On this episode of Monday Mornings with Dr. Mona, a mom calls in because her 22 months old daughter has started to wake up at night screaming and she is unsure if this is separation anxiety, a nightmare, or a night terror.

I’ll explain the difference between a common sleep regression, nightmares and night terrors, what causes them to happen to toddlers, and how to support them.

00;00;00;00 – 00;00;17;26

Dr. Mona

Saying it was just a dream or it’s nothing to be afraid of isn’t very helpful. Although I know it’s our first instinct, right? We want to just comfort them and say, no, it’s nothing, it’s nothing. Obviously it was something for them. So saying it was just a dream. They may not know what that means and saying they’re not afraid and that they shouldn’t be afraid.

 

00;00;18;03 – 00;00;28;07

Dr. Mona

This minimizes their fear and worries, which doesn’t help in validation and processing. That is so important for kids and frankly, for us as well.

 

00;00;28;09 – 00;00;48;01

Dr. Mona

Hello and welcome back to the PedsDocTalk podcast and Monday mornings, the Doctor, Mona. This is a podcast that keeps growing because of you and your reviews. So thank you for tuning in and being here today. On this episode of Monday Mornings with Doctor Mona, I’m talking about nightmares. How young is too young to have nightmares and how to navigate this.

 

00;00;48;03 – 00;00;50;21

Dr. Mona

Let’s get to our callers. Question.

 

00;00;50;23 – 00;01;11;01

Michelle

Hi Doctor Mona, this is Michelle from Washington State. I have a question on nightmares. Nightmares and being afraid of the dark. My daughter is 22 months old and we did similar sleep training as you did with Ryan. She’s a great sleeper, a great napper. But for the past couple of weeks, she’s been waking up once a week screaming.

 

00;01;11;03 – 00;01;30;18

Michelle

It’s really hard to control her. She fall asleep on me. But then the second I try to go place you back in her crib, she collapsed around my neck. Her legs. I wrapped around my back, and I just can’t lay her down. And I’m just wondering, how do I know if she’s having nightmares, if that’s going to happen or if she’s having night terrors, what to do, how to talk to her about it.

 

00;01;30;20 – 00;01;43;04

Michelle

Also, her room is pitch black and I’m wondering, is she afraid of the dark? Is it time to introduce a nightlight? Anyways, I’m just hoping you can touch on the subject. Thanks for all your help and all your content as much. Appreciate it. Right.

 

00;01;43;06 – 00;02;06;22

Dr. Mona

Good morning Michelle, thank you so much for this question because I agree it can be really confusing. Is this a nightmare? Is it normal separation anxiety that happens around this age? Is it a night terror which I will touch upon? So you have a 22 month old? I’m not sure if she’s very verbal, but is she telling you that she’s scared of something, or saying any words that would make you think that it’s a nightmare or nightmare?

 

00;02;06;24 – 00;02;25;20

Dr. Mona

It sounds as if you might be dealing with separation anxiety, which is very common in toddlers, especially after two until about two and a half months. I commonly see that even the best of sleepers all of a sudden realized, wait, what? Where is my parent? Or where’s my guardian? I want them back in here. I want you to listen to episode 52 of my podcast.

 

00;02;25;21 – 00;02;47;21

Dr. Mona

This may be helpful as like I said, this could be separation anxiety. Even sleep train children can change and want you in there and that is okay. So it’s important to rule out. Is she dealing with an illness or fever? Is there some safety issue which I imagine is fine. You know, if there’s a concern and if you want, you can always look on your monitor before going in, making sure she’s okay.

 

00;02;47;23 – 00;03;10;27

Dr. Mona

And then you also want to consider, do you want to retrain her with any of the tips in episode 52? Lay next to them. Give ten minute intervals before checking in. Are my usual recommendations for toddlers, the latter being almost like a Ferber method. You asked about night terrors and nightmares, so I did want to discuss the difference briefly, and then also how to handle if in fact this was a nightmare.

 

00;03;11;03 – 00;03;28;20

Dr. Mona

I’ll leave night Terrors fully for another episode. So children as young as two can have nightmares, and it can be common until age six where it’s concerning to them. You know me, and you probably have nightmares, but you will wake up in the morning and likely not wake up in the middle of the night from them. Sometimes it can happen.

 

00;03;28;22 – 00;03;50;00

Dr. Mona

A child is still unsure of these thoughts while sleeping, so they may be confused. Me and you know the difference between dream and reality. Hopefully. But children can have a harder time, so they don’t know how to differentiate that reality and that dream. Nightmares are a very common way to process emotions and information, and your child will eventually outgrow them concerning them.

 

00;03;50;03 – 00;04;17;05

Dr. Mona

They usually occur in lighter sleep, so it’s more common in the morning time or in between deeper sleep cycles. And they happen commonly in the toddler years because the toddler brain is constantly processing a lot of information, images and sounds quickly, and they spend way more time in lighter sleep than babies do. And toddlers are in that stage where, again, they can’t separate that reality from make believe their cognitive brain is develop very rapidly.

 

00;04;17;05 – 00;04;37;02

Dr. Mona

But they still don’t understand that differentiation. Some other things that can make nightmares worse. Fever and illnesses can sometimes cause more nightmares. Some meds for example, my son Ryan was on prednisone and I remember he was just a raging toddler. He was just so cranky. He didn’t have the nightmares, but it can cause some change in sleep that I’ve seen.

 

00;04;37;04 – 00;04;58;04

Dr. Mona

Another cause is change in routine. So these are all common triggers that may cause nightmares. Of course, seeing scary images, which I don’t imagine your toddlers doing something they may have seen like a spider that may not be scary to you, could be scary to them. So here’s what I want you to look out for. In a nightmare, your child will be awake and screaming for you when you come to the rescue.

 

00;04;58;04 – 00;05;18;11

Dr. Mona

They may be clinging to you because they remember the dream, or they may be telling you what happened. If they’re verbal, it’s okay to sit with them during this moment so that you can reassure them. Now, this may look the same as separation anxiety, right? If that child is not fully verbal yet, you may seem like, well, yeah, she’s clinging to me, so your management may be the same.

 

00;05;18;11 – 00;05;38;22

Dr. Mona

So I want you to listen to episode 52, and I’ll go over some tips here on how to reassure. I want to briefly talk about night terrors. So night terrors, on the other hand, occur in deeper sleep. Your child’s eyes may be open wide and she may be screaming, thrashing around, panting, and even sweaty. And some kids may even sleepwalk if they’re not in a crib and they’re able to get out of their room.

 

00;05;38;24 – 00;06;03;14

Dr. Mona

She may shout for you, but she can’t sense your presence or be comforted by you. So imagine a person just so upset, so distraught by something happening, but their eyes are still awake. Sometimes they’re even closed, but they’re still awake. But they’re not. You can’t get to them. You can’t really talk to them or comfort them. And the child won’t remember the event when they wake up, which can be so hard for parents because they’ll kind of act like nothing happened and you’ll be like, wait, what?

 

00;06;03;15 – 00;06;25;21

Dr. Mona

I was in your room and you don’t remember any of this. I can do an entirely separate discussion on night terrors, if you like, as these are important into adulthood, too. I know adults who have had night terrors, and I think it’s an important thing to talk about. So like I said, it sounds like your daughter may be having a nightmare or maybe just a sleep progression where she just wants you in there, as she may not be fully verbal yet because I know 22 month olds are not always.

 

00;06;25;28 – 00;06;48;07

Dr. Mona

It may be hard to tell, and can be managed similarly with the reassurance and your parental approach to sleep training. So now, if you really do believe that this is a nightmare, you know, she’s saying that she’s scared or that there’s something that’s looking at her or something like that. I want you to say, if something scared you while you were sleeping, you’re safe saying it was just a dream or it’s nothing to be afraid of isn’t very helpful.

 

00;06;48;15 – 00;07;10;18

Dr. Mona

Although I know it’s our first instinct, right? We want to just comfort them and say, no, it’s nothing. It’s nothing. Obviously was something for them. So saying it was just a dream. They may not know what that means and saying they’re not afraid and that they shouldn’t be afraid. This minimizes their fear and worries, which doesn’t help. Invalidation and processing that is so important for kids and frankly, for us as well.

 

00;07;10;20 – 00;07;35;24

Dr. Mona

So I want you to focus on saying something scared you while you are sleeping. Something scared you, right? So you’re validating that something was scaring her. Now, again, you may not know if it’s a nightmare or versus a sleep regression, but I’m talking if you’re a child saying mommy dark, scared, you know, saying words that are saying like she’s scared of something, you can then verbally reassure and set expectations so you’re not abandoning them, quote unquote.

 

00;07;35;24 – 00;07;58;29

Dr. Mona

Remember, your approach to the situation is your parenting philosophy. I would expect you to go in. Obviously, if you have a child who’s normally sleeping and all of a sudden waking up just to make sure that things are okay, are they sick? Like I said, are they waking up because they have a fever? But if you go in and they seem okay and they’re clinging to you, I want you to say, I see that you’re safe and it’s time to go back to sleep.

 

00;07;59;01 – 00;08;14;29

Dr. Mona

As a parent, you can decide your next step. Maybe for a night or two. You sleep in the bed. Next to them are on the floor next to them, or in a couch or chair or whatever you have in the room next to them. Or your plan may be to leave and come back in ten minutes. A further training method, if you will.

 

00;08;15;02 – 00;08;39;04

Dr. Mona

We talk about this in episode 52 of my podcast. The first option is okay laying next to them or, you know, laying in the bed next to them. However, if this is becoming the rule and not the exception, you may want to consider a new retraining strategy. We want to encourage them to fall asleep on their own. So maybe you ask if they want a specific lovey item, or you’re going to stay there until they fall asleep.

 

00;08;39;04 – 00;09;02;17

Dr. Mona

This one night. But we want to teach them that their sleep environment is safe. You mentioned that you wanted to introduce possibly a nightlight. Now, I don’t generally love night lights. I just don’t think that they’re great. They can add more stimulation. I know that they’re more of a lighter setting, but you can do a nightlight if you feel like your child wants it, particularly like night lights for a child who’s verbal and who says that they want it.

 

00;09;02;23 – 00;09;18;18

Dr. Mona

Yes, I want a nightlight. But I think it’s really great at this age to teach them that they are in a safe space. And what this means is that you may need to be there a little bit longer than you used to be, or you may need to do a Ferber method where you say, I love you so much, you are safe.

 

00;09;18;18 – 00;09;44;10

Dr. Mona

I understand that you woke up. Mommy is going to check in in ten minutes. And you can say that even though they don’t understand the concept of time, but then you’re going to show up again. If you’re going to do that Ferber or you’re going to lay down next to them and then you’re going to stay there if whatever the rules are that you said, whatever the expectation you laid out for them with toddlers and sleep, whatever you’re doing, whatever the reason, it is so important that you are very consistent with the expectation that you laid out.

 

00;09;44;12 – 00;10;03;25

Dr. Mona

So if you said, yeah, mommy will lay here with you until you fall asleep, then that’s what you’re going to do. You want to really follow through with what you are saying you’re going to do, because toddlers actually really remember that for nightmares in general. Because again, if you think that this might be a nightmare, avoid scary books, movies that may add more fear and try to continue having that normal bedtime routine.

 

00;10;03;25 – 00;10;23;09

Dr. Mona

I don’t think you’re actually doing that many times with children. They may have a nightmare of something that they saw or they witnessed that you weren’t there with them for, right? Maybe, like I said, they saw a spider or a classmate in preschool said something to them. I mean, it’s very hard for us to be with our children at all times, and we can’t control all of their fears.

 

00;10;23;13 – 00;10;39;05

Dr. Mona

But what we can do is validate it. Right? And like I said, you really want to validate and said something scared you while you were laying down. Something scares you while you were sleeping. If in fact you think it was a nightmare, the most important take home here is that I want you to check in to reassure them.

 

00;10;39;07 – 00;10;55;26

Dr. Mona

The beauty of having a child who is sleeping through the night is that when they start not sleeping through the night, you can tell yourself that something’s up now, that something up could be an illness. Like I said, it could be a sleep regression. Is it a nightmare that’s for you to kind of figure out? Obviously, from a medical standpoint, I want you to rule out is it an illness?

 

00;10;56;04 – 00;11;12;02

Dr. Mona

Because when there’s an illness, you’re going to have a little more TLC, right? If you are more of the type to do a more Ferber method, maybe if they’re sick, you’re going to do something different. But once you’ve ruled out that it’s not an illness, again, fever, irritability from that fever, then you’re going to check to make sure that, okay, do they just need that reassurance.

 

00;11;12;02 – 00;11;27;20

Dr. Mona

So you’re going to be checking in and then you’re going to be consistent with how you approach the after. Right. Are you going to lay down with them. Are you going to rock them and then lay them down. You have a spider monkey okay. That’s what I call it when Ryan clings to us. And that is completely normal that they’re going to be like that.

 

00;11;27;26 – 00;11;42;16

Dr. Mona

But you’re going to put them down and you may have to pat their back, and then you have to decide how do you want to proceed. And like I said, you can do a method where you lay down next to them. We’ve done that. You can do a method where you say, mommy loves you. I know you were very scared or whatever the reason is.

 

00;11;42;16 – 00;12;02;03

Dr. Mona

Maybe they just wanted you. I see that you really want mommy, and I know that you’re so brave and that you can sleep on your own and mommy will be back. If you need me. And then that’s when you do that ten minute check that I said you can decide what it looks like, but we don’t want to introduce new long term inability to fall asleep on their own, as then you would have to retrain again.

 

00;12;02;03 – 00;12;19;22

Dr. Mona

So the goal here is figure out what the reason is if you can, and then follow through with the method that works for your family. Try to stay away from crutches if you can, like sleep crutches that aren’t really needed. But of course, in a time of need you’re going to do what you need to do. I hope this was helpful for you, Michelle.

 

00;12;19;22 – 00;12;36;21

Dr. Mona

I hope that it gives you some guidance. Obviously, I would love to know more about what exactly was happening and what she was saying at the moment. And do make sure to leave a review or rating wherever you listen to podcasts, so this podcast can continue to grow and I will talk to you next week. Thank you for tuning in for this week’s episode.

 

00;12;36;21 – 00;12;50;08

Dr. Mona

As always, please leave a review. Share this episode with a friend. Share it on your social media. Make sure to follow me at PedsDocTalk on Instagram and subscribe to my YouTube channel, PedsDocTalk TV. We’ll talk to you soon.