Nightmares: A-to-Z Guide from Diagnosis to Treatment to Prevention

Adorable girl in pink sleeping peacefully. Do children have nightmares?Introduction to nightmares:

Mommy, I had a bad dream…

What are they?

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 them?

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?

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 they 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 they last?

Individual nightmares are brief.

Nightmares can occur throughout life, but tend to decrease with each passing year.

How are they 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 they 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 they 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 concepts:

Bad Dreams.

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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