As your baby becomes a toddler, chances are they will give you some sleepless nights. In this week’s post I’ve got your solution.

But first a little fun fact.

Strange but true: whether or not your toddler awakens you, each night you’re almost certainly waking up about every hour or so – nearly everybody does. The difference is that most of the time you go right back to sleep.

Why, oh why, doesn’t your baby do the same?

A couple of things are at play here: The first is that your baby is just about to learn to walk, and secondly, separation anxiety generally peaks around this time.

Since your baby is just about to enter toddlerhood, they eagerly want to try walking at every opportunity. This includes when they stir at 4am. And when they do wake up, they become frightened because they realize that for the first time in their life, you aren’t there with them.

It’s a growing pain for the whole family.

Lots of my patients have rediscovered the bliss of a good night’s sleep using my simple method. Watch the video below where I talk about how to do exactly that (spoiler alert: you don’t even have to pick them up or feed them).

This is a simple, effective solution to help everyone get a sound night’s sleep (yourself included). Give it a try with your child, and I’ll bet that in just 3-4 days you’ll find it works for your family as well.

If you do decide to give it a shot, leave me a comment telling me how this method has worked for you.

Or, do you have a method that’s been particularly helpful share it with the community!

Dr. Greene`s Answer:

The average amount of sleep at 3 months is 15 hours out of 24 give or take an hour or two. This may come in almost any combination of naps or nighttime. But when kids sleep less than about 12 hours out of 24, it is important to determine why.

It could be related to nutrition, but it also could be a variety of other things: an ear infection that hurts when he lies down, a food intolerance, a cow’s milk allergy (up to 20 percent of those intolerant to milk are also intolerant to soy), even a hernia. Sometimes, too much thyroid hormone can keep kids awake. Either way, this is a good reason for a visit with your pediatrician.

Related concepts:

Snoring, Obstructive sleep apnea, OSAS, Adenotonsillar hypertrophy

Introduction to sleep apnea:

Parents are quick to mention some things to their pediatrician: fevers, seizures, and bleeding. Snoring is another important symptom that your child’s doctor needs to know about, though it often goes unreported.
Any child who snores may have obstructive sleep apnea, and may not be getting adequate sleep.
Not all kids with sleep apnea snore. Even when they do, sleep apnea is often overlooked. Instead, the child may be diagnosed with a behavioral disorder — most commonly ADHD.

What is sleep apnea?

Most people make some quiet snoring noises when they have (or are recovering from) a cold but this quickly resolves after the cold. Some people snore even when not ill, and some snore loud enough that others can easily hear them. In these cases, snoring may be the sign of obstructive sleep apnea syndrome (OSAS), where there is prolonged partial blocking, or intermittent blocking, of breathing during sleep. The obstruction is usually caused by large tonsils or adenoids, which may be temporarily enlarged by infection or allergies.
Children with sleep apnea do not get sound sleep. They may also get suboptimal oxygen to the brain at night. Obstructive sleep apnea can have a serious negative impact on a child’s intellect and behavior.
OSAS can cause growth problems. It has also been linked to ADHD, poor school performance, learning difficulties, bedwetting, high blood pressures, lung disease, heart disease, and rarely even death.
OSAS is different from primary snoring (PS), the name given to snoring that doesn’t cause sleep disruption or breathing problems. Primary snoring is more common than OSAS.

Who gets sleep apnea?

OSAS occurs in about 2 percent of children. The peak age is 2 to 5 years old, but it can occur at any age.
In older children and adults, it is more common among the obese. It is also common in those with sickle cell disease, Down syndrome, birth injuries, or any other condition that might narrow the upper airway.

What are the symptoms of sleep apnea?

Classically, those with sleep apnea snore quite loudly for a bit, then are silent (sometimes not appearing to breathe), then snort briefly, move about, and resume snoring. If snoring is accompanied by nighttime breathing difficulty and pauses in breathing, then it may well be sleep apnea.
However, many children with OSAS do not follow this classic pattern. OSAS and PS cannot be reliably distinguished from each other based on the symptoms alone.
Other common symptoms of sleep apnea include mouth breathing, restless sleep, difficulty paying attention during the day, decreased academic performance, oppositional behavior, and restlessness.

Is sleep apnea contagious?

No

How long does sleep apnea last?

Children often outgrow OSAS within several years.

How is sleep apnea diagnosed?

Snoring should be brought to the attention of your pediatrician. You might want to make a cassette tape of your child’s sleep noises to bring with you.
OSAS and PS cannot be reliably distinguished from each other based on the physical examination and history alone. Other tests must be used. A sleep study is the gold standard test for telling the difference. Thus, snoring needs to be reported to the doctor, and when snoring lasts longer than a brief respiratory infection, or fails to respond to allergy treatment, it deserves thorough evaluation. Often pediatricians enlist the help of ear-nose-and-throat, neurology, or pulmonary specialists to help distinguish between the two.

How is it treated?

Because enlarged tonsils and adenoids usually cause the obstruction, removing them can usually solve the problem.
Sometimes the obstruction is treated with gentle positive air pressure in the airway at night – nasal CPAP (continuous positive airway pressure).
Supplemental oxygen, and correction of anemia may provide additional help.
Decongestants, steroids, antibiotics, or other medicines might reduce snoring caused by enlarged tonsils or adenoids in PS but are unlikely to be of much help with true obstructive sleep apnea.

How can it be prevented?

Early treatment of primary snoring might prevent the cycle that leads to obstructive sleep apnea. Preventing or treating obesity and nasal congestion can also help protect children from OSAS.

Related A-to-Z Information:

Adenovirus, Allergies (Allergic Rhinitis), Anemia (Low hemoglobin), Asthma, Attention Deficit Hyperactivity Disorder (ADHD),Bronchiolitis,Cerebral Palsy, Cleft Lip and Palate, Common Cold, Congenital Heart Disease, Cough, Croup, Depression, Down Syndrome, Enuresis (Bedwetting), Epilepsy, Gastroesophageal Reflux, Head Banging,Obesity, Pertussis (Whooping cough), Sudden Infant Death Syndrome (SIDS), Tonsillitis

Related concepts:

Bad Dreams

Introduction to nightmares:

Mommy, I had a bad dream…

What are nightmares?

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 nightmares?

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 of nightmares?

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 nightmares 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 nightmares last?

Individual nightmares are brief.
Nightmares can occur throughout life, but tend to decrease with each passing year.

How are nightmares 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 nightmares 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 nightmares 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 A-to-Z Information:

Colic, Ear Infection, Gastroesophageal Reflux, Hernia (Inguinal hernia), Night Terrors, Separation Anxiety, Tantrums

Related concepts:

Confusional arousal; Partial arousal state; Sleep terrors

Introduction to night terrors:

Your little angel wakes up screaming in the middle of the night, calling for his mommy – but his mommy is right there, unrecognized. You try to comfort him, but he shrieks even louder, eyes bulging. He might be having a night terror.

What are night terrors?

Within fifteen minutes of your child’s falling asleep, he will probably enter his 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, become stuck and are 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 closely related phenomena are all part of the same spectrum of behavior.
When most people (including the popular press and popular parenting literature) speak of night terrors, they are generally referring to what are called confusional arousals by most pediatric sleep experts.
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 fight or flight sensation. Once it is finally over, the child usually settles back to quiet sleep without difficulty.
These are very different from nightmares.
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.

Who gets night terrors?

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.
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).

What are the symptoms of night terrors?

Typically, 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 his parents’ names, he will not recognize them. He will appear to look right through them, unable to see them. Parental attempts to comfort the child by holding or cuddling often prolong the situation.

Are night terrors contagious?

No.

How long do night terrors last?

Most often, 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.

How are night terrors diagnosed?

The diagnosis is based on the history. When a question remains, a physical exam or tests may be run to rule out other possibilities.

How are night terrors treated?

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 his subjective experience is one of being held or restrained; he would likely arch his 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.
Night terrors can also be treated with medications, hypnotherapy, or with other types of relaxation training if they become a significant problem.
A Novel Approach – The Greene Technique
When my youngest child was going though night terrors, I observed that he was also “working on” achieving nighttime dryness. In fact, night terrors are most common at the same ages that children are becoming aware of the bladder feeling full during sleep. It dawned on me that perhaps some of these kids just need to go to the bathroom, but are not yet able to wake up fully when their bladders are full. I’ve now treated many kids by having the parents take them to toilet while they’re still asleep. For many of these children, even though they do not recognize their parents, they will often recognize the toilet and urinate. For these children, the episodes stop abruptly and they return to sleep. The calm is dramatic.

How can night terrors be prevented?

Prevention usually involves trying to avoid letting the child get over-tired, and trying to keep the wake/sleep schedule as regular as possible. Taking the child to the bathroom before the parents go to bed can also prevent some night terrors.

Related A-to-Z Information:

Enuresis (Bedwetting), Epilepsy, Nightmares, Sleep Apnea

Introduction to colic:

It usually strikes toward the end of a long day, when your baby is just about at the age when your sleep deprivation has really begun to set in. Your baby stops being the quiet, peaceful, miracle baby and begins screaming every evening. It is no wonder that parents become frustrated, discouraged, and depressed.

What is colic?

Almost all babies go through a fussy period. When crying lasts for longer than three hours a day, and is not caused by a medical problem (such as a hernia or an infection), it is called colic. This phenomenon is present in almost all babies, the only thing that differs is the degree.
The child with colic tends to be unusually sensitive to stimulation. Some babies experience greater discomfort from intestinal gas (and they tend to swallow even more air when they cry!). Some cry from hunger, others from overfeeding. Some breastfed babies are intolerant of foods in their mother’s diets. A few bottle-fed babies are intolerant of the proteins in formula. Fear, frustration, or even excitement can lead to abdominal discomfort and colic.
Whatever the mechanism, I believe that the fussy period exists in order to change deeply ingrained relationship habits. Even after the miracle of a new birth, many parents and families would revert to their previous schedules and activities within a few weeks – if the new baby would only remain quiet and peaceful. It would be easy to continue reading what you want to read, going where you like to go, doing what you like to do as before, if only the baby would happily comply. Instead, the baby’s exasperating fussy period forces families to leave their previous ruts and develop new dynamics that include this new individual. Colic demands attention. As parents grope for solutions to their child’s crying, they notice a new individual with new needs. They instinctively pay more attention, talk more to the child, and hold the child more – all because of the colic. Colic is a powerful rite of passage, a postnatal labor pain where new patterns of family life are born.

Who gets colic?

Almost all babies will develop a fussy period. About 20 percent of babies will cry enough to meet the definition of colic. The timing varies, but colic usually affects babies beginning at about three weeks of age and peaking somewhere between four and six weeks of age.

What are the symptoms of colic?

For most infants the most intense fussiness is in the evening. The attack often begins suddenly. The legs may be drawn up and the belly distended. The hands may be clenched. The attack often winds down when the baby is exhausted, or when gas or stool is passed.

Is colic contagious?

Colic is not contagious, but babies do respond to the emotions of those around them. When others are worried, anxious, or depressed, babies may cry more, which can make those around them more worried, anxious, or depressed.

How long does colic last?

Colic will not last forever! After about six weeks of age, it begins improving, slowly but surely, and is generally gone by twelve weeks of age. When colic is still going strong at 12 weeks, it’s important to consider another diagnosis (such as reflux).

How is colic diagnosed?

Colic is usually diagnosed by the history. A careful physical exam is wise to be sure the baby does not have a hernia, intussusception, a hair tourniquet, a hair in the eye, or another medical problem that needs attention.

How is colic treated?

Helping a child with colic is primarily a matter of experimentation and observation. Different children are comforted by different measures. Some prefer to be swaddled in a warm blanket; others prefer to be free. The process of treating colic involves trying many different things, and paying attention to what seems to help, even just a little bit.
Holding your child is one of the most effective measures. The more hours they are held, even early in the day when they are not fussy, the less time they will be fussy in the evening. This will not spoil your child. Body carriers can be a great way to do this.
Some babies are only happy when they are sucking on something. A pacifier can be like a miracle for some.
Singing lullabies to your baby can be powerfully soothing. It is no accident that lullabies have developed in almost every culture. The noise of a vacuum or of a clothes dryer is also soothing to many babies.
As babies cry, they swallow more air, creating more gas and more abdominal pain, which causes more crying. This vicious cycle can be difficult to break. Gentle rocking can be very calming (this is directly comforting and seems to help them pass gas). When you get tired, an infant swing is a good alternative for babies at least 3 weeks old with good head control.
Holding your child in an upright position may help (this aids the movement of gas and decreases heartburn). A warm towel or a hot water bottle on the abdomen can help. Some babies prefer to lie on their tummies, while someone gives them a backrub. The gentle pressure on the abdomen may help.
Some children seem to do best when they are going for a ride in the car. If your child is one of these, you might try a device developed by a pediatrician to imitate car motion and sound.
Some parents report an improvement by giving simethicone drops, a defoaming agent which reduces intestinal gas. It is not absorbed into the body and is therefore quite safe. Sometimes doctors will prescribe stronger medicines for severe colic (but this should only be done after a physical exam). If nothing else seems to work, you might try pretending your baby is sick, and taking a rectal temperature (do not use a mercury thermometer). This will often cause babies to pass gas and obtain relief.
There are many stories about foods that breastfeeding moms should avoid. Most often, I hear about abstaining from broccoli, cabbage, beans, and other gas-producing foods. The scientific evidence is strongest for avoiding stimulants such as caffeine and caffeine-related compounds (those found in chocolate). The other foods in mom’s diet that are most likely to cause a problem are dairy products and nuts. I would try eliminating these for a few weeks. Other foods may also irritate the baby. Experimentation and observation will guide you.
Switching formulas is not helpful for most babies, but is very important for some.
Taking a break is a good idea. Each of you can take charge and spell the other. Time for oneself is an important part of the new family dynamic. You will be able to pay more loving attention to your baby when you’ve had a chance to get refreshed.

How can colic be prevented?

A fussy period is likely no matter what prevention techniques are undertaken. Good feeding techniques (as advised by a lactation consultant, if appropriate), good burping, and early identification of possible allergies in the baby’s or mother’s diet may help prevent colic. Experimenting with the comfort techniques outlined above before colic develops can help you identify your baby’s needs and desires, and can help stop the fussy period from becoming so intense.

Related A-to-Z Information:

Diaper Rash, Food Allergies, Gastroesophageal Reflux, Hernia (Inguinal hernia), Intussusception, Nightmares

Dr. Greene’s Answer:

How exhausting! Missed sleep is tough for all of us, but yours has been long and consistent and without a failsafe solution if you just get too tired. Most young kids will return to sleep well if rocked, or cuddled, or fallen asleep with (of course, whether or not you want to do this is another issue).

Sometimes adjustments in bedtime or napping can make a difference. In some children, periods of waking can occur when a child is toilet training. In these children, taking them to the bathroom in the middle of the night can solve the problem. If a child wakes up in need of comfort, a special blanket or stuffed animal may help.

But when kids don’t sleep well in the most conducive setting, I like to have them seen at a sleep center. Thankfully, sleep is beginning to get the attention it deserves, and sleep centers are springing up in many places.

Occasionally, sleep specialists recommend medicines after other options have been explored. I am in favor of this (although I am not a fan of the Benadryl class, at least as either a medium- or long-term solution). I prefer medicines in the hypnotic class that are eliminated from the body relatively quickly. Sleep is so valuable for health (his and yours) that, in some situations, the benefits clearly outweigh the costs. Your doctor can refer him to a sleep center if necessary.

Dr. Greene’s Answer:

Speaking generally, the total amount of sleep a child gets is more important than how they schedule that sleep. The typical 2-year-old averages about 12-13 hours of sleep over 24 hours, but an hour or so more or less than that can be normal.

The average 2-year-old gets about 90 minutes of the total during the day as one or more naps — but again more or less than that can be fine.

Some individual children do fine with no nap at all at that age. Others seem to really benefit from a nap. When it comes to this, parents’ intuition is usually accurate about what their children need.

Dr. Greene’s Answer:

The truth about dreams, nightmares, and night terrors will surprise you.

Dreams have been described since the beginning of human history, but it was only in 1953 that Aserinsky and Kleitman discovered the brain wave pattern we call REM (rapid-eye-movement) sleep. During sleep, we go through four progressively deeper stages of sleep (stages 1 to 4) in which the brain is quiet but the body may move or shift.

In a separate stage, called REM sleep, the brain is highly active, but the body seems paralyzed (except for the eyes, which dart back and forth). This REM sleep is what we know as dreaming. As adults, we spend about 20% of our sleep time in REM sleep.

A preschool-aged child patters down the hall in the middle of the night to appear at her parent’s bedroom door. Tears streak her face. “Mom, I’ve had a bad dream!” she reports. “Robbers were chasing me!”

At age 3 or 4, most children begin remarking about their dreams. In their desire to imitate adult behavior, children at that age assert (with confidence) many things that aren’t quite factual. Are they really having dreams? Or might they be using their fertile imaginations to describe what they’ve heard others talk about, perhaps as yet another way to try to maneuver into the parents’ big bed?

“I can’t sleep. Can I get in?”

Alternatively, might children begin dreaming even earlier, and only start talking about it as preschoolers?

To solve this mystery, Roffwarg and associates undertook a classic study in 1966 (the associates included Dement, whose popular new book The Promise of Sleep is getting rave reviews). The research team began by studying sleep waves in newborns. The investigators believed that infants do not have REM sleep because they do not dream, but the researchers intended to discover what newborn sleep waves looked like. The team would continue to measure sleep waves throughout infancy and toddlerhood to learn when and how dreaming begins.

The startling discovery was, not only do newborns dream — even on the first day of life — they actually dream more than the college students in the original studies (Science, 1966; 152:604).

This study has been repeated several times, confirming and expanding our knowledge. We dream more in the first 2 weeks of life than at any other time. The visual part of the brain is more active during newborn REM sleep than during adult sleep. They seem to have more vivid visual dreams.

Infants 3 to 5 months old dream much more than infants 6 to 12 months old do. 18-month-olds dream almost twice as much as 3-year-olds do. By age 3, the amount of time spent dreaming per night is in the same range as that of young adults. As the wheel of time turns throughout life, each year we dream a little less (Science, 1966; 152:604).

If children dream from the moment that they are born, might they dream before that time? We now know that they begin to sleep at as early as 4 weeks of gestation (Electroencephalography and Clinical Neurophysiology, 1975; 38:175). REM sleep waves have been found at as early as 28 weeks of gestation, and REM sleep waves accompanied by the eye movements of dreams by 30 weeks of gestation (Principles and Practice of Sleep Medicine in the Child, WB Saunders, 1995). It seems dreaming begins 2 or 3 months before babies are even born!

Dreams appear to be a kind of parallel processing by which we integrate our experience, making new connections in our brains. In the uterus, babies probably dream about the muted light they see and the sounds they hear (heartbeats, voices, and music). After birth, perhaps they dream about the explosion of new sights, sounds, tastes, smells, and textures as they delight in getting to know their parents.

We may dream more during the day than we do at night! As mentioned earlier, when we sleep, we dream only about 20%of the time. During non-REM sleep, the brain rests. Growing evidence suggests that we have real dreams all day long, but these are not noticed because of the “loudness” of our senses and our conscious thinking (Principles and Practice of Sleep Medicine, WB Saunders, 1994). In a similar way, we have an unobstructed view of stars in the sky all day long, but we can’t see them because they are overwhelmed by the light of the sun.

At night, the stars and the dreams come out.

Nightmares are unpleasant dreams that awaken a dreamer from sleep.

Traumatic events 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 difficult events and emotions to weave them into the fabric of our minds in a constructive way. Because the forces that produce nightmares are simpler than the complex drives that may initiate our other dreams, nightmares might be a good entrance into understanding the significance of dreams in general (Psychiatry, 1998; 61:223-238).

Nightmares are thought to be most common between the ages of 3 to 5 years –the peak age for fears — they are said to begin around that time, or shortly before. Though I don’t know of any others who concur, the available evidence leads me to a vastly different conclusion: that just like other dreams, nightmares are most common long before the preschool period.

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. It seems to me that anything worth crying about is worth dreaming about.

We know from older children that nightmares commonly follow surgery (Anesthesia and Analgesia, 1999; 88:1042-1047), tooth extraction (British Dental Journal, 1999 13; 186:245-247), and motor vehicle accidents (European Child and Adolescent Psychiatry, 1998; 7:61-68). Why wouldn’t they follow childbirth?

We don’t want to believe that our little ones experience anything unpleasant. So strong is this desire that it led to the long-held (now finally and forcefully disproved) belief that newborns don’t feel pain when circumcised. How absurd!

Knowing how much young babies dream and cry (and wake up crying), it seems equally absurd to me to believe that all of their dreams are happy ones. 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.

Confusional arousals (popularly called night terrors) are an entirely different phenomenon, which I have described elsewhere. These happen when children get stuck between two stages of non-REM sleep. They might talk, scream, or open their eyes, but they aren’t awake and they aren’t dreaming.

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 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? If readers try this and let me know what happens, we will find out. If you give it a try, let me know the results, either way. I’ll correlate the different experiences and broadcast the results. Together we can learn more about the wonder and mystery of sleep in children.

Aren’t they angelic when they are asleep?

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.

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.

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.