What To Ask If Your Child Is Having Night Terrors
If you've come to me worried about your child's night terrors, here's the first thing I want you to hear: you're doing a great job. Night terrors are genuinely frightening to witness, and it's completely natural to feel worried, helpless, even emotionally spent. But here's what matters most—in the vast majority of young children, these episodes are not a sign of serious underlying illness. With thoughtful evaluation, we can chart a path toward calmer nights.
Let me walk you through how I approach this in clinic. I'll share the questions I ask, the physiology behind them, and how your answers help us figure out whether we're dealing with something straightforward and self-limited, or whether we need to dig deeper.
1. "Tell me about your child's bedtime routine, how much sleep they're getting, and what their days look like lately."
Why I ask this:
Night terrors belong to a group of sleep disturbances called non-rapid eye movement (NREM) parasomnias. They typically happen during the deepest stages of sleep—stage 3 or 4 NREM—usually in the first third of the night. When a child is overtired, hasn't been napping consistently, or their schedule has been disrupted, the brain becomes more prone to these abrupt "arousal" events from deep sleep. Essentially, sleep deprivation makes night terrors more likely.
What I'm listening for:
Is bedtime consistent and age-appropriate?
Has their total sleep time (nighttime plus naps) dropped recently?
Have there been any schedule disruptions—travel, illness, extra activities—that might have created sleep debt?
Are naps being skipped or shifted around?
How this helps:
If you tell me the routine has been stable with consistent naps and adequate sleep, then overtiredness probably isn't driving this—which actually gives us useful information, because it means I need to look elsewhere. But if bedtime is late, naps are getting skipped, or the schedule is chaotic, then improving sleep hygiene becomes our first and most important intervention. For many children, disrupted or insufficient sleep is the primary trigger.
2. "Has your child ever snored, gasped for air, or seemed to pause their breathing during sleep? What about bedwetting, mouth-breathing, chronic nasal congestion, or enlarged tonsils?"
Why I ask this:
Sleep-disordered breathing—including obstructive sleep apnea or partial airway obstruction—can fragment deep sleep and trigger arousals from NREM sleep, significantly increasing the risk of parasomnias like night terrors. Here's the physiology: during episodes of increased upper-airway resistance or brief apneas, the brain experiences micro-arousals (brief awakenings) that disrupt slow-wave sleep architecture, making it much more vulnerable to parasomnia events.
What I'm listening for:
Habitual snoring (more than 3 times a week when not sick) or mouth breathing, especially if there's a history of enlarged tonsils or adenoids
Frequent awakenings, restless sleep, sweating at night, or bedwetting (all of which can signal sleep fragmentation)
Daytime symptoms like excessive sleepiness, behavioral issues, or hyperactivity (which sometimes correlate with sleep-disordered breathing)
How this helps:
If I'm hearing red flags for possible sleep-disordered breathing, I may recommend a sleep study (polysomnography) or an ENT evaluation. Treating underlying breathing issues can sometimes resolve the night terrors entirely. If there are no signs of this, we can focus our attention on other potential triggers.
3. "How has development been going—motor skills, language, behavior? Are there any neurodivergent features like sensory sensitivities, autism spectrum characteristics, or ADHD traits? How's their anxiety level or stress during the day?"
Why I ask this:
While night terrors are often benign and self-limited, they do occur more frequently in children with developmental differences, sensory processing challenges, or certain behavioral profiles. From a neurophysiology perspective, children in periods of rapid brain maturation may have less stable arousal mechanisms—the transitions between deep sleep and partial wakefulness aren't as smoothly regulated yet—which can predispose them to these parasomnia events.
What I'm listening for:
Any motor delays, language delays, or sensory processing challenges
ADHD traits (inattention, hyperactivity) or autism spectrum features (social communication differences, restricted interests)
Elevated anxiety during the day or recent major life stressors (moving, starting school, family changes)
How this helps:
If any of these factors are present, I know the night terrors may have multiple contributing factors, and I might bring in developmental or sleep specialists earlier in the process. If development is typical and stress levels are manageable, I can reassure you that sleep hygiene interventions alone may be sufficient.
4. "Have there been any recent illnesses, fevers, or new medications? What about reflux, asthma, or seasonal allergies?"
Why I ask this:
Medical triggers are surprisingly common in children experiencing night terrors. Febrile illnesses, upper respiratory infections, reflux (GERD), asthma flares, or even certain medications—particularly stimulants or sedatives—can all act as precipitants. These conditions create additional arousal stress and increase sympathetic nervous system activation (elevated heart rate, changes in breathing), making NREM arousals more likely. Neurophysiologically, night terrors represent a dissociation between NREM sleep and wakefulness—essentially a partial arousal—and any additional arousal burden increases the risk.
What I'm listening for:
Recent throat infections, fever, or viral illnesses
Reflux symptoms (waking up coughing or choking)
Whether your child takes ADHD medications, antihistamines, or any new prescriptions (some medications alter sleep architecture in ways that can trigger parasomnias)
How this helps:
If there's a clear medical trigger, I'll prioritize treating that condition—managing reflux, treating allergies, adjusting medication timing—alongside implementing good sleep hygiene. If there's no obvious trigger, we'll treat this as more idiopathic night terrors and focus on behavioral strategies.
5. "How often are these episodes happening? How long do they last? What time of night do they occur? Does your child remember anything the next morning?"
Why I ask this:
These details help me distinguish typical benign night terrors from other sleep disorders like seizures, REM parasomnias, or nightmares. Classic night terrors occur early in the night—usually within the first one to three hours after falling asleep—during deep NREM sleep. The child appears terrified, may scream or bolt upright, seems inconsolable, and typically has no memory of the event the next morning. The frequency, duration, and specific features guide me in deciding whether this is likely benign or whether we need further workup like a sleep study or neurology consult.
What I'm listening for:
Does the event happen soon after falling asleep rather than later in the night?
How long does it last? (Typically 10-30 minutes in children)
Does your child seem awake—eyes open—but unaware and unresponsive? Are there signs of autonomic activation like sweating, rapid heartbeat, or dilated pupils? (These are classic for NREM parasomnias)
Does your child remember the episode in the morning? (Usually no)
How this helps:
If the pattern fits the classic presentation, I can confidently reassure you that this follows a known benign course, and we'll focus on non-medical interventions. If the pattern is atypical—occurring late at night, very brief, with full recall the next day, or accompanied by other neurological signs—I'll consider further evaluation to rule out seizures or other sleep disorders.
Putting It All Together
Based on your answers to these questions, I'll work with you to create a management plan. In most cases, our first steps are behavioral and educational: reinforcing good sleep hygiene, establishing a consistent early bedtime, ensuring adequate total sleep, maintaining regular naps, screening for and treating any breathing issues, and reducing daytime stressors when possible. The reassuring news is that most children with night terrors improve over time and eventually outgrow them completely.
I'll also help you with safety strategies for managing episodes in the moment: gently guide your child to a safe space (move any furniture hazards, gate off stairs), but don't try to forcefully wake them—that can actually prolong the episode or increase confusion. Just keep them safe until they settle back into sleep naturally.
If after two to three weeks of consistent sleep routines, breathing evaluation, and trigger management the episodes persist—especially if they're happening more than once a week, lasting longer than 30 minutes, or accompanied by unusual features like daytime neurological symptoms—then I'd recommend referral to a pediatric sleep specialist or neurologist for additional workup.
And Just Remember…
I know how scary it feels to hear your child scream, watch them bolt upright with wild eyes, and then see them drift back to sleep with no memory of what just happened. But please hear this: this is not your fault. And in most healthy children, it's not a sign of something sinister. With patience, a consistent routine, sleep-supportive measures, and careful monitoring for any red flags, your child will do just fine.
Keep observing the patterns, maintain that consistent routine, and stay connected to what you're noticing. And if you ever feel uncertain or worried, please bring it to your pediatrician's attention—it's always better to check in and feel confident than to carry that worry alone. You’re doing just great — just take it one step at a time.
Sending you a big hug,
Anjuli
Disclaimer: This blog post is for informational purposes only and should not replace the specific instructions provided by your child's surgeon or healthcare provider. Always follow the post-operative care instructions given by your medical team.
References:
American Academy of Pediatrics. Atopic Dermatitis: Update on Skin-Directed Management. Pediatrics. 2025. AAP Publications+2rheumatologyadvisor.com+2
American Academy of Dermatology. Atopic Dermatitis (Eczema): Self-care and Treatment in Children. American Academy of Dermatology+1
Elias PM, Sugarman J. Moisturizers vs Barrier Repair in Atopic Dermatitis. JAAD Reviews. 2025. PMC+1
Additional peer‐reviewed articles on pediatric atopic dermatitis treatment and management. PMC+1