Nightmares in Children
A handout for parents and children explaining why nightmares happen, how they differ from night terrors, and what families can do at bedtime and after a bad dream. Includes a simple 'change the ending' rescripting activity for the child.
About this resource
Occasional nightmares are a normal part of childhood and peak in the preschool and early school years, when imagination is vivid and the line between real and pretend is still forming. They become a clinical concern when they are frequent, when the child dreads going to bed, or when they follow a frightening event. Because a nightmare is remembered and the child wakes fully, it is often the anticipatory anxiety about sleep, rather than the dream itself, that disrupts the household.
This handout gives parents a clear account of what nightmares are, how they differ from night terrors (which occur in deep sleep, are not remembered, and need a different response), and what tends to make them more likely: overtiredness, stress, changes in routine, and frightening content in the evening. It then offers a calm, consistent way to respond in the night and a daytime activity based on the principles of imagery rehearsal, in which the child redraws or retells the dream with a new, safe ending.
The professional version notes when to look further: nightmares that begin after a traumatic event, that are accompanied by daytime avoidance and hyperarousal, or that persist alongside other anxiety symptoms warrant assessment for trauma-related or anxiety disorders rather than a sleep-only approach. It also flags the distinction from night terrors and sleepwalking, for which the parent guidance is different.
How to use it
- Ask the parent to describe what happens in the night: does the child wake fully and remember the dream, or sit up screaming and inconsolable with no memory the next day? The first is a nightmare; the second is more likely a night terror, and the handout explains the difference.
- Screen briefly for a precipitating event and for daytime anxiety. Frequent nightmares after a frightening experience may be part of a trauma response and should be assessed as such.
- Read the 'What helps at bedtime' and 'What to do after a nightmare' sections with the parent and agree on a consistent plan that both caregivers will follow.
- Do the 'Change the ending' activity in session with the child, using a recent nightmare. Keep it light and creative. The child chooses the new ending and draws or describes it.
- Ask the family to practise the new ending for a few minutes each day for a week or two, and to keep a simple record of nightmare frequency so progress is visible.
References
- Mindell, J. A., & Owens, J. A. (2015). A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems (3rd ed.). Lippincott Williams & Wilkins.
- Krakow, B., & Zadra, A. (2006). Clinical management of chronic nightmares: Imagery rehearsal therapy. Behavioral Sleep Medicine, 4(1), 45-70.
- American Academy of Sleep Medicine. (2014). International Classification of Sleep Disorders (3rd ed.). American Academy of Sleep Medicine.
