

• a sudden scream, crying or sitting bolt upright
• looking terrified, with eyes open and a glassy stare
• thrashing, or getting up and running around
• fast breathing, a racing heart and heavy sweating
• not recognising you and not being comforted by you

Then, often just as suddenly, your child settles back to sleep. The next morning they usually have no idea anything happened.

What a nightmare looks like

Your child wakes up properly, frightened, and calls for you or comes to find you. They can usually tell you something about the dream, and may be scared to go back to sleep. The Sydney Children's Hospitals Network's nightmares page calls nightmares a normal part of growing up.

At what ages are night terrors and nightmares most common?

The AAP's guide to nightmares, night terrors and sleepwalking says night terrors occur most often in toddlers and preschoolers, and that nightmares can start as young as 6 months and tend to peak between 3 and 12. The RCH says about 5 in 100 children have night terrors. KidsHealth says nightmares are especially likely in the preschool years.

What should I do during a night terror?

1. Stay calm and stay close. It's harder to watch than it is for your child, who isn't aware of it.
2. Don't try to wake them. The NHS says your child may not recognise you and may get more upset if you try to comfort them. KidsHealth says waking them usually doesn't work and can leave them confused.
3. Only step in for safety. The NHS says not to talk to them or hold them unless they could hurt themselves. The RCH says trying to settle them often makes the episode worse. The AAP suggests gently stopping them if they try to get out of bed.
4. Wait for it to pass. Most children fall back asleep on their own.
5. Don't make a big deal of it in the morning. The RCH says this can make your child or siblings anxious about bedtime.
6. Tell other carers. The AAP and RCH suggest telling babysitters, grandparents or anyone your child sleeps over with what to expect and what to do.

Can you prevent night terrors?

If night terrors happen at about the same time each night, the NHS suggests waking your child about 15 minutes beforehand, every night for 2 weeks. KidsHealth suggests 15–30 minutes before. Keep the waking gentle and brief, then let them go back to sleep. The RCH says medication isn't recommended for preventing night terrors.

What should I do after a nightmare?

1. Go to your child quickly. The AAP says the best response is to comfort them.
2. Reassure them. KidsHealth suggests telling them you're there, it was a dream, it's over and it didn't happen in real life. Acknowledge that the fear feels real.
3. Stay until they're calm. The Sydney Children's Hospitals Network suggests talking gently about the dream if they want to, and staying until they're ready to sleep.
4. Use comforts. KidsHealth suggests a nightlight, a torch, a favourite soft toy or soft music. The AAP suggests removing anything real that looks scary, like a shadow on the wall.
5. Keep the night short. KidsHealth suggests helping them back to sleep without a long talk, then talking, drawing the dream or giving it a happier ending in the morning.

To reduce nightmares, KidsHealth suggests a regular bedtime and wake-up time, a calming routine, no scary books, shows or screens before bed, and no caffeine. If fears are making bedtime a battle, see bedtime stalling.

What triggers night terrors and nightmares?

The same few things come up across the sources:

• Being overtired or short of sleep. The NHS, RCH and Sydney Children's Hospitals Network all list this for night terrors, and the Network says nightmares happen more when children are overtired. See overtired baby.
• Illness or fever. Listed by the NHS, RCH, KidsHealth and the Sydney Children's Hospitals Network.
• An irregular sleep routine. The Sydney Children's Hospitals Network lists this for night terrors, and KidsHealth lists it for sleepwalking.
• Stress, worry or big changes, such as a move or a new sibling.
• Disturbed sleep, such as a full bladder or sudden noise (NHS), or sleeping somewhere new (KidsHealth).
• Scary books, shows or films before bed, for nightmares (KidsHealth, NHS).
• Snoring or sleep apnoea, which the NHS and KidsHealth say can make night terrors more likely.

The NHS, RCH and KidsHealth say night terrors tend to run in families, especially where relatives had night terrors or sleepwalked. Protecting sleep is the main prevention: a steady bedtime, an earlier night after a missed nap, and extra rest during illness. Big changes, like those around age 2, can bring a run of disturbed nights; see the two-year sleep regression.

How do I keep a child safe during night terrors or sleepwalking?

Some children with night terrors also sleepwalk. KidsHealth's sleepwalking guide says children tend to sleepwalk within an hour or two of falling asleep, and episodes can last from seconds to about 30 minutes. The AAP says not to try to wake a sleepwalking child, but to gently guide them back to bed.

Safety steps from KidsHealth, the AAP, the RCH and the Sydney Children's Hospitals Network:

• Lock outside doors and windows, and consider child safety locks.
• Put a safety gate at the top of the stairs and, if needed, across the bedroom door.
• Clear the bedroom floor of toys and clutter.
• Keep the bed low if you can, and don't let a child who sleepwalks sleep in a top bunk.
• Move sharp or breakable things away from the bed.

When should I get help?

Call 999 now for any of the signs above. The NHS guide to urgent help for under-5s lists a seizure, difficulty breathing, and blue, grey or pale skin, lips or tongue as reasons to call an ambulance. The RCH says night terrors have no link with epilepsy, and KidsHealth lists drooling, stiffening or jerking during an episode as reasons to call the doctor; we use the stricter emergency tier for anything that could be a seizure.

Talk to your GP or health visitor soon if:

• your child snores most nights, or you notice pauses or problems breathing during sleep; the AAP's sleep apnoea guide says to let your doctor know right away, and to call 999 if breathing stops for more than 20 seconds
• episodes are very brief (under a minute) or often happen in the second half of the night, which Cleveland Clinic lists as reasons to see a doctor

Talk to your GP or health visitor if:

• night terrors last longer than 30 minutes, happen more than once a week or disrupt sleep (KidsHealth), or happen often and disrupt the family's sleep (RCH)
• episodes are violent or dangerous, such as running or hitting, or your child is very sleepy during the day (RCH, Sydney Children's Hospitals Network)
• nightmares happen more than once a week, stop your child getting enough sleep, or come with other emotional or behaviour problems (KidsHealth)
• your child has frequent nightmares, or nightmares after an upsetting or frightening event (NHS)
• nightmares continue after 6, night terrors continue after 12, or night terrors start after 5 (NHS)
• sleepwalking is very regular, dangerous or causes daytime sleepiness (KidsHealth)
• your child seems very sad, fearful or stressed during the day (KidsHealth)

A GP may refer you to a paediatrician or sleep specialist, as the RCH notes.

What's worth noting down?

For a couple of weeks, jot down the time each episode starts and how long it lasts, what it looked like, and the day's nap, bedtime and any illness. Timings help you try scheduled waking and show your GP whether episodes are getting more or less frequent. If it's safe to do so, a short phone video of a typical episode can help a doctor see what you're seeing.