Nightmares Clinical Presentation

  • Author: Daniel R Neuspiel, MD, MPH, FAAP; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Mar 9, 2011
 

History

Sporadic nightmares are common in children and usually occur in the middle of the night or early morning, when REM sleep is more common.

Dream content varies with the child’s age. Nightmares may involve a monster, ghost, fierce animal, or bad individual. The dream typically involves some danger or threat to the child (eg, being chased or teased).

Other common themes are loss of control and fear of injury.

Vocalizations may occur, but movement, and autonomic symptoms are minimal.

When awakened, the child becomes oriented, can be calmed, and usually recalls the details of the dream.

Good history taking allows the clinician to rule out other sleep disorders such as night terrors.

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Physical

Nightmares are not associated with specific physical findings.

Heart rate and respiratory rate may increase or show increased variability before the child awakens from a nightmare. Mild autonomic arousal, including tachycardia, tachypnea, and sweating, may occur transiently upon awakening.

Movement is uncommon due to REM sleep– atonia.

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Causes

Developmental, genetic, psychological, and organic factors can contribute to occurrence. The high prevalence of parasomnias in early childhood has been associated with separation anxiety.[4]

Approximately 7% of individuals who have frequent nightmares have family history of nightmares.

Nightmares are more common in children with mental retardation, depression, and CNS diseases; an association has also been reported with febrile illnesses.

Medications may induce frightening dreams, either during treatment or following withdrawal. Withdrawal of medications that suppress REM sleep including tricyclic antidepressants and selective serotonin reuptake inhibitors can lead to an REM rebound effect that is accompanied by nightmares.

Nightmares are associated with anxiety disorders particularly in adolescents.[8]

Daytime emotional conflicts and psychological stress often contaminate sleep and predispose the child to nightmares.

Nightmares may result from a severe traumatic event and may indicate posttraumatic stress disorder.

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Contributor Information and Disclosures
Author

Daniel R Neuspiel, MD, MPH, FAAP  Director of Ambulatory Pediatrics, Levine Children's Hospital, Carolinas Medical Center; Adjunct Clinical Professor of Pediatrics, University of North Carolina School of Medicine

Daniel R Neuspiel, MD, MPH, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Physician Executives, American Public Health Association, New York Academy of Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Erin Hollingsworth Stubbs, MD  Faculty Physician, Division of General Pediatrics, Levine Children's Hospital, Carolinas Medical Center

Erin Hollingsworth Stubbs, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Chet Johnson, MD  Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH  Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and coding manual. 2nd. Westchester, IL: American Academy of Sleep Medicine; 2005.

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th. Washington, DC: American Psychiatric Association; 1994.

  3. Partinen M, Hubin C. Epidemiology of sleep disorders. In: Kryger MH, Roth T, Dement WC. Principles and Practice in Sleep Medicine. Philadelphia: WB Saunders; 2000:pp 558-579.

  4. Petit D, Touchette E, Tremblay RE et al. Dyssomnias and parasomnias in early childhood. Pediatrics. 2007;119:e1016-e1025. [Medline]. [Full Text].

  5. Nielsen TA, Laberge L, Paquet J, et al. Development of disturbing dreams during adolescence and their relation to anxiety symptoms. Sleep. Sep 15 2000;23(6):727-36. [Medline].

  6. Muris P, Merckelbach H, Gadet B, et al. Fears, worries, and scary dreams in 4- to 12-year-old children: their content, developmental pattern, and origins. J Clin Child Psychol. 2000;29:43-52. [Full Text].

  7. Kotagal S. Parasomnias of childhood. Curr Opinion Pediatr. 2008;20:659-665. [Medline].

  8. Bloomfield ER, Shatkin JP. Parasomnias and movement disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am. Oct 2009;18(4):947-65. [Medline].

  9. Sadeh A. Cognitive-behavioral treatment for childhood sleep disorders. Clin Psychol Rev. Jul 2005;25(5):612-28. [Medline].

  10. Hauri PJ, Silber MH, Boeve BF. The treatment of parasomnias with hypnosis: a 5-year follow-up study. J Clin Sleep Med. 2007;3:369-373. [Full Text].

 
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