What are Night Terrors?

What are “night terrors” and why do children get them?
Grace Montenegro – Fremont, California

What are Night Terrors?

Dr. Greene’s Answer:

Within fifteen minutes of your daughter’s falling asleep, she will probably enter her deepest sleep of the night. This period of slow wave sleep, or deep non-REM sleep, will typically last from forty-five to seventy-five minutes. At this time, most children will transition to a lighter sleep stage or will wake briefly before returning to sleep. Some children, however, get stuck — unable to completely emerge from slow wave sleep. Caught between stages, these children experience a period of partial arousal.

Partial arousal states are classified in three categories: 1) sleep walking, 2) confusional arousal, and 3) true sleep terrors. These are closely related phenomena that are all part of the same spectrum of behavior.

When most people (including the popular press and popular parenting literature) speak of sleep terrors, they are generally referring to what are called confusional arousals by most pediatric sleep experts (Principles and Practice of Sleep Medicine in the Child, by Ferber and Kryger). Confusional arousals are quite common, taking place in as many as 15% of toddler and pre-school children. They typically occur in the first third of the night on nights when the child is over-tired, or when the sleep-wake schedule has been irregular for several days.

A confusional arousal begins with the child moaning and moving about. It progresses quickly to the child crying out and thrashing wildly. The eyes may be open or closed, and perspiration is common. The child will look confused, upset, or even “possessed” (a description volunteered by many parents). Even if the child does call out her parents’ names, she will not recognize them. She will appear to look right through them, unable to see them. Parental attempts to comfort the child by holding or cuddling tend to prolong the situation. Typically a confusional arousal will last for about ten minutes, although it may be as short as one minute, and it is not unusual for the episode to last for a seemingly eternal forty minutes.

During these frightening episodes, the child is not dreaming and typically will have no memory of the event afterwards (unlike a nightmare). If any memory persists, it will be a vague feeling of being chased, or of being trapped. The event itself seems to be a storm of neural emissions in which the child experiences an intense flight or fight sensation. A child usually settles back to quiet sleep without difficulty.

These are very different from nightmares. Nightmares are quite common, occurring in about 60% of children in the preschool years (Pediatrics in Review, March 1996). You won’t become aware of your child’s nightmares until after she awakens and tells you about them. They are scary dreams that usually occur during the second half of the night, when dreaming is most concentrated. A child may be fearful following a nightmare, but will recognize you and be reassured by your presence. She may have trouble falling back asleep, though, because of her vivid memory of the scary dream.

True sleep terrors are a more intense form of partial arousal. They are considerably less common than confusional arousals, and are seldom described in popular parenting literature. True sleep terrors are primarily a phenomenon of adolescence. They occur in less than 1% of the population. These bizarre episodes begin with the child suddenly sitting bolt upright with the eyes bulging wide-open, and emitting a blood-curdling scream. The child is drenched in sweat with a look of abject terror on his or her face. The child will leap out of bed, heart pounding, and run blindly from an unseen threat, breaking windows and furniture that block the way. Thus true sleep terrors can be quite dangerous, in that injury during these episodes is not unusual. Thankfully they are much shorter in duration than the more common confusional arousals of the pre-school period.

The tendency toward sleepwalking, confusional arousals, and true sleep terrors often runs in families. The events are often triggered by sleep deprivation or by the sleep schedule’s shifting irregularly over the preceding few days. A coincidentally timed external stimulus, such as moving a blanket or making a loud noise, can also trigger a partial arousal (which again shows that the event is a sudden neural storm rather than a result of a complicated dream).

Interestingly, a recent study published in the journal Pediatrics in January 2003, showed that children who have recurrent partial arousal states may also have other sleep disorders (including sleep disordered breathing and restless leg syndrome) that may benefit from a physician’s care.

Treatment usually involves trying to avoid letting the child get over-tired, and trying to keep the wake/sleep schedule as regular as possible. When an event does occur, do not try to wake the child — not because it is dangerous, but because it will tend to prolong the event. It is generally best not to hold or restrain the child, since her subjective experience is one of being held or restrained; she would likely arch her back and struggle all the more. Instead, try to relax and to verbally comfort the child if possible. Speak slowly, soothingly, and repetitively. Turning on the lights may also be calming. Protect your child from injury by moving furniture and standing between him or her and windows. In most cases the event will be over in a matter of minutes. True night terrors, or bothersome confusional arousals, can also be treated with medications, hypnotherapy, or with other types of relaxation training.

Recently, my youngest son was having a confusional arousal, and his mother observed that these events are most common at the same ages that children are becoming aware of the bladder feeling full during sleep. Perhaps some of these kids just need to go to the bathroom? We stood him in front of the toilet, and he urinated, still not awake. The episode faded abruptly, and he returned to sleep. The calm was dramatic.

Was this a coincidence? Or might this be a revolutionary new help for parents whose kids have these frightening episodes? A number of readers have tried this approach. Most said it worked wonders; a few said it had no effect. If you try it, let me know the results, either way. Together we can learn more about the wonder and mystery of sleep in children. I have sat with my children through confusional arousals, and know how powerfully these episodes tug at a parent’s heart. Just understanding what they are (normal childhood sleep phenomena that children outgrow — not a sign of maladjustment or the result of bad parenting) helps tremendously.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Joana

    Although at first my 3 year old will refuse to pee, at second or third attempt he will do so and in a matter of seconds the night terror stops. Once I found this out it was definitely a relief. Before, he would keep crying and screaming for more than 20 minutes. I had even tried wetting his hands and feet but with no success. Apparently emptying his bladder works the best, at least for us! Thank you for the article. I will definitely share it!

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  2. Mandy

    Just wondering at what age do night terrors typically occur? Do babies or toddlers have night terrors?

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    • Hi Mandy,

      Dr. Greene says, “The tendency toward sleepwalking, confusional arousals, and true sleep terrors often runs in families. They tend to be more common in boys, and are much less common after age 7.”

      Hope that helps,
      @MsGreene

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  3. LBuren

    Recently, my 10 year old son has been waking up every night about an hour after he begins sleeping. He always yells out for us, gets out of bed, and moves quickly to find us. His arms and hands are shaking while he appears very upset. He is inconsolable but talking with eyes open. He uses the bathroom to urinate and sometimes throws up from being so worked up. Shortly after, he returns to his bed and usually does not get up again (except for a few times when he has awoke several times). I’ve thought it was stress induced. His words do not always make sense but sometimes they are related to schoolwork, teachers and classes. He does not remember anything the next morning. This information about a full bladder is very interesting to me and I certainly can not argue against a possible connection based upon my experiences. I still wonder if some of the school issues and his other physical changes might also be factors. It is a helpless feeling as a parent to have to watch your child exhibit these behaviors. I am thankful that he does not recall the events each night.

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    • Here is my response as a mom (note: I am not a doctor):

      I wonder if he isn’t getting enough sleep. Exhaustion may be causing him to sleep deeper than normal. In addition, I wonder if he may be stressed out about school and the combo is coming out in this sleep pattern.

      If this is the case, can you help him get to bed earlier? Perhaps over the weekend he could catch up a bit by also sleeping in?

      Best,
      @MsGreene
      Co-founder & Executive Producer DrGreene.com, Mom

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  4. AtALoss

    My son is doing the moaning and rolling around about same time every night within a 3 hour window, between 1 and 4 am. Most of the times he needs to pee and wakes up fine to go and then is right back to sleep as soon as head hits the pillow. A few times it’s not so easy and tonight has been the worst of them all.

    Tonight started out with rolling around and moaning and trying to snuggle into my shoulder. I asked if he needed to go potty and he shook his head no and I immediately asked him again and he gets up holding himself and said yes. I asked him if he wanted his potty chair, which is in the room next to the beds, or if he wanted the toilet. He said not his chair so we trekked upstairs to the bathroom and I got his pants down to go to the bathroom and as I was sitting him on the toilet he started freaking out and screaming. He jumped off the toilet ran all over upstairs screaming and telling me no mommy I don’t want to go on there and then he started trying to slam the door and when I held the door so he couldn’t close it he bit me and gave me an instant bruise with some blood and then he started picking up his toys and throwing them across the room, and it was his bigger heavier toys not the little easier to throw ones, while still screaming blood curdling screams. He stopped screaming and throwing stuff after he urinated on my area rug. Then he was crying and when I asked if he was done pottying he said yes so he went and got his underwear and pj pants so I could help him get dressed. He let me help him and then sat in the rocking chair while I did a quick clean up on the rug. I carried him back to bed and he crawled onto his blankets and was snoring in seconds.

    Amongst his screaming and yelling he said I don’t like automatic ones and I kept reassuring him our toilet was not an automatic toilet. He’s terrified of the automatic vacuum suck toilets that are everywhere.

    Would this be an instance of confusional arousal? He gets violent in whatever they are but it’s mostly just hitting and screaming, tonight escalated to biting and throwing his big toys and trying to slam doors. He will be 3 in December.

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    • AtALoss,

      This sounds like a combination of confusional arousal and an irrational fear. (Though in this case, it might be a rational fear. Those automatic toilets, that flush while you’re still sitting on them are at best unpleasant!)

      The key for many kids is not to ask them if they want to sit on the potty, but to gently help them get their clothes in position and sit them on the potty while gently talking with them — “It’s potty time. I’m going to help you. It’s right here. Go ahead and sit. You can pee now.” In the half awake state, they do not need to make a decision and often can’t make one. Or if they try, it sends them over the edge.

      I hope that’s helpful.

      @MsGreene

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  5. Tiredmom

    My 4yo daughter has had two night terrors over the past few months. Both times after a few minutes of intense crying and thrashing and not responding I put her on the potty and as soon as she urinated the night terror immediately stopped and she fell right back asleep. I’m so glad I found your site and tried this tactic.

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    • Tiredmom,

      Thank you so much for letting us know. It’s very rewarding to know people are being helped.

      Best,
      @MsGreene

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  6. margaret

    We’ve had a few isolated episodes of night terrors with our 10 month old son, but after last night’s 2 hour episode, I realize that maybe that’s what has been going on for a few weeks straight. I thought we had just lost any sleeping luck after a vacation, but now I think it’s been smaller episodes every night.
    Our son’s first episode was on a plane(!), the second flight of a long day of travel delays when he was 8 months old. He seemed to wake up on the plane (we thought we were home-free with a sleeping baby), screamed inconsolably for 10 minutes, and then passed out again like nothing happened. Once we put together that he never really saw/heard us or even woke up, we looked up night terrors.
    A few weeks later, he kept waking us up while he tried to scream/crawl in his sleep. Those wakings subsided once he learned to crawl. He was never really one to wake up crying, and the thrashing around made it obvious. I could nurse him back to sleep.
    Then recently, after screwing up schedules with a vacation, I assumed we had ruined any sleep routines we had by sleeping in the same room and/or bed and nursing back to sleep. (And of course, front teeth coming in.) Every night he wakes up crying around 10:30 pretty reliably, after 2 1/2 hours of sleep. He’s sitting up in his crib now, mad he’s alone, which seemed to make sense. I have been nursing him back to sleep, then he does it again at 1-1:30am. Then I nurse him and bring him to our bed, where he’d cries and thrashes before he wakes up in the morning. All this from the baby who had never really had trouble getting through the night, and had been weaned at night. We never even really had to cry-it-out before.
    I’ve been chicken to cry it out this time because he’s older, more vocal, and more mobile. Last night nursing back to sleep didn’t help and he thrashed around for a couple hours, as I said. Is it possible night terrors are the disturbance? We will try to preempt the night terrors starting tonight. We’ll let you know how it goes!

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    • Margaret,

      Oh, I feel your pain. This has got to be tough on you all.

      I think your observation that the last tough time was when he was learning to crawl is very fascinating. By chance, is he trying to learn a new skill now? Walking perhaps?

      It’s very common for kids who are learning to walk to have a period of rough sleep. They go to sleep, but wake up in the middle of the night because they’re so exciting about working on this cool new thing that they almost have. Perhaps your son is going through that, but he’s one of these kids that can’t fully wake up or who get caught between sleep stages.

      Do let us know how it goes!

      Best,
      @MsGreene

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  7. Caroline Ricardson

    Hi help!! My daughter is 6 and has been having night terrors for a year or so now, mostly every night but then sometimes goes a week without one then pop it starts again. We went to a sleep charity and had a sleep study done that found she had 68 episodes of sleep apnea in one night. She also suffered with enlarged tonsils and lots of tonsillitis so she had a tonsillectomy and adenoids out a few months ago. Her tonsils were grade 3 and she had abnormally large adavoids so they definitely needed taking out BUT unfortunately we are still having night terrors.
    We have tried everything I can think of, from no TV, relaxing massages before bed, sleeping in our bed, me sleeping with her in her bed, earlier bedtime, waking her after 40 mins of sleep (just before a terror due) but she would just have one half hour after this
    ..u name it we tried it. We tried taking her to the toilet like this suggests but she does nothing when there and most of the tume its impossible to get her to sit as she is that fraught running round and jumping about. She screams and cries and can’t see us its like were invisible it’s so awful. I have tried waking her for toilet before a terror and then a while after the terror to see if a wee was lurking but she 99% of the time does nothing. BUT she generally always has a wet pull up in the morning which I can only guess happens between 11pm-6am while am asleep cos I check all the other times.
    The only thing I can think of that could trigger the terror is her being too hot, she has always been a hot child and even in winter kicks off her duvet. Every time she has a terror her face is bright red and she is damp with sweat n red hot to touch, even when she is in bed with just a vest n pj’s shorts with a sheet over her why is she so hot on a night?? We have had a fan on her the last week and funnily enough she hasn’t had a terror, yet tonight she went to bed with my husband as he on earlys n had a terror but had no fan on her n was boiling so could this be it?

    Am lost, I hate seeing my child so upset and terrified and I feel so helpless I don’t know what else to do. She is such a bright happy girl, she has loads of friends and is doing so well at school and is always happy, she is a loving healthy girl with a big heart and a great loving family. The only thing is she is quite sensitive and often gets upset about things n takes things to heart, she often questions things about mummy n daddy always being there for her n never going away, she doesn’t want to leave us or grow up or change n never wants us to go to heaven or get older…I think she thinks bout these things too much n not sure why. Could this over thinking n the heat be causing terrors? Also she is scared of being alone n wont be on her own anywhere without someone being with her. So if I go upstairs, she follows etc etc.. anyway I just thought I’d try put this together to see if we could get any suggestions /thoughts / answers? Thank u

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    • Caroline,

      This sounds horrible for all of you!

      The fan sounds very promising. I don’t know why it she may be extra hot, but it doesn’t sound like there is a down side to using the fan.

      One of our guest bloggers wrote a post that may be helpful for you –> How to Stop Night Terrors Now!.

      Please let us know how she’s doing.

      @MsGreene

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  8. Angie

    Just listened to you on the sleep summit. I was eager to learn about night terrors. My son had them for several years, 9-12, and has outgrown them. We thought he was too hot when he went to bed as he would be sweating. He is 15 now but as I look back, my husband would take him to the bathroom and once he urinated he began to calm down. That was our “go to” in the hopes he’d settle down. I’m so glad that is over. So for any parent going through this, hang in there. The blessing is that they don’t even remember it happening. After a while we didn’t even tell our son he had an episode. When we spoke about it after the fact, we realized he was wondering what was wrong. We didn’t want him to think there was something “wrong with him” as none of us understood at the time what was going on, so we then went through the motions and didn’t discuss it with him.

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    • Thanks so much for providing your input. Your story adds to what we’ve heard from others.

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      • Joni Parks

        My daughter has had night terrors for the last3 years started when she was 7 and still occur. She wakes scared, crying runs from one end of the house to the other and flails her hands yelling no getting her to go to the bathroom has also been my go to resolution and usually always works. This should be made more known to parents! Thanks for the article

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  9. Kelly

    Wow! My daughter has been dry at night for 7 months now… She’s had a few nights where I’ve assumed she’s had night terrors. Many times I’ve googled to just find they start around her age so presumed that was it. Thank god I found this tonight. It’s almost 1am and my daughter was really restless before in bed and ended up getting really upset, eventually waking herself up. Came across the link to your page here and tried her on the potty. Ok it’s not ideal she’s awake at this time but she’s talking nicely now and we should be asleep soon. Thank you!!!

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  10. laura

    I just read your article and couldn’t believe you made a connection between a full bladder and night terrors. That was my cure for my daughter who would get them. I would pick her up and put her on the potty. As soon as she peed terror was over. I thought it was a fluke but it really worked for her.

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    • Thanks for sharing your experience with your daughter. It’s great hearing from parents.

      Best,
      @MsGreene

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  11. A.T.

    Hi I read the article about night terrors and I have the same issue with my son who is now almost 5 but he has had these since he was 3 and I have also came to notice that after I make him go to the toilet he also stops crying quite suddenly and off to sleep he goes again so I believe that this does have something that relates to why they have night terrors.

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  12. Hana

    Thank you Dr Green, Helped me understand my daughter and her shaking at night and then urinating on my lap.

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  13. Nkim

    I just wanted to really thank you for providing the guidance on resolving night terrors.

    My 3 year old started night terrors at about 2 years old – almost every night. They were extremely painful to observe.

    I’ve researched for mnths on this topic and tried many things to resolve it from diet changes, earlier bedtimes, longer naps so he feels more rested and nothing worked. We were almost at the point of going to a sleep clinic to see if it was a sleep apnea issue.

    But then came your article on emptying the bladder. It really was revolutionary. We brought him to the toilet 60 minutes from when he fell asleep. We tried this for a week straight and today we have experienced no night terrors for almost a month!

    We feel even that his speech development is accelerating now that he is getting uninterrupted sleep through the nights.

    Thank you for this. You were the only areticle that suggested the bladder connection and it totally makes sense.

    So glad we found you!

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  14. Sam

    Both my boys suffer from confusional arousal. And both need to be taken to the bathroom or they run around the house screaming and crying and no one can calm them and they don’t recongize me and they will eventually urinate where ever they are standing. And as they are urinating they are calming down and go right back to sleep. So I physically pick them up and put them at the toliet. It happens almost every night between the both of then aged 2 and 5.

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  15. Kim

    Our daughter has had a few of these episodes and it’s always when she has to urinate. She screams and shakes and sweats but wont respond to me. I put her on the toilet and she goes right back to bed immediately afterward without any problems. I’m a nurse and see elderly people act crazy when they have urinary retention. I definitely think there is a correlation!

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  16. Nikki

    My 9 year old son has this, he literally just sprinted from his room 20 minutes ago looking for a bathroom, it’s always when he’s absolutely bursting to use the bathroom and it scares me, I worry for him and my other children. I used to think it was just when he was overtired but it’s always when he needs the bathroom so surely it must be to do with that. I hope if he stops drinking before bed time these will disappear.

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  17. Amber

    This article has hit the nail on the head for our 5 year old daughter. She started having these at age 4, and after many observations and journaling of the terrors…it finally hit me that almost everytime she had a night terror she would soak her pull up. After about a year into them, her pull up leaked one night and got everything wet. After that episode, I started checking her pull-up after she would calm down and everytime it would be soaked. Now when she has a terror I put her on the potty and she always goes, then right back to sleep. I thought I was the only one who thought this could be the reason for her horrible night terrors. Noone else seemed to think they had anything to do with each other. Hopefully we are at the end of these terrible things!

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  18. Katrina May

    Dr Greene , I think you’ve hit the nail on the head with regards to night terrors and their causes/origins! My much younger sister would constantly experience night terrors beginning about age 6 until about 10 or 12 yrs old. We would usually attribute it to a bad nightmare, but it was far more sinister than that because as you said she didn’t recognize us and would be flailing her arms around with her eyes open and talking in a highly anxious and rapid state that was frightening to watch – and if I didn’t know better it appeared to have similar characteristics of a seizure, but it was not because it only happened after she had been asleep for about an hour or two.

    She would start calling out names and then when we would come into the room she would not recognize or connect with anyone as if she were still in the dream. But most of the time she was crying a lot and for no apparent reason as she went to bed fine. If we didn’t get to her quickly enough before realizing she was having one of her night terrors (it didn’t happen every night) she always headed to the bathroom and went in the toilet to urinate. We never put two and two together, but she did outgrow it over time, thank goodness! However you have cleared up a big question for me which I will pass on to her one day – and that is what caused her to have these episodes:; being tired I can see was probably a big contributor but having to go to the bathroom with a full bladder to pee while in a deep sleep was definitely the culprit! After she would go to the bathroom and we’d bring her back to bed – usually having to carry her in both directions until she got too big and heavy – she would then sleep the whole night through.

    So I am convinced that you are absolutely right about the full bladder connection and being very overtired – maybe too tired even to subconsciously make the connection between needing to get up to go to the bathroom to relieve ones self. But it still begs the question: why do some kids get night terrors with a full bladder vs others wetting their beds vs the majority who get up and go to the potty without any night terrors? And what goes on in the mind that causes so much fear and terror in otherwise very normal children? My sister was a very well adjusted child – smart, popular, nice and very attractive and athletic too. But she did have these night terrors that seemed to go on for many years and they were upsetting for all of us to see her suffer through.

    There is some documented research suggesting that mood disorders or bipolar personality disorder is associated with night terrors. If you had asked me if she suffered from either as a child I would say definitely not at all. However, as an adult today she really is struggling with a lot of mood and personality issues that we are at a loss for – I am constantly searching for answers and tell tale clues from the earlier years of our life and the night terrors are the only real significant episodes that we can link back to figure out what may have been abnormal behavior.

    As an older sibling I feel obligated to help her figure out what went wrong so she can get the help she needs now. In my opinion, I think night terrors are linked to full bladders, but they are also indicative of some underlying serious psychological disorders, too. I hope you can weigh in some more on this and educate other parents and family members to be alert to the connections and patterns that link night terrors to a full bladder and a warning sign that things are not all that they seem – and that there are probably other issues going on for the child, too. Reminding these kids to always go to the bathroom right before bed is a key component here!

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  19. Hagar Berlin

    My 10 month old just woke up with what fits the confusion arousal description perfectly. It was very different from any of her previous night waking and a bit scary, except that she was clearly asleep the whole time despite her screams. Is confusion arousal possible so young?

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    • HippieMom

      My daughter’s nighttime crying started somewhere around 3 months old. We didn’t know for a long time that it was night terrors. When she was older and talking it became more obvious that she wasn’t really seeing or hearing me. I’d always read that night terrors were triggered by over tiredness, heat, cold or pain. When we figured it out for my daughter, it was garlic, primarily in spaghetti sauce. When we eliminated fresh garlic and onions from her diet the night terrors virtually went away. I loved garlic before that, so there was likely a lot of garlic in my breastmilk too.

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  20. gortday

    I love this article. I have loved it since my oldest daughter (now 6) was potty training and this helped me stop her confusional arousals in their tracks. I still use this trick on my youngest with great success and again just tonight when my eldest was sleepwalking and not making any sense. Guiding her to the potty helped me get her back into bed quickly without any harm.

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