When should you be concerned, and what should you do?
All of us can clearly recall at least one heart-pounding, fear-inducing nightmare from childhood that startled us out of our sleep. Whether it was a chasing dragon or a precipitous fall from a great height, it felt so real it left us shaken long after awakening. However, as adults we know that there isn’t a monster under our beds waiting to snatch us, even if we just dreamt about one. For children, nightmares can be confusing because they feel so very real. And as young children, the line between fantasy and reality is blurred,
Nightmares are completely normal phenomena, especially for children. They usually begin between age 2-4 and tail off by age 10-12. They are a developmental process and are a normal response to fear. They can be triggered by stressful events like starting school, family illness or conflict. In fact, nightmares can actually help process emotional events.
However, despite their potential to be helpful, nightmares do cause considerable distress and can disrupt sleep. So how can you help your child if they have frequent and distressing dreams?
- OFFER COMFORT AND SAFETY
Give them a hug, let them know they’re safe, that they’re not alone. Their nervous system is in a charged state. They need soothing to restore a sense of safety in their bodies.
- DON’T DISMISS DREAMS
Don’t try to talk them out of their experience or dismiss their dream using logic. In an attempt to offer comfort, don’t say, “It was just a dream, it’s not real” and expect that to be the end of it. Children experience their dreams as very real, and for certain, the intense feelings nightmares stir up are tangibly experienced.
- NORMALIZE TALKING ABOUT DREAMS
Ask your child about their nightmares. If they feel okay telling you about it, listen to the story of their dream. Sharing it with you will help take away some of the charge. It gives them a way to talk about their fears. There may be pressures they are facing that you have no idea about. Growing up is fraught with uncertainty and challenges that may seem inconsequential from an adult perspective.
Some children rarely articulate what’s scary for them, so we don’t get a chance to dispel needless worries or offer help. But their nightmares can do the talking for them in the form of metaphors and expressions of their main concerns.
Keep tabs on your child’s dream life, especially if it seems unusually dark and disturbing. If you make talking about dreams a normal part of the routine, you’ll know how often your child has nightmares and how distressing they are. You’ll be in a good position to know if professional help is warranted. And you will have gathered useful information to convey to a therapist about your child’s sleep.
- WHEN TO CONSIDER PROFESSIONAL HELP
Nightmares are considered chronic if they happen every week or more for at least 6 months. Fully 5% of children between the ages of 3-10 experience chronic nightmares, and for many, this is a normal developmental process. However, if chronic nightmares persist past about age 10, they are more likely to continue into adolescence and beyond. Age 9-11 is a critical juncture, a time to consider treatment if your child continues to have frequent, distressing nightmares.
Fortunately, effective treatment is available.
Imagery Rehearsal Therapy, (IRT) has been found to be effective in numerous controlled clinical trials in adult populations (ie with veterans and rape victims). This evidence has also been extended to children in a number of smaller studies that have shown it to reduce nightmare frequency, distress and general anxiety in children. Results were sustained 6-9 months post-treatment.
Imagery Rehearsal Therapy (IRT) is the most highly-recommended approach to nightmare treatment for any age group. Other protocols, like Exposure, Relaxation and Rescripting (ERRT) appear to work as well, but have simply not been studied as much. IRT is a non-invasive, cognitive behavioural approach that simply asks the dreamer to imagine and rehearse a new dream ending. This seeds a new story that often weaves its way into future dreams. One study showed that some children using IRT spontaneously became lucid after treatment and were able to alter their nightmares from right inside the dream.
- TRY DREAM THERAPY AT HOME
The original protocol for IRT suggests changing the dream in any way you want. However, for children, I recommend asking them the shift the dream in ways that help them feel better about the dream, ideally ways that bring a sense of hope and mastery.
To try your own version of this approach, first help your child feel safe and calm. Then ask them to recall their nightmare briefly, perhaps just up to the place where they might want something about the dream to change. Then ask them what they imagine could happen next in the dream to make the dream better. For example, ask what form of help, escape route, magic or superpower they might want to use. Let them know it’s their dream, and they can change it it any way they like.
For example, suppose your child dreams there is an evil monster under the bed, lurking and waiting for a limb to dangle over the edge so it can grab an arm or leg and drag them under. You could ask your child to imagine going back into their dream, to the part before it got scary. They could change the dream so what’s now under the bed is a favorite toy, perhaps a cuddly teddy bear that comes to life and takes them off to play in the clouds.
Or they might dream of a fire-breathing dragon chasing them. Often, it can really help to turn and face the dragon or monster, to really see it and perhaps ask what it wants. I did this with my daughter, reminding her of how I often sang Puff the Magic Dragon to her at bedtime. Her dream dragon became like Puff — lonely and in need of a friend. When playing with how to rescript nightmare, encourage children to give their imagination free rein, offer suggestions and keep it positive.
After rescripting, a further step in IRT is to rehearse the new dream ending, something children may need to be reminded to do. You can do a number of things to reinforce the new dream imagery for a child. You might suggest they draw a picture of it, imagine it again during the day, and/or tell you about it again as you tuck them in at bedtime.
What happens when we reimagine our nightmares or help our kids to do so? Sometimes the new dream ending becomes incorporated into future dreams, making them less frightening. Other times, people report a new ability to change their dreams from within. And sometimes the nightmare just stops coming. If the process doesn’t work the first time, try again, and play with different dreams as they come up. Do seek professional help if chronic nightmares persist or the process itself is upsetting (this is extremely rare). With the right support, and in time, your child will have fewer, less distressing nightmares. They may even come to cherish their dreams.
Are you a parent concerned about the frequency and intensity of your child’s bad dreams? Should you be concerned?
Learn more about Nightmare Relief for Everyone designed by nightmare expert Dr. Leslie Ellis, this self-paced user-friendly and accessible online course covers the very latest in science and research about what nightmares are, and what they’re not. Leslie offers some simple steps you can take to get some relief from nightmares and other nocturnal disturbances – both for yourself and for others, including your children.
References
Fernandez, S., DeMarni Cromer, L., Borntrager, C., Swopes, R., Hanson, R. F., & Davis, J. L. (2013). A Case Series: Cognitive-Behavioral Treatment (Exposure, Relaxation, and Rescripting Therapy) of Trauma-Related Nightmares Experienced by Children. Clinical Case Studies, 12(1), 39–59. https://doi.org/10.1177/1534650112462623
Mélanie St-Onge, Pierre Mercier & Joseph De Koninck (2009) Imagery Rehearsal Therapy for Frequent Nightmares in Children, Behavioral Sleep Medicine, 7:2, 81-98, DOI: 10.1080/15402000902762360
Schredl, M., Fricke-Oerkermann, L., Mitschke, A., Wiater, A., & Lehmkuhl, G. (2009). Factors affecting nightmares in children: parents’ vs. children’s ratings. European child & adolescent psychiatry, 18(1), 20–25. https://doi.org/10.1007/s00787-008-0697-5
Schredl, M., Fricke-Oerkermann, L., Mitschke, A. et al. Longitudinal Study of Nightmares in Children: Stability and Effect of Emotional Symptoms. Child Psychiatry Hum Dev 40, 439–449 (2009). https://doi.org/10.1007/s10578-009-0136-y
Simard, V., & Nielsen, T. (2009). Adaptation of imagery rehearsal therapy for nightmares in children: A brief report. Psychotherapy: Theory, Research, Practice, Training, 46(4), 492–497. https://doi.org/10.1037/a0017945