A 4-year-old child, who is hospitalized with pneumonia, tells the nurse, “I got sick because I was bad. I yelled at my little sister yesterday.” The nurse determines that which of the following is an accurate explanation for the child’s comment? The child is:

Night terrors are a type of sleep disturbance common in preschool-aged children, usually occurring in the first few hours of sleep during deep (non-REM) stages. Unlike nightmares, the child is not fully awake and typically does not remember the event. The best approach is to let the episode pass without waking the child, while ensuring the environment is safe.

Rationale for correct answer:

3. Night terrors are self-limiting and usually resolve as the child matures. Waking the child during a night terror can be confusing or distressing and may prolong the episode. Offering reassurance afterward, if the child does wake up, is appropriate. Otherwise, observe quietly and ensure safety.

Rationale for incorrect answers:

1. Talking about fears during the day is more helpful for nightmares, not night terrors. Night terrors are not typically linked to daytime anxiety or specific fears, and the child does not remember the episode, so discussing it may be unhelpful.

2. A night light may help children afraid of the dark or experiencing nightmares, but it does not prevent night terrors, which occur during non-REM sleep and are not related to external stimuli like lighting.

4. Waking the child up and telling them they are safe is suited for nightmares, not night terrors. In a nightmare, the child wakes up and seeks comfort. In a night terror, the child appears awake but is actually in a deep sleep and will often not recognize or respond to others.

Take home points

• Night terrors are common in preschoolers and usually go away without intervention.
• During a night terror, the child is not fully awake and typically doesn’t recall the event.
• Do not try to wake the child; instead, observe, ensure safety, and allow the episode to pass.
• Distinguish between nightmares where the child wakes and remembers the dream, and night terrors where the child remains asleep and is unaware.

Preschool and early school-age children often do not yet fully grasp the concept of clock time. They understand time better when it is related to familiar daily routines like lunch, snack time, or nap time.

Rationale for correct answer:

3. Linking the mother's arrival to a concrete, familiar routine such as lunch time, helps the child feel more secure and better understand the timing. This approach is developmentally appropriate for kindergarten-age children, who typically cannot yet tell time or interpret abstract time intervals.

Rationale for incorrect answers:

1. “In about a half hour” is too abstract for most 5-year-olds. They do not have a reliable sense of what "30 minutes" feels like.

2. “When both hands on the clock reach 12” assumes the child knows how to read an analog clock, which most kindergarteners cannot do yet.

4. “At 12 o’clock noon” uses formal clock language, which is generally not meaningful to children at this stage of development.

Take home points

• Young children understand time in relation to routines, not numbers on a clock.
• Nurses should provide concrete, relatable explanations to reduce anxiety and promote understanding.
• Developmentally appropriate communication builds trust and emotional comfort, especially when a child is sick or upset.
• Avoid using abstract time language like minutes or hours when talking to young children.