Confusional Arousal

Does your child wake up confused in the middle of the night? Dr. Greene explains this normal phenomenon called confusional arousal and what to do about it.

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.

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.

Published on: July 12, 2001
About the Author
Photo of Alan Greene MD
Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Recent Comments

Can he night terrors be caused by PTSD?

My 2 1/2 has been waking up at some point between 1-3 am since he was a baby. I thought once we got the milk intolerance issues under control it would stop. It did taper down but never fully ended. These wakings have always involves him being very upset, screaming, arching back and no desire for comfort. However, here in the last few months they have started up more frequently and involve very physical behaviors. He thrashes, hits, kicks, screams no. In that time frame (anywhere from 5 minutes to 30 minutes) he is not interested in being consoled but eventually wants to be held and cuddled back to sleep. I give him space but he will even swing at me at a distance or scream louder if I scoot further back. He does not behave like this during the day and awake. Feeling very helpless and tired and would love some comfort for him and a non-pinched night!😁

My child is 15 months and confusional events is pretty much spot on as to what I think she’s dealing with. But I’m confused as to what I should do? Just let her cry it out? She’s had episodes that can last an hour sometimes. Help!


I know first hand that this is terrifying.

Is you child learning something new? Did she just learn to walk or some other major milestone? If so, she may be so excited that she’s trying to wake herself up to use her new skill. If that’s the case, these confusional events may disappear when she’s fully learned the new skill. In the meantime, children don’t usually like to be held or even touched when they are in the middle of the event. Hearing a familiar voice can be comforting to some children.

The key thing is to make sure your child is safe (can’t fall or do something that could hurt her physically). You can rest assured that your child won’t likely remember anything about the event in the morning.

Hope that helps,