When a child has a tantrum at night

Article taken from a publication by Dr. Emanuela Malorgio
National coordinator of the Sleep Study Group – FIMP (Italian Federation of Pediatricians)

When a child has a whim at night, cries and does not allow himself to be comforted by his mother or father, are we sure that it is always a whim? Or are we facing a sleep disorder such as Pavor Nocturnus ?

And if so, what is Pavor?

Pavor, or Night Terror, is one of the parasomnia , a heterogeneous group of episodic or intermittent events that occur during sleep without altering its structure; parasomnia they are characterized by abnormal and unpleasant verbal or motor behavioral phenomena that occur in the transition phase from wakefulness to sleep, during sleep or in the awakening phase; they are more frequent in children than in adults and are distinguished according to the international classification into NREM sleep parasomnias, REM sleep parasomnias and Other parasomnias.

Today we talk about the nREM sleep parasomnias

The sleep parasomnias NREM (arousal disorders) occur mainly during the phase of ” deep sleep “, mostly represented in the first part of the night, have a very variable duration (from a few seconds to 30 minutes) and are not remembered by those who lives them.

In this case, the parent tells of one or more events that occurred in the first 2-3 hours of sleep , lasting from a few minutes to half an hour, in which the child cries and despairs but does not seek eye contact, much less physical contact with him .

This is the most frustrating aspect for the parent because he is unable to console his child and even worse he feels “rejected by him”.

It is important to speak to the pediatrician to rule out other pathologies, and it would be advisable to show the doctor the event through a video recording. The pediatrician will be able to explain to the mother and father that the baby is sleeping, that in the morning he will not remember anything, but above all that the episodes do not correspond to a pathology and that they will most likely disappear spontaneously by adolescence . Many times even parents as children have experienced similar episodes in childhood.

But how do these episodes present themselves?

In a very heterogeneous way, so much so that there are 3 different manifestations that can also occur in the same child.
We can have a partial awakening , during which the child appears confused, disoriented, sometimes aggressive, speaks incoherently, usually does not get up and does not walk (Confusional Awakening).
Or he has more or less complex automatic behaviors , finalistic or afinalistic, he walks, gets up, tries to leave the room, to eat or drink (Sleepwalking). Finally, it may present a partial awakening, often with sudden onset, with an expression of terror, intense agitation, sweating, pallor, labored breathing, tachycardia; the child screams, is inconsolable, unresponsive to environmental stimuli and does not recognize the parents ( Night Terror or Pavor Nocturnus ).

Confusionali notturni	SONNAMBULISMO	RISVEGLI	TERRORI
Insorgenza	Primo terzo	Primo terzo	Primo terzo
Durata	1-10 minuti	5-40 minuti	1-5 minuti
Agitazione	Nessuna-Scarsa	Lieve	Marcata
Incidenza	40%	5%-15%	1%
Età	Preadolescenza	Prescolare	Tarda infanzia
Amnesia	Sì	Sì	Sì
Soglia di Arousal	Alta	Alta	Alta
Famigliarità	Elevata	Elevata	Elevata

The cause of these events is not yet clear, but recent studies consider them as ” partial awakenings from nREM sleep “, awakenings that involve and activate only some brain areas (for example motor ones) and not other areas (such as those involved in the processes of memory or “consciousness”) that would remain deactivated. For this reason, during these events the subject is able to perform actions, even apparently aimed, but appears confused and often does not keep any memory of what happened.

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