Tuesday 15 October 2019

How to help your child deal with night terrors

Illustration by Maisie McNeice
Illustration by Maisie McNeice
David Coleman

David Coleman

Clinical psychologist David Coleman advises on techniques to deal with night terrors and a child who soils himself.

Question: My 10-year-old son is still having sporadic but significant night terrors. They are horrendous to witness, as he can be screaming wildly and almost rigid with the fear. I was told he would grow out of it as he got older.

He is a cheerful, sunny child who is happy at school and gets on very well with his older siblings. I would like to know if I should hold him when he is afraid or should I wait until he wakes up?

I have been told that holding him may exacerbate his fear, but I find it hard to witness his distress.

David replies: Night terrors are more common than you might expect with between one and five children in every hundred suffering from them. Their occurrence peaks in children aged between three and four and gradually drops off in frequency as children get older, usually stopping entirely by the time children reach adolescence.

So those folks who tell you that your son will grow out of them are correct.

Night terrors are different to nightmares. Sleep is normally divided into two categories: rapid eye movement (REM) and non-rapid eye movement (non-REM). Non-REM sleep is further divided into four stages, progressing from stages 1-4. Night terrors occur during the transition from stage 3 sleep to stage 4 sleep, usually beginning 60-90 minutes after your child falls asleep.

Nightmares, on the other hand usually occur during REM sleep and most children will experience them as a very bad dream that they can recall when they wake.

Night terrors are characterised by extreme fear, and often very intense crying, that occur regularly during sleep. Your child might appear to be awake but is actually asleep and, in fact, can be very difficult to arouse during the night terror.

Most children who have had a night terror will not remember it the following morning. If they do get woken just after the night terror they rarely have a memory of a dream.

During the night terror you might also notice that your son's heart rate and breathing rate are increased and he may be quite sweaty. In addition to the rigidity in his body, that you observe, I would guess that he seems confused, disorientated and doesn't respond to you or your efforts to comfort him.

Sometimes there is a family history of night terrors, so check if anyone in your family or your husband's family had them as a child.

However, night terrors are most often caused by stressful life events and children not getting enough sleep. So, it is unlikely to be any direct fault of yours.

Even though he is a generally happy and cheerful child, it may be that he experiences some stresses in the day that only get released at night time.

The bad news, I am afraid, is that there is no known treatment or solution for night terrors. Most children will grow out of them, but how quickly that will happen I can't tell you.

The best thing to do, in the meantime, is to help him reduce any stress that he may experience in his daily life. That might be by actually removing the source of stress, if there is any, or by teaching him skills to regulate his stress.

Practical relaxation techniques should help your son to wind down, both generally, and especially in the hour before he goes to bed. Massage can be good for this, as can relaxing music. Meditation might also be a useful wind-down before bed.

In terms of what you do during the night terror itself, gentle, reassuring touches from parents are enough. Unless he is thrashing about and likely to hurt himself (which doesn't seem to be the case) then there is no need to hold him in a hug.

Indeed, I am sure you notice that your son is not even aware of your presence during the night terror and so whatever reassurance, either verbal or through touch, you might be offering him is unlikely to penetrate to his unconscious. Usually you just have to wait it out.

However, being there as the terror finishes, to hold him and soothe him might be as much as you can do until he grows out of them.

My five-year-old has begun soiling his clothes and smearing the poo. How do I get him to stop?

Question: My son is five. For some time now he has been soiling his clothes and sometimes smearing it. In every other way he is a well-adjusted child, very affectionate, sensitive and outgoing. When I ask him why he does it, he says it's because he wants me to stay home and not go to work. This is not really financially feasible.

I would be so grateful for some insight into this problem as I am so very worried he will get bullied at school if this happens there. He gets a lot of quality time with both parents, so I don't think it is attention-seeking.

David replies: Soiling, or encopresis as it is properly known, can often be a difficult behaviour to change. Typically, there are two kinds of soiling. Soiling that has always occurred, as if the child had never toilet trained properly (primary encopresis) and soiling that starts after training has been successfully established (secondary encopresis).

The soiling that you describe seems to be the latter kind. It seems that your son has started to soil himself, adding in the smearing behaviour too. Secondary encopresis of this kind, with smearing of the faeces, is usually an indicator of significant emotional distress for a child.

Your son has indicated that he is very worked up about your work arrangements and whatever alternative care is available for him. When he does try to explain his soiling, he seems to be very clear that your working is a direct cause. So that might mean that he really misses you when you are at work. However, soiling as a reaction to separation anxiety is not very typical. I agree with you that his soiling is unlikely to be attention-seeking, as he seems to have opportunity for lots of positive attention.

From how you have described the situation, he seems to be quite deliberate in his soiling, with the additional factor of smearing his faeces, such that it does seem to be a very strong behavioural message to you that all is not well in his emotional world.

Another alternative, that I think you need to consider, then, is that he is very distressed by some aspect of the care he receives while you are working, or by something significant that happens in school.

Where is he minded while you are at work? Naturally, he is in school now for a lot of the day, but I presume he was with a minder or in crèche or pre-school full time prior to starting school? Did the soiling start while he was in full-time care or has it only started since he has started school?

Has he continued in after-school care in the same place? Are you happy with the level of care he is receiving? Do you think, or suspect, that your son could be at any risk of harm (either neglect or abuse) in the care setting where he is?

I don't want to alarm you, but I do want you to give serious consideration to the possibility that your son is distressed by some, perhaps negative, aspect of the care that he receives, or by something bad happening at school, or even at home.

If you haven't already done so, do go and speak with his carers to see if they are aware of anything bothering him and go and talk with his teacher to see how he is settling in school.

Also, even though he is young, you can talk with him about school and about his after school care. If he senses that you are understanding and caring about any possible "bad" things that might occur, it may help him to voice them.

If it is the case that your son's soiling is prompted by some level of emotional distress, then dealing with the source of that distress should lead to a resolution.

So, if you can find out what may be bothering him and resolve that, his toileting will, hopefully, return to his previous healthy habits.

Alongside your efforts to identify and deal with any emotional upset that might be present, you may also want to reestablish a toilet-training programme.

Keep it focussed on regular trips to the loo to just sit, ready to poo, coupled with small rewards for poos that go into the toilet. At the same time, stay calm and matter-of-fact if he does soil himself.

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