While all parents wish sweet dreams for their kiddos, sometimes a little one’s night can be less than peaceful. Enter: Night terrors, nightmares, and confusional arousals. Here’s how to tell the difference—and how to help your bub get the sound sleep they need. 

What are confusional arousals?

Confusional arousals are just what they sound like. Your child sits up in bed and appears to wake up, but they’re confused as to where they are and what’s going on. They may mumble or sob and thrash about, seeming upset or even agitated. They may even cry out and push you away, saying, “No, no! I don’t like it!” But your tot is not fully awake. These episodes usually occur in the first half of the night and often last for just a minute or two and then end with your child returning to a deep sleep. However, some episodes can last as long as 30 to 40 minutes. Confusional arousals don’t involve the fear that’s commonly seen in sleep terrors and most kiddos have no memory of the event when they wake up in the morning.

How common are confusional arousals in children?

Up to 17% of children have confusional arousals. And this sleep hiccup appears to be most common between the ages of 2 and 5 years old.

What causes confusional arousals?

Confusional arousals often occur in perfectly healthy and happy tots. There are some common factors that can trigger episodes of parasomnias (aka disruptive sleep-related disorders). Most often, confusional arousals are brought on because of…

  • A fever

  • Sleep deprivation

  • Stress

  • New surroundings

  • Obstructive sleep apnea (if confusional arousals are a recurrent issue)

How do you treat confusional arousals?

While you probably want to comfort your child during a confusional arousal episode, know that you may make them even more agitated. Instead, try to gently guide your bub back to peaceful dreamland without talking to them or waking them up. Remember, confusional arousals are natural and you may not be able to completely stop them. However, you can take a number of steps to reduce the frequency and intensity of confusional arousals:

  • Reduce your child’s stress.

  • Make sure your child sticks to a healthy, regular sleep and nap routine.

  • Create a comfortable sleep environment for your child.

  • Make bedtime as relaxing as possible.

What are baby night terrors?

Sleep terrors or night terrors tend to occur in the first half of the night (about two or three hours after falling asleep) and they’re an extreme version of confusional arousals…and they can be scary to witness. Your child may cry out—or scream—arching their back, their little face filled with panic. Your kiddo may be sweating, with a heaving chest and racing heart, staring into the darkness, yet totally unaware of your presence! Parents are often confused because their child looks almost awake, but they’re totally unreachable. That’s because, in reality, they’re deep in sleep.

We call these terrors, but we don’t even know if children experience the type of fear we call terror. What we do know is that nothing parents do during an episode seems to help. These disruptions usually last between 5 and 15 minutes, but occasionally longer. In the end, children usually fall back to sleep or awaken, dazed, with no recollection of the event. Parents, on the other hand, may be totally traumatized for hours!

How common are baby night terrors?

Only 3 to 6% of children experience night terrors, making them a relatively rare occurrence. Night terrors usually affect children between ages 4 and 12, but toddlers as young as 18 months old have been known to have night terrors, too.

What causes baby night terrors?

Some of the things that trigger confusional arousal do the same for night terrors, like being overtired, snoozing in a new environment, and feeling stressed. Plus:

  • Illness

  • Reaction to a new medication

  • Consuming caffeine

In general, however, night terrors are caused by overarousal of the central nervous system during sleep. In short, your kiddo’s night terror is not a dream, but a sudden reaction during the transition from one sleep stage to another.

How can I help my baby with night terrors?

During an episode, turn up the white noise to be as loud as a shower, sing a familiar lullaby, or just repeat simple words like “You’re safe, you’re safe, Mama is here….” Eventually, your child will lie back down asleep again…usually in just a few minutes. As with confusional arousals, night terrors often simply disappear with no intervention as your kiddo’s nervous system matures.

To help sidestep night terrors in the future, steer clear of stimulants and try to reduce your child’s life stresses—including violent TV, video games, and cartoons. Make sure your little one keeps to their regular nap and nighttime schedule, since going to bed too late can be a provocation. Use strong white noise all night. During your bedtime sweet talk, mention how your little one’s brain can be so relaxed that they’ll surely sleep beautifully all the way till morning. You might even add a drop or two of sleep-inducing lavender oil on the mattress.

All About Child Nightmares

Sleepwalking and night terrors are a mix of movement and drama, and nightmares are all drama with very little action. Nightmares occur during REM sleep, where the brain’s commands to the muscles of the body can’t get past a “roadblock” at the base of the brain. So even though there may be a riot of thoughts and visions going on in the dream, the body stays still, even limp. (Thank goodness!)

For adults, bad dreams often seem to be about old memories…but for older toddlers, nightmares are about the threatening here and now, like angry adults, loud trucks, or mean dogs, for example.

Unlike sleep terrors, nightmares are definitely upsetting to children. Think about how real dreams sometimes seem to us, and imagine how real—and scary—they must seem to a toddler! They can cause a child to fear falling asleep, and even to fear being in the bedroom. To help quell those uneasy feelings, try a just-bright-enough nightlight, like SNOObie. Many little ones feel safer if they can see familiar surroundings when they wake at 2am…not just a gulf of darkness!

Nightmares are very common and can start in children as early as 2 to 3 years old. (It usually takes until about preschool age for kids to start understanding that a nightmare is only a dream.) Nightmares begin at this time for the same reasons that fears begin:

  • Kids are feeling more vulnerable.

  • They’re witnessing and experiencing more upsetting things, either in real life or on screens.

  • Children may be holding back angry feelings, because grownups are starting to expect growing kids to be able to control their aggressive impulses and not hit, bite, or yell. All those corralled thoughts and actions can break through at night into violent, scary dreams.

With night terrors, children push their parents away or just ignore them, but with nightmares children cling to loved ones for dear life! Some children fall back to sleep after a nightmare, but many need reassurance. So be prepared to either cozy up in your sweetie’s bed or let them come into your bed for a reassuring cuddle.

If your child remembers their nightmare of, say, a scary monster or animal, draw pictures of it the next day and then let them jump up and down on it or crumple it up. You can also make up a little story about Benny the Bunny having a scary dream and create an ending that’s less scary. Finally, consider engaging in some role-playing games in which you’re the scared child and your kiddo is the big monster…and then switch roles so they get to be the brave child and you’re the bully monster, who’s really just a scaredy-cat who misses their mommy!

Final Thoughts on Confusional Arousals, Night Terrors, and Nightmares

Confusional arousals, night terrors, and nightmares can be scary for both you and your child. Remember that it’s all perfectly natural and can be improved by implementing a relaxing bedtime routine and sticking to a sleep schedule, including naps. If you use the advice above and your child is still waking up with frequent night terrors, consider consulting your care provider.

If your child has had one of these disturbances, warn any babysitters before leaving your child in their care. But DON’T talk to others about it in front of your child, because it may confuse or embarrass your sweet pea. And don’t hesitate to let your doctor know, especially if the disturbances happen after midnight, just so they can rule out other problems.  

At Happiest Baby, we’re committed to helping families get the sleep they need! For additional sleeping tips for babies and toddlers, check out The Happiest Baby Guide to Great Sleep.

About Dr. Harvey Karp

Dr. Harvey Karp, one of America’s most trusted pediatricians, is the founder of Happiest Baby and the inventor of the groundbreaking SNOO Smart Sleeper. After years of treating patients in Los Angeles, Dr. Karp vaulted to global prominence with the release of the bestselling Happiest Baby on the Block and Happiest Toddler on the Block. His celebrated books and videos have since become standard pediatric practice, translated into more than 20 languages and have helped millions of parents. Dr. Karp’s landmark methods, including the 5 S’s for soothing babies, guide parents to understand and nurture their children and relieve stressful issues, like new-parent exhaustion, infant crying, and toddler tantrums.

View more posts tagged, sleep

Have questions about a Happiest Baby product? Our consultants would be happy to help! Submit your questions here.

Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.