Night Terrors and Confusional Arousals in Children

Night terrors are a parasomnia — a category of sleep disorder that includes events such as confusional arousals and sleepwalking. They are alarming for parents to watch but, in almost every case, harmless to the child and not a sign of any emotional or psychiatric problem.

What are night terrors?

A child experiencing a night terror may suddenly scream, cry, or appear extremely frightened. They may sit up, mumble incoherently, answer disjointedly, or even get out of bed. The crucial thing to understand is this: although the child looks awake, they are in fact in deep sleep. The episode is not a memory the child can describe afterwards — they are not consciously experiencing fear in the way an awake child would.

Night terrors typically last between 5 and 10 minutes — sometimes longer — and end as suddenly as they begin, with the child returning to peaceful sleep with no memory of the event in the morning.

Confusional arousals

Closely related events, called confusional arousals, last 5 to 15 minutes (sometimes longer) and involve agitation, confusion, and movement, but without the intense fear of a classic night terror.

When and to whom do they happen?

Night terrors usually occur 1–2 hours after the child has fallen asleep, during a phase of deep (slow-wave) sleep. They are most common in early childhood and tend to disappear by adolescence. There is often a family history — a parent or sibling who experienced night terrors or sleepwalking.

How are night terrors different from nightmares?

• Night terrors happen in the first part of the night, in deep sleep. The child does not remember them.
• Nightmares happen in the second half of the night, in REM (dreaming) sleep. The child usually remembers them clearly.

Read more about nightmares →

What triggers night terrors?

• Genetic predisposition (often a family history)
• Stress and anxiety
• Sleep deprivation
• Fever and illness
• Certain medications
• Irregular sleep schedule
• Co-existing sleep disorders (such as sleep-disordered breathing)
• An unfamiliar or unstable sleeping environment

Typical signs of an episode

• Sudden onset out of deep sleep
• Intense fear, crying or screaming
• The child does not respond to attempts at comfort
• Movements: kicking, thrashing, sitting up, sometimes getting out of bed
• Sudden end, returning to sleep with no memory of the event

How to support a child during a night terror

1. Safety first. Make sure the child cannot fall, hurt themselves, or leave the bedroom. Stay close, but do not restrain unless safety requires it.
2. Do not try to wake the child. Waking during an episode tends to extend the confusion. The episode will end on its own.
3. Keep a consistent, calming sleep routine. Predictable bedtimes and good sleep hygiene reduce frequency.
4. Address stress and anxiety. If the child is going through a stressful period, this often shows up as more frequent episodes.
5. Seek professional assessment if the episodes are very frequent, very intense, occurring nightly, or causing injury.

When to seek professional help

Most children outgrow night terrors without any treatment. However, professional assessment is recommended when:

• Episodes happen multiple times per week
• The child is at risk of injury
• Episodes persist into adolescence
• There are other symptoms suggesting sleep-disordered breathing (snoring, pauses in breathing) — these need investigation
• Daytime functioning is affected

Treatment is largely behavioural and involves stabilising sleep schedules, reducing triggers, and — where helpful — a technique called scheduled awakenings, applied carefully under guidance.

In summary

Night terrors are not dangerous and do not require emergency medical intervention. Understanding the phenomenon, patience, and the right kind of support help families manage them safely until they pass.