Night terrors in toddlers (pavor nocturnus): is it a tantrum in the night?

In this episode I explain why a toddler might seem to throw a tantrum in the middle of the night — and why it is very probably not a tantrum at all.

Short answer: is this a night terror?

• A night terror (pavor nocturnus) is a partial waking, not a bad dream and not a tantrum: your child is stuck between deep sleep and lighter sleep.
• The tell is that she is not responsive. She will not answer simple questions, cannot be consoled, and usually remembers nothing in the morning.
• The three usual triggers are being overtired, an irregular schedule, and dependent sleep associations — anything that makes her feel she has to get up and do something.
• They are common and harmless. As frightening as it looks, your child is not in pain and is not scared.
• The fix is the same whether it is a night terror or ordinary night waking: a regular schedule, an age-appropriate bedtime, a calm bedtime routine, and falling asleep independently.

Would you like to listen to a podcast episode about this? Help, my daughter is in rage when she wakes up in the middle of the night!

What does “pavor nocturnus” mean?

Pavor nocturnus is the Latin name for what English-speaking parents usually call a night terror or a sleep terror. Pavor means dread or terror, nocturnus means of the night. It is still the everyday clinical term in a lot of European languages, which is why you may meet it in a doctor's letter even though nobody says it out loud in English.

A night terror is not a bad dream. Sleep specialists group it together with sleepwalking, sleep talking and confusional arousals as a partial waking: the child gets stuck halfway between deep sleep and lighter sleep. She looks awake — her eyes may be open, she screams, kicks, walks around the house — but she is not really awake, which is why she does not answer you and cannot be comforted. Most children remember nothing about it in the morning.

A nightmare is the opposite. It wakes the child up properly, she wants you, and she can tell you about it afterwards. Classic night terrors tend to happen in the first hours of the night, when deep sleep is longest, but the same partial wakings can occur at any transition between sleep cycles, including in the small hours. They are most common in preschool and early school-age children, but two-year-olds get them too.

Why does my toddler wake up at 3 a.m. screaming?

Hi there. We have first-time parents to a bubbly and energetic 22-month-old girl. At the moment we have my mother-in-law living with us because of the pandemic. Because Nana is with us, my little one is all about Nana and refuses to let anyone put her to bed except Nana. Well, that's just one issue. However, a more pressing issue is her 3:00 or 4:00 a.m. rages. She goes to sleep at around 7:30, 8:00 p.m. every night, and wakes up between the hours of 3:00 to 4:30 a.m. Most of the time it's wanting a cuddle, and she will fall back asleep and is out till 5:30 or 6:00 a.m. But lately she has been waking up at those times and having a fit. She doesn't want to go into her cot, she doesn't want to be in her room, and doesn't want to go into our beds. All she wants to do is go outside to look at the moon or sit in the lounge crying and kicking up a fuss. We are completely baffled. She isn't showing signs of teething, no fever, nappy isn't overly full, won't accept water, will sometimes accept a bottle of milk but won't go back to sleep after it and continue her rage. We suspect that perhaps she is trying to signal to us that she's over her cot and wants to transition into a big girl bed.

At daycare they have begun to transition her from cot to stretcher bed as she will be moving into the toddler room next year with her peers.

We are wondering if she wants the same thing at home.

My other thought is perhaps she is having night terrors and that's causing her to refuse to go back into her room. I don't know. Has anyone gone through this? Please let me hear your reviews, suggestions, or any advice. We are at a loss and we just want to be able to help her out so she can get a good night's rest so that we can too.

What do night terrors look like in a 2-year-old?

Wow, this sounds intense. I'm so sorry.

Let me tell you that my daughter had exactly the same behavior around 2 years of age, and it was really, really frightening because during those episodes she seemed like she's hurt or she's angry, and she was completely unresponsive. So whatever we did, she kicked and screamed, and sometimes it took as long as half an hour, and it was really difficult for us until my mom figured out what it was. And I think it's the same in your situation. But before we go in there, let me rule out some of the other possibilities that were raised either by you or by other readers.

Is it a growth spurt, or does she need a big-girl bed?

So someone suggested that it might be a growth spurt. Well, I don't think so. Growth spurts do not usually cause this kind of behavior at night. It's true that if a child goes through a growth spurt, it can make the child want to wake up to eat because they are more hungry than usual.

But this is not the case in your daughter. You said that sometimes she accepts the milk but not always, and she doesn't seem like that she wants to eat. Also, growth spurts wouldn't cause all this drama. So I suggest don't give her milk.

I understand that you're trying everything to see what works, but this could build a new habit that is not good for any of you. And do not offer snacks, and do not offer a story, because these will be just other things to do that she can get used to, and besides, I don't think they would help. The big girl bed. You can ask her about the big girl bed during the day, not at night when she has these episodes, but during the day.

But I don't think that that would be the cause. It can be the case that she wants a big girl bed, but that wouldn't wake her up in the middle of the night and wouldn't cause this behavior. The other thing is, I wouldn't transition her to a big girl bed until this issue resolves. Okay, so based on the information that I have, I have two possibilities for you, and luckily the solution to both problems is the same.

Can dependent sleep associations cause night waking?

You mentioned that your mother-in-law is living with you at the moment because of the pandemic, and that your daughter only wants to go to sleep with her grandma. And you said that's a problem. Well, I wouldn't call this a problem in itself, but it might cause the problem. I mean the fact that your daughter only wants to let her grandma to put her to bed.

I would be happy about this. I mean, unless you're jealous, this could be a great help. And this also can strengthen their bonds, which is good for both of them. So I wouldn't say that this is a problem.

But you didn't mention how her grandma puts her to bed. So is it different than how you did it before your mother-in-law moved to your house? My main question is, does your daughter fall asleep independently? I'm guessing that maybe she used to fall asleep independently, but now with her grandma, maybe the grandma stays in the room or maybe rocks her, or maybe, I don't know, pats her or shushes or sings to her or something like that.

And that is really nice of her, but that can cause problems because in this way your daughter can develop dependent sleep associations. It means that they will depend on these things that your grandma provides at bedtime to fall asleep. And after she falls asleep, as every child does, she goes through sleep cycles. And at the end of each sleep cycle, children and also adults wake up briefly.

Usually we don't even notice this, but this is when children will wake up in the middle of the night. And those children who can fall asleep independently, they will just go back to sleep, while those who have these dependent sleep associations who fell asleep with the help of someone else, they will call for that person and will ask her or him to help them fall asleep again. So most of sleep training is just removing these dependent sleep associations and teaching the child to fall asleep independently. So I think one possibility is that due to your mother-in-law's help putting your daughter to sleep, and due to the fact that she might do it differently, your daughter might have developed dependent sleep associations, and that makes her wake up in the middle of the night.

That's one possibility.

Is it a night terror (pavor nocturnus)? How to tell

The other possibility is night terrors, as you mentioned. To know which one is the cause, I would check whether your daughter is responsive during these episodes. Can she answer simple questions? Does she react to what you say?

Does she make sense? I mean, it seems like she doesn't talk much, but still, can she point to her body parts that she already know the name of, or things like that? Can she be consoled? It seems like she cannot.

So this really sounds like a night terror or pavor nocturnus. And this also can be caused by dependent sleep associations.

Night terrors that look like a temper tantrum

Richard Ferber describes exactly this in Solve Your Child's Sleep Problems, on page 294, in the chapter on partial wakings.

Partial wakings or confusional events, which are sleep talking, sleepwalking, confusional arousals, and sleep terrors. So your child, I think, either has confusional arousal or sleep terror, which is just a more intense version. Okay, so partial wakings. He describes a variant of partial wakings, seen in toddlers and school-age children, that looks exactly like a temper tantrum but is not one: a real tantrum begins while the child is awake, and this can happen even to children who never have tantrums during the day.

The child may stomp about angrily, seem upset and confused, run away from you, and make demands without seeming to know what she wants — she might ask for an object and throw it away the moment you hand it to her. Ferber writes that these events "last from 10 to 45 minutes before ending" as peacefully as any other partial waking. Okay, so this seems really similar to what you describe. To understand it more, these partial wakings happen when a child transitions from deep sleep to lighter sleep.

And when that transition doesn't go smoothly, the child is between the state of being awake and being asleep, and this causes these confusional events.

Are night terrors dangerous?

The good news is that, as scary as they might seem, these confusional events are completely normal. And by normal, I mean both common and also not harmful. So it is quite common in children. And also your daughter probably doesn't feel anything scary or hurtful.

Usually children don't even have a memory of these events, but even during the event, they don't experience anything bad. Think of it as a physiological state which is between being awake and being asleep, and which doesn't let the child react rationally or normally as they would when they were awake. But it seems like they are awake, so that's why it's very confusing for parents. So don't worry, it doesn't hurt your child.

What causes night terrors in toddlers?

So I mentioned two things: night terrors, or confusional events, and dependent sleep associations. The thing is that night terrors can be caused by dependent sleep associations. So one of the root causes of night terrors is that the child feels like she has to get up. So when from deep sleep they transition to lighter sleep, and usually they wake up for a few seconds.

If in that half waking up state they feel like they have to get up to do something, like to call their grandma or get grandma back into the room, then it can disturb this transition from deep sleep to lighter sleep and then going back to deep sleep. So that's why it can be a cause of night terrors. Another probability is that maybe her schedule became irregular. You mentioned that she goes to daycare, so I'm guessing that her schedule stayed the same, but I cannot be sure.

Just check whether her schedule changed lately, and if it became irregular, that can be a root cause of a night terror. And a third very common cause of night terrors is being overtired. So if she has to wake up earlier in the morning, maybe to go to daycare, than she used to, or if bedtime became later for some reason, that can be a cause. Or maybe if she just gets more tired during the day and she doesn't get more sleep, that can be a cause for night terrors too.

How do you stop night terrors? Step one: a regular schedule

Okay, so the other good news is, even better news, is that you don't have to really know whether it's a night terror or just waking up due to dependent sleep associations, because the treatment is basically the same for both, and it's just good sleep hygiene. So just try to go through the steps of sleep coaching quickly in your mind, and try to check if everything is in order, and if not, then just fix those things that are not in order. So first step is the schedule, as I have mentioned. So try to make her schedule as regular as possible, at least until this issue resolves.

Also look up age-appropriate schedules for this age. I'm assuming she only naps once a day at daycare. Ask the daycare what time she usually falls asleep for the nap and how long she sleeps, and try to keep the same schedule during the weekend. Also try to find a bedtime and a wake-up time.

I'm guessing that your wake-up time is fixed because of the daycare. So try to find a bedtime that is not too late so that she can sleep enough.

Step two: a calming bedtime routine

Okay, second step, routine. Try to design a soothing bedtime routine. It shouldn't be too long. It shouldn't be too complicated.

I think it should include grandma. And just try to figure out, maybe together with your mother-in-law, what this bedtime routine should involve. What are the activities that your child likes? For example, if she likes bathing, if it calms her, then do that.

But if she gets super excited during bathing, then maybe don't put it in the bedtime routine, but bathe her earlier in the day so that she doesn't get too excited before bedtime. Also maybe read books together if she likes that. Yeah, and also figure out with your mother-in-law who will put her to bed. I mean, this shouldn't be an issue or cause for resentment between you two.

If I were you, I would definitely let her do that. I think it doesn't take anything away from you. You can have plenty of time, plenty other opportunities to bond with your daughter, and it just makes your job easier, really. And you can accept this help, I think.

Step three: teach her to fall asleep on her own

But if you let her do that, then please let her do it in a way that your daughter doesn't fall asleep until she's there. So if she wants to do the bedtime story part, or if she wants to sing a lullaby, or if she wants to stay with your daughter a little bit and maybe pat her back until she calms down, but then tell her to come out of the room until your daughter is still awake so that she falls asleep independently, and then she can repeat falling asleep independently during the night. So that is actually sleep training. If your daughter doesn't know how to do that, that would be sleep training.

And it can be the case that she knew how to do that, but now she got used to this new habit of falling asleep with her grandma. I made a huge assumption that your mother-in-law stays with her until she falls asleep, but if it's not the case, it can still be night terrors. So night terrors can happen without dependent sleep associations. So any of the other causes, like an irregular schedule or just being overtired, can cause this.

Frequently asked questions

What does “pavor nocturnus” mean?

Pavor nocturnus is the Latin name for night terrors, and it is still the everyday clinical term in many European languages. Pavor means dread or terror and nocturnus means of the night. In English the same thing is called a night terror or a sleep terror.

Is it a night terror or a nightmare?

During a night terror your child is not really awake: she will not answer simple questions, does not make sense, cannot be consoled, and may push you away or ask for something and then throw it. A nightmare wakes her up properly, she wants comfort, and she can tell you about it afterwards. A night terror is usually forgotten by morning.

What causes night terrors in toddlers?

The three most common triggers are being overtired, an irregular schedule, and dependent sleep associations. Night terrors happen at the transition from deep sleep to lighter sleep, so anything that makes your child feel she has to get up and do something at that moment — such as calling the person who usually helps her fall asleep — makes them more likely.

What should I do during a night terror?

There is nothing to fix in the moment. Your child is not in pain and will not remember it, so keep her safe and wait it out instead of trying to wake her or reason with her. The real work happens during the day: a regular schedule, a bedtime that keeps her from getting overtired, a calm bedtime routine, and letting her fall asleep on her own.

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