Not-so sweet dreams: tips for dealing with nightmares

Nightmares are very common among youngsters, writes Dr Melanie Woodfield in her investigation into what's disrupting our preschoolers' sweet dreams.
It's a brave mum or dad who admits they've never been afraid of the dark. Most of us are no longer jumping on our beds in case the monsters grab our ankles, so what happened? Did the fears just disappear? Where did they come from in the first place? Why is it that so many children are afraid of the dark, of thunder and monsters?  A few years ago, Peter Muris and his colleagues at Maastricht University in the Netherlands interviewed 190 children aged four to 12. They asked the children about three things: fears (when the child is actually confronted with a dangerous situation), worries (when the child is thinking about things but there's no actual danger) and scary dreams. It very quickly became clear that children are troubled by different things at different ages. Between four and six, children were fearful of animals, imaginary creatures and the dark. They were worried about being separated from their parents, death and burglars. If they had bad dreams they were mostly about witches, ghosts, monsters, or dogs, snakes or other scary animals.As children grow up their fears, worries and scary dreams change. While 10 to 12 year olds were still afraid of some animals, they were also fearful of being kidnapped or teased at school. They worried about test performances and accidents happening to themselves or others. Their nightmares featured kidnapping, accidents, as well as the monsters and other imaginary creatures from childhood dreams.

Where does the fear come from?
Muris and his colleagues also tried to tap into how the fears, worries and scary dreams came about in the first place. They came up with three different scenarios that might explain children's fears and worries:
Conditioning: No, not the Rachel Hunter hair-tossing kind, but classical conditioning. In other words, the fear, worry or scary dream started after being exposed to something frightening. For example, a child who experiences an earthquake has frightening dreams for a while, or a child has worries about death that began after a family member or pet died.
Modelling (social): The fears, worries or scary dreams started after observing parents, friends or siblings acting that way.
Exposure to negative information: Usually through television or the newspaper. For example, a child worries about being kidnapped after seeing a kidnapping on television. The Muris study found that exposure to negative information was by far the most common cause (69.3%) of scary dreams, showing that watching scary things on TV does indeed give kids nightmares.
Another important factor in determining why a child is fearful, is temperament. It's a fact that we're all born with different temperaments - tendencies towards different patterns of emotional reactions to situations, different sensitivities and different moods. These patterns can be seen in newborns, in their reactions to noises, movement, light and touch, so researchers tend to think that  a child's basic temperament is largely in-built. Some children are more likely to be fearful and anxious than others - it's in their genes.

Fears and phobias unravelled
The difference between fears and phobias is small but important. A fear is a state of agitation or distress in the presence of, or anticipation of, something that really is dangerous or scary. The most common reaction to fear is one of the three Fs: fight, flight or freeze. If we're unfortunate enough to encounter a dangerous snake, we can either hit it with a stick (fight), run away (flight) or stand very, very still and hope for the best. It's important to note that fear can be very helpful. If we weren't afraid of something that really was very dangerous we'd likely end up as tiger fodder.
 Phobias are specific and persistent - they don't go away. The key part is that they are irrational - the fear is out of proportion to the actual danger. An example is arachnophobia - the fear of spiders. As icky as they can be, spiders aren't normally particularly dangerous, yet we can be so afraid of them we run screaming from the room.
Phobias are much less common than general fears or worries. In their book Emotional and Behavioural Problems of Young Children: Effective Interventions In the Preschool and Kindergarten Years, child and adolescent clinical psychologists, Gretchen Gimpel and Melissa Holland estimate around 10% of children experience a specific phobia. Generally, fears fade over time, but for a few children, they persist into adolescence and adulthood.

Night terrors and nightmares
Night terrors are relatively uncommon (3-6% of children, according to Gimpel and Holland). They usually occur in the first one to three hours of sleep, and can be related to a lack of sleep, or to an unusual stress in the child's life. Children usually wake suddenly, scream, and seem afraid. They usually don't respond to parents' attempts to soothe them and will often still be half asleep. The best approach is to avoid waking the child - just check she's safe. She will usually go back to sleep within a few minutes. Chances are, she won't remember the night terror in the morning.
Nightmares are a bit different. They usually happen in the second half of the night, and the child often wakes. Chances are, the child will remember the dream. Nightmares are very common - estimates range from 10% to 50% of three to six year olds, depending on the study. Nightmares tend to become less frequent as the child grows, and are seen as a typical part of children's development (although they can be exacerbated by stress). The best approach is usually to comfort the child and allow her a chance to talk about the nightmare if she'd like to (but no pressure).

Time for help 
Younger children generally worry less often than older children, and most studies suggest that girls have more fears than boys. According to Jean Piaget's theories of cognitive development, preschool children are still in the "pre-operational" stage of cognitive development. Their cognitive abilities are limited so their anxiety tends to be related to concrete, immediate threats (rather than abstract, delayed possibilities). Kids of this age are also prone to "magical thinking", adding to their fears about imaginary creatures such as witches, ghosts and monsters.
It can be hard to notice if a young child is anxious, as they're not particularly skilled at talking about their feelings. Instead, young children tend to complain of headaches or of having a sore tummy or they act out their worries through crying, tantrums or clinginess.
Once you've identified that your child is anxious, try to validate her feelings, for example by saying something like, "I can see that you're really upset by seeing that dog, and I want to help you to feel better."
It's really unhelpful to tell a child she's just being silly. While most fears go away over time, some will persist into adolescence and adulthood, so it's important not to dismiss your child's fears as "attention seeking". It means she's less likely to talk to you next time.
A technique suggested by experts is to validate your child's fear, without confirming that the fear is real, for example, something like "I understand the trees make scary shadows outside your window and that you feel afraid. I know that you know those are just trees outside, but they do move around a lot at night, don't they?" This helps the child to feel as if she's been understood, and also helps her to make sense of the situation.
But if those techniques don't work, it's important to recognise when children have an ongoing or excessive fear, as there are really effective therapies that can prevent the situation worsening. The questions below might help you work out if your child needs help:
Is the fear unreasonable? Excessive?
Does she become immediately anxious when confronted with the feared object or situation? (Young children can show their anxiety by becoming clingier, crying a lot or throwing a tantrum).
Does she avoid the object or situation? Or, can she endure it with only extreme anxiety?
Does the anxiety linger for a long period of time? Is it interfering with her normal routine, such as going to kindy?
If you're concerned contact your GP or Plunket nurse. They can refer you to free child and adolescent mental health services. In some cities there's free treatment for anxiety.
The Phobic Trust offers a free, 24-hour confidential support line, 0800 14 ANXIETY.

Dr Melanie Woodfield is a child and adolescent clinical psychologist in Auckland, and the mother of two little boys.


As seen in OHbaby! magazine Issue 17: 2012
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