A previously well 4-year-old boy is brought to your office by his mother.

This presentation is characteristic of a non–rapid eye movement (NREM) sleep arousal disorder (sleep terror) . MCCQE objectives highlight that sleep terrors typically occur in children aged 3–7 years and arise during the first third of the night , shortly after sleep onset, during deep NREM (slow-wave) sleep. Children abruptly awaken screaming, appear terrified, flushed, and autonomically aroused, and are inconsolable and minimally responsive to caregivers. Episodes usually last 10–20 minutes and resolve spontaneously, with the child returning to sleep and having no memory of the event the next morning.

Nightmares, in contrast, occur during REM sleep (later in the night); the child is awake, alert, consolable, and can recall the dream. Nocturnal seizures are typically brief, stereotyped, and may include tonic–clonic activity or a postictal state. Panic disorder occurs during wakefulness. Temper tantrums occur while awake and are behaviorally triggered.

Management is reassurance and ensuring safety; most children outgrow sleep terrors without intervention.