What Are Night Terrors?

Most parents might have comforted their child after an occasional nightmare. But if you have ever experienced what’s known as a night terror (or sleep terror), your child’s fear was likely inconsolable no matter what you tried. During that time, a child might suddenly sit upright in bed and shout out or scream in distress. The child’s breathing and heartbeat might be faster, he or she might sweat, thrash around, and act upset and scared. After a few minutes, or sometimes longer, a child simply calms down and returns to sleep. This kind of situation is really like a terror for the parent.

A night terror is a sleep disruption that seems similar to a nightmare, but with a far more dramatic presentation. Though night terrors can be alarming for parents who witness them, they’re not typically cause for concern or a sign of a deeper medical issue.

Unlike nightmares, which kids often remember, kids won’t have any memory of a night terror the next day because they were in deep sleep when it happened and there are no mental images to recall.

Night terrors are sleep disturbances in which a child may suddenly bolt upright in bed, cry, scream, moan, mumble, and thrash about with his eyes wide open, but without being truly awake. Because he’s caught in a sort of a twilight zone between being asleep and being awake, he’s unaware of your presence and isn’t likely to respond to anything you say or do. In fact, researchers think of night terrors as mysterious glitches in the usually smooth transitions we make each night between sleep stages. As many as 15 percent of children have night terrors, typically beginning in the toddler and preschool years but sometimes starting later and continuing up to adolescence. An episode can last anywhere from two to 40 minutes, and when it’s over your child falls back to sleep abruptly with no memory of the incident.

In which phase of sleep Night Terrors occur?

During a typical night, sleep occurs in several stages. Each is associated with particular brain activity. Sleep is divided into 2 categories: rapid eye movement (REM) and nonrapid eye movement (non-REM). The rapid eye movement (REM) stage is the stage when most dreaming occurs.Non-REM sleep is further divided into 4 stages, progressing from stages 1-4. Night terrors occur during the transition from stage 3 non-REM sleep to stage 4 non-REM sleep, beginning approximately 90 minutes after the child falls asleep. This sleep transition is from deepest stage of non-REM sleep to lighter REM sleep. Usually this transition is a smooth one. But rarely, a child becomes agitated and frightened and that fear reaction is a night terror.

Night terrors usually occur 1/2 hour to 3 1/2 hours after falling asleep. During these episodes people are unaware of their surroundings and unresponsive to attempts to comfort them.

They may not calm down for 10 or 15 minutes, although they return to sleep quickly once the episode ends. Generally they do not remember what scared them, but rarely a person will retain a vague image of something terrifying. A few children and adults who experience night terrors will sleepwalk during the episode.

The sleep disorder of night terrors typically occurs in children aged 3-12 years, with a peak onset in children aged 3 ½ years. An estimated 1-6% of children experience night terrors. Boys and girls are equally affected. Children of all races also seem to be affected equally. The disorder usually resolves during adolescence.

How are night terrors different from nightmares?

Unlike a night terror, a nightmare leaves your child truly awake he can remember his dream and sometimes talk about it, and he’ll seek out and feel comforted by your presence. Also, kids have nightmares during dream (REM) sleep, often in the early morning hours between 2 and 6 a.m. They commonly have night terrors, on the other hand, in the first few hours of the night, during deep non-dream (non-REM) sleep.

The easiest way to tell the difference between a night terror and a nightmare is to ask yourself who’s more upset about it the next morning. If your child is more agitated, he had a nightmare. If parents are the one who’re disturbed, then the child probably had a night terror. The “terror” of a night terror lingers far longer in the parent who watched it than in the child who lived it.

What Causes Night Terrors?

Night terrors are caused by over-arousal of the central nervous system (CNS) during sleep. This may happen because the CNS (which regulates sleep and waking brain activity) is still maturing. Some kids may inherit a tendency for this over-arousal about 80% who have night terrors have a family member who also experienced them or sleepwalking (a similar type of sleep disturbance).

Night terrors have been noted in kids who are:

• Overtired, stressed or fatigued
• Sleeping in a new environment or away from home
• Stressful life events
• Fever
• Sleep deprivation
• Medications that affect the central nervous system (the brain)

A child might have a single night terror or several before they cease altogether. Most of the time, night terrors simply disappear on their own as the nervous system matures.

In both adults and children, night terrors may be caused by unresolved psychological conflicts, traumatic events or fatigue. In children, traumas such as the loss of a favorite toy, overhearing a loud argument between parents, watching scenes of violence on television or listening to frightening stories could trigger a night terror.

Particularly among adults, prescription drugs such as antihistamines, decongestants, levodopa, reserpine, beta-blockers, and antidepressants, as well as withdrawal from addictive drugs, all can provoke sleep disturbance.

When to Seek Medical Care?

Sleep disruption is parents’ most frequent concern during the first years of a child’s life. Half of all children develop a disrupted sleep pattern serious enough to warrant physician assistance.

Understanding night terrors can reduce your worry and help you get a good night’s sleep yourself. But if night terrors happen repeatedly, talk to your doctor about whether a referral to a sleep specialist is needed.

In children younger than 3 ½ years, peak frequency of night terrors is at least 1 episode per week.

Among older children, peak frequency of night terrors is 1-2 episodes per month.

If your child seems to be experiencing night terrors, an evaluation by the child’s pediatrician may be useful. During this evaluation, the pediatrician may also be able to exclude other possible disorders that might cause night terrors.

How to Cope up With Night Terrors?

Night terrors can be very upsetting for parents, who might feel helpless at not being able to comfort or soothe their child. The best way to handle a night terror is to wait it out patiently and make sure the child doesn’t get hurt by thrashing around. Kids usually will settle down and return to sleep on their own in a few minutes.

Do not try to wake kids during a night terror. Attempts usually don’t work, and kids who do wake are likely to be disoriented and confused, and may take longer to settle down and go back to sleep. Don’t try to wake him. And expect that your efforts to comfort him will be rebuffed a child having a night terror really can’t be calmed down, and if you try to hold him it may make him wilder. Unless he’s in danger of hurting himself, don’t attempt to physically comfort him. Just speak calmly, put yourself between him and anything dangerous (the headboard of his bed, for instance), and wait for the storm to pass. Before you go to bed, take the same precautions you would for a sleepwalker, since children in the grip of a night terror often stumble out of bed:

• Pick up any toys or objects on the floor that he could trip on,
• Fasten a gate at the top of the stairs, and
• Make sure windows and outside doors are locked.

There’s no treatment for night terrors, but you can help prevent them. Try to:

• Reduce your child’s stress
• Establish and stick to a bedtime routine that’s simple and relaxing
• Make sure your child gets enough rest
• Prevent your child from becoming overtired by staying up too late

If your child has several night terrors, you can try to interrupt his/her sleep in order to prevent the night terror.

• Note how many minutes the night terror occurs from your child’s bedtime.
• Then, awaken your child 15 minutes before the expected night terror, and keep him/her awake and out of bed for 5 minutes. You may want to take your child to the bathroom to see if he/she will urinate.
• Continue this routine for a week.

Hope this article help you in effectively handling night terrors.

When we think about kids’ sleep and growth, many questions come to our minds. Getting enough sleep is important for a young child for many reasons. Restoring energy to build brain connections needs adequate rest for child. Not to mention children’s sleep gives Mom and Dad a needed break But science shows that sleep also fuels physical growth.

Sleep is more important than you may think. Maybe you can think of a time when you didn’t get enough sleep. That heavy, groggy feeling is awful and, when you feel that way, you’re not at your best.

The average kid has a busy day. There’s school, taking care of your pets, running around with friends, going to sports practice or other activities, and doing the homework. It’s tiring just writing it all down. By the end of the day, the body needs a break. Sleep allows the body to rest for the next day.

The Science behind growth

Growth is a complex process that requires several hormones to stimulate various biological events in the blood, organs, muscles, and bones. A protein hormone secreted by the pituitary gland called growth hormone (or “human growth hormone”) is a key player in these events. Several factors affect its production, including nutrition, stress and exercise. In young children, though, the most important factor is sleep.

Growth hormone is released throughout the day. But for kids, the most intense period of release is shortly after the beginning of deep sleep.

No child grows at a perfectly steady rate throughout this period of childhood. Weeks or months of slightly slower growth alternate with mini “growth spurts” in most children. Kids actually tend to grow a bit faster in the spring than during other times of the year!

How much sleep do they need?

Kindergartners need about 10 to 12 1/2 hours of sleep per night (with naps declining and eventually disappearing around age 5), and older elementary age kids need 9 1/2 to 11 1/2 hours a night. Sleep needs are somewhat individual, with some kids requiring slightly less or more than their peers.

Without adequate sleep, growth problems - mainly slowed or stunted growth can result. Growth hormone production can also be disrupted in kids with certain physical sleep problems, such as obstructive sleep apnea.

More than your child’s height can be affected by a shortage of sleep. Some kids fail to produce enough growth hormone naturally, and a lack of sleep makes the problem worse. It can lead to a condition known as growth hormone deficiency that can affect heart or lung strength or immune system function. (It’s treatable with a supplementary hormone.)

Kids who don’t get enough sleep show other changes in the levels of hormones circulating in their body too. Hormones that regulate hunger and appetite can be affected, causing a child to overeat and have a preference for high-calorie carbs. What’s more, a shortage of sleep can affect the way the body metabolizes these foods, triggering insulin resistance, which is linked to type 2 diabetes.

A lack of sleep at night can also affect motor skills and concentration during the day, leading to more accidents and behavioral problems, and poor performance at school.

How to Ensure a good night’s sleep?

Most kids need more sleep than their parents think. Signs that your child may not be getting enough rest include crankiness or lethargy by day, difficulty concentrating in school or failing grades, and being hard to wake up in the morning.

To help your child get plenty of zzz’s:

• Establish a consistent bedtime. School-age children should be in bed by 8 to 9 p.m. (earlier for the youngest grades and kids who need a lot of sleep).
• Avoid stimulating activity before bedtime.
• Don’t keep a TV and computer in your child’s room.
• Set up a good bedtime routine, which helps signal to your child’s body that it’s time to wind down. This might include giving him a bath or a snack, reading a bedtime story, and talking or singing to him softly while tucking him in.
• Make sure your child’s room is conducive to sleep. It should be dark and quiet.
• Stick to the same timetable and routines for bedtime on weekends and vacations that you follow during the week. A variation once in a while won’t cause long-term disruptions, but erratic bedtimes can lead to poor sleep habits and sleep deprivation.

Starting your baby on solid foods is a very important milestone for your baby as well as you. This is the beginning of lifelong eating habits that contribute to her overall health. For this reason we have some general guidelines that can help you start your baby out on the right track to a healthy life.

How do you know if your baby is ready for solid foods?

Your baby may be 3 months old or 4 months old when you start to feel she may need “something more” than formula or breastmilk.

Your baby may begin to wake more frequently at night for a feeding and/or may begin to eat non-stop (cluster feed) as she once did as a newborn. But Growth Spurts do not mean baby needs solid food. Offer your baby more frequent nursing sessions and/or bottle feedings instead of solids; you will find that within a week or two, oftentimes the growth spurt is over and baby is back to usual feeding.

As per AAP Policy Note – 194 -introduction of complementary feedings before 6 months of age generally does not increase total caloric intake or rate of growth and only substitute foods lack needed nutrients and the protective components of human milk (and formula).

Remember that BEST food for babies is breastmilk and/or formula and these contain all the important nutrients that an infant needs to develop properly. Breast milk in particular and/or formula will be enough to sustain your baby’s nutritional needs for up to age 4 to 6 months, so don’t be in a rush to start solid baby foods. In fact, introducing solids too early may displace the important nutrition your baby needs to receive from breast milk and/or formula.

What does WHO says about starting solids?

“Complementary feeding should be timely, meaning that all infants should start receiving foods in addition to breastmilk from 6 months onwards. It should be adequate, meaning that the nutritional value of complementary foods should parallel at least that of breastmilk.”

Starting solids too early can cause your baby to develop food allergies. Your baby’s intestinal tract is not as fully developed during the first few months and introducing solids at this time can be too much to handle.

How Will You Know When Your Baby is Ready to Eat Solid Foods? Here are some guidelines you must check out.

1. Loss of tongue-thrust reflex – When any unusual substance is placed on the tongue, it automatically protrudes outward rather than back by infants using tongue-thrust reflex. In the first few months, the tongue thrust reflex protects the infant against choking. The loss of tongue-thrust reflex might start appearing in babies at anytime between 4 to 6 months of age. This allows baby to drink and swallow liquids with ease. But with the tongue-thrust reflex still present, baby may simply drink in liquid purees or push the food back out.

As and when tongue-thrust reflex diminishes, baby is ready to hold the food in his mouth without protruding it. This is an important signal to be taken into account for starting solids.

2. Chewing motions – Your baby’s mouth and tongue develop in sync with his digestive system. Infants don’t have the digestive system strong enough to digest solid foods. Similarly babies are yet to master the synchronization of mouth and tongue at that time. To start solids, she should be able to move food to the back of her mouth and swallow. As she learns to swallow efficiently, you may notice less drooling.

3. Head Control – Your baby needs to be able to keep her head in a steady, upright position. This milestone is usually achieved for most of the babies by the time they turn 4 months. Reaching this milestone ensures that baby can control her head while eating solid foods if you start.

4. Sitting well when supported- Even if your child might not quite ready for a highchair yet. Your baby needs to be able to sit upright to swallow well.

5. Curiosity about what you’re eating.  Usually breast milk or formula is the only food for the babies. But as the baby grow, she gets interested in the food others eat. Your baby may begin eyeing your bowl of rice or reaching for a forkful of fettuccine as it travels from your plate to your mouth.

6. Significant weight gain- Most babies are ready to eat solids when they’ve doubled their birth weight (or weigh about 15 pounds) and are at least 4 months old.

7. Growing appetite - The baby seems hungry even with eight to ten feedings of breast milk or formula a day. As baby gets older, her appetite increases. But keep in mind that growing appetite cannot be an indication that your baby is ready for solids.

If baby is breast feeding at least 8-10 times per 24-hours ( even after the first few weeks which probably is not Growth Sprut), empties both breasts at each feeding, and still wants more and the time between feedings becomes shorter and shorter over a period of several days, then baby needs supplementary food intake. The baby also might be signaling by becoming fussy in the middle of the night, whereas before she slept through with no problem or her sleep periods are becoming shorter instead of longer.

8. Ability to let you know she is full from a meal with signs such as turning away from the bottle or breast. This is important so that baby is able to self-regulate the amount of food  is being eaten.

Please keep in mind that these outer signs of being ready for solids do not mean that your baby’s inner digestive system is mature and ready. You should discuss with your baby’s pediatrician about starting your baby on solid foods. Only when you have thoroughly discussed the pros and cons of introducing solid foods with your pediatrician you will be able to have a better grasp of just when you should begin offering baby solid foods.

When it comes to first solid food for your baby, you definitely want to make no mistake, as this experience is going to be deciding factor for eating habits getting cultivated in your baby. There are many factors you should consider. There are many myths, much confusion and many misinterpretations. So its important to have a clear guideline.

Here we go by considering all aspects about first solid food for your baby -

• A good rule of thumb is to start with rice cereal, which is gluten-free and less allergenic than other foods. Give your baby one or two teaspoons of dry cereal mixed with enough formula or breast milk to make a semi-liquid. Babies shouldn’t be directly transitioned to solid from breast milk / formula. Semi-liquid is important milestone in the transition and the time for transition need to be a long enough, which depends on baby’s response to it.
• Foods should be prepared and given in a safe manner, meaning that measures should be taken to minimize the risk of contamination with pathogens.
• Ensure that you are using a soft comfy spoon.  Remember baby’s gums may be tender from teething and a hard metal spoon may aggravate baby’s gums. If baby refuses the spoon or if the spoon seems to make baby uncomfortable, use your finger!
• If you are trying to feed a baby solid when baby is very hungry, she may be more likely to resist. Always offer breast milk and/or formula first and then offer solids.
• Introduce new foods during the morning or early afternoon. This will enable you to deal with any adverse reactions when your pediatrician is in office.
• Don’t Make a Fuss Over the Feeding Session! Follow your baby’s cues and allow him or her to explore the dish, utensils and the food herself!
• Don’t Force Your Baby to Eat! Wait for baby to open her mouth when food is offered. Always let your baby eat at his or her own pace and on his or her own terms!
• Offer a Variety of Foods and Colors! Offer your baby different foods once you have begun to introduce solid foods.
• Some babies need practice keeping food in their mouths and swallowing. Give her time to get used to the new food habits.
• Start with single ingredients only, that too introducing each new food at a space of 4 days apart. This way you’ll get a heads-up if your baby has an allergic reaction to one of them. The signs of an allergy may include diarrhea, a bloated tummy, increased gas, or a rash.
• If you’re feeding your baby from ready-to-eat jars of baby food, scoop some into a little dish and feed her from that. Also, throw away any baby food jars within a day or two of opening them.
• Stay away from foods that might cause her to choke.
• Avoid fast food for as long as possible.
• While you are feeding solids to your baby, if your baby leans back in her chair, turns her head away from food, starts playing with the spoon, or refuses to open up for the next bite, she probably had enough. Understand the clues given by your baby. Don’t overfeed your baby. But also keep in mind that sometimes a baby will keep her mouth closed because she hasn’t yet finished with the first mouthful, so be sure to give her time to swallow.
• If your baby turns away from a particular food, don’t push. Try again in a week or so. Don’t try to make your child eat food he doesn’t like. Respect her preferences and avoid power struggles over food.
• Don’t be surprised if your baby’s stools change color and odor when you add solids to her diet. If her stools seem too firm, switch to other fruits and vegetables and oatmeal or barley cereal. Usually rice cereal, bananas, and applesauce can contribute to constipation in babies.
• Make sure that the nutritional value of complementary foods should parallel at least that of breast milk. Solid foods are not meant to provide for baby nutritionally in the first few months, breast milk and/or formula fill this role! Also do not let solids interfere with liquid intake! 

Each baby will have unique food preferences, but the transition should go something like this:

1. Semi-liquid cereals

2. Strained or mashed fruits and vegetables

Good fruits and vegetables to start with include – sweet potatoes, potato, squash, applesauce, bananas, carrots, cauliflower, green peas, broccoli, oatmeal, mashed ripe banana, mashed ripe avocado, boiled apple, mashed pear and peaches. All food should be strained or mushy as at this stage your baby will press the food against the top of her mouth and then swallow. 

• Vegetables and fruits should be steamed or boiled and should be mixed with baby food made into a puree or you can give just puree of boiled vegetables and fruits to your baby.
• Whether you are giving her vegetables or fruit always peel the skin and boil it in little water so that the vitamins are preserved. Don’t add salt or pepper.

3. Finely chopped table foods, including meat and other protein sources

 These points will definitely help you to get a good schedule for starting solids for your baby.

It is important as a parent you recognize some early warning signs of vision problems in children. Young children often cannot verbalize what is going on with their eyesight. Here are some warning signs your child may have a vision problem:

1. Frequent straining to see things
2. Poor eye/hand coordination
3. Excessive blinking or Frequent eye rubbing
4. Lazy eye
5. Problems in school
6. Difficulty keeping eye contact
7. Squinting, tilting or turning the head or closing one eye when looking at things
8. Tearing
9. Frequent headaches
10. Holding books close to the face when reading or sitting close to the TV
11. Avoiding close work (sometimes by claiming they dislike it)
12. Losing place when reading or using a finger as a guide
13. Difficulty seeing distant objects, like a blackboard

Any or all of these signs may help alert you to possible vision problems early on. You can then work with your healthcare provider to help your child find a suitable pair of lenses.

In addition to nearsightedness, farsightedness and astigmatism, common vision problems of schoolchildren include:

Your child’s eyes should be examined early for vision problems such as “lazy eye” (amblyopia), in which one eye usually is weaker than the other. With amblyopia, eye patching often is used to help strengthen the weaker eye.

• Lazy eye (amblyopia): Your eye doctor will want to rule out amblyopia, or “lazy eye,” which is decreased vision in one or both eyes without detectable anatomic damage. Unfortunately, amblyopia is not always correctable with eyeglasses or contact lenses and may require eye patching to strengthen the weaker eye.
• Misalignment of eyes (strabismus): Crossed or misaligned eyes (strabismus) can have different causes, such as problems with muscle control in the affected eye or eyes. Strabismus is a common cause of amblyopia and should be treated early in childhood so vision and eye teaming skills can develop normally.
• Inability to maintain eye alignment when viewing near objects (convergence insufficiency): Eye doctors will assess the ability of eyes to pull inward (convergence) and maintain proper alignment for comfortable reading.
• Focusing ability, depth perception and color vision: The eye doctor also may test your child’s focusing (accommodation) ability. Depth perception or ability to gauge distances between objects also may be examined, and color blind tests may be used to assess your child’s color vision. [Read more about color vision and how the eye refracts light.]
• Anterior eye and eyelid health: Your eye doctor will closely examine your child’s eyelids to look for abnormal or infected eyelash follicles, bumps (papillae), discharge and swelling (edema). The doctor also will examine the cornea, iris, and lens to look for cloudiness (opacities) or other irregularities.
• “Cloudy” eyes
  If the surface of the eye, which is normally clear, instead appears cloudy, there may be a cataract or other problem.
• Ptosis
  This condition involves a drooping upper eyelid that covers the eye either somewhat or entirely, and so blocks vision.
• Learning disabilities and vision
  Learning disabilities include disorders in understanding or using spoken or written language or symbols.

These disabilities result from the brain’s misinterpretation of images received and relayed by the eyes, rather than from structural or functional eye problems. That’s why learning disabilities are not treatable by eye exercises or vision therapy. Children with learning disabilities do not have more visual problems than those who do not have learning disabilities.

The child may experience problems with reading (dyslexia), writing, listening, speaking, concentration, or mathematical calculations.

The evaluation for a learning disability should include a complete eye examination by an Eye M.D. (ophthalmologist). Treatment for learning disabilities is best provided through an educational approach, using tutors and resource teachers. Whether or not learning disabilities are suspected, all students need vision screening to check for visual acuity and general eye health.