Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Epidemiology | Nighttime Fears Scale | Symptoms | Causes | Diagnosis | Treatment
Children experience fears that can intensify as day progresses into night. These fears can range from classic monsters under the bed to world problems, such as war, which can be challenging to comprehend. Anxiety can increase and feed an overactive childhood imagination.
Nighttime fears in children are a common reason for an inability to sleep, causing drowsiness during the day and leading to other disorders, such as childhood anxiety, if not addressed promptly.
A child spends a significant amount of time playing in fantasy land, so it’s hard to differentiate between make-believe and reality. Their fears could be simple, from being afraid of what is in the dark (and seeing their stuffed animals come to life) to the fear of being alone.
In one study, 80 children, ages 4-6, experiencing nighttime fears were compared to 32 children who were not experiencing them. The children viewed images and were asked to decipher between imaginary fears or situations that could occur in real life. The study showed that the children who were experiencing nighttime fears had greater difficulty differentiating between reality and fantasy.
Another study of children between the ages of 6-12 showed that 43 percent of children had many fears and concerns. A common fear children share is simply being afraid of the dark. Others may have experienced trauma, such as a death in the family, and become fearful of loss. Some children see the news and become afraid of the world.
Nighttime fears usually begin around age two and can last until age 12 but typically ease with maturity. 
The Nighttime Fears Scale
This self-assessment tool is a scale with a four-factor structure consisting of 21 items that could warrant fear in children, specifically at nighttime.
The Nighttime Fears Scale (NFS) is used by clinicians and researchers to identify nighttime fears and evaluate their intensity. This tool is beneficial in assessing common nighttime fears and addressing their cause.
Children can fear many aspects of nighttime, from a lonely bedroom to conjuring up imaginative thoughts.
However, when these nighttime fears become a pattern, children suffer from sleeplessness, which leads to emotional deregulation, and eventually, behavioral issues.
Obvious symptoms for nighttime fears are reluctance to go to bed, using the classic “I’m thirsty” to delay bedtime, and vocalizing concerns, such as being afraid of the dark. Some more serious signs could manifest in physical symptoms as well, such as:
- Increased Heart Rate
Identifying specific fears will lead to finding out the root cause of physical and behavioral symptoms. 
Nighttime fears in children can lead to the fear of sleep itself and cause frequent waking during the night. Determining the cause will alleviate the symptoms and allow for a full night’s rest. 
Some nighttime fears have a genetic factor, others an environmental. Sometimes, it can be a case of both.
Fear may be based on a previous scary experience. For instance, if a child had an encounter with a spider that struck fear, then naturally, the child would fear a spider in the darkness of the bedroom.
More serious trauma, such as a sick pet, could provoke fear of loss or illness. A child exposed to scary movies might fear what was seen on the screen, not mature enough to understand that the instance was not real. 
If your child is suffering from relentless fear and comforting techniques prove unsuccessful, a clinical diagnosis may be needed to alleviate extreme phobias. A psychiatric evaluation will determine a specific diagnosis and treatment plan. 
Most children experience fears of going to bed but often outgrow them in time. The most crucial part of treating the child’s fears is determining the actual fear.
Once the root of the fear is established, comforting the distress is the next step. If the fear is imaginary, such as a monster in the room, reassure the child that it is simply a shadow. Do not make fun of the child or dismiss the fear as silly, as the anxiety they’re experiencing is real.
Try comforting techniques:
- Leave the bedroom door cracked
- Have a dim night light on in the room, especially if the child is afraid of the dark
- Offer the child’s favorite stuffed animal or pet
- Prevent your child from being exposed to frightening movies, news media, or books
- Open communication about the fears to build up their self-confidence to overcome their fear of them
- Reassure the child is safe, especially if they are afraid to sleep alone or call out several times
- Do not encourage the child to get out of bed, and assure them that the bed is a safe place
- If the fear is derived from being alone, do five-minute check-ins, then do ten minutes, and so on until the child falls asleep
It is vital that your child learns that the bed and the bedroom are safe at night, so if you wake up at night to see your child’s face, it is best to put them back to bed and reassure them that they are okay.
If symptoms persist or worsen, consult your child’s pediatrician for an evaluation to treat the developing anxiety issues. 
- Zisenwine, T., Kaplan, M., Kushnir, J., & Sadeh, A. (2013). Nighttime fears and fantasy-reality differentiation in preschool children. Child psychiatry and human development, 44(1), 186–199. https://doi.org/10.1007/s10578-012-0318-x
- Understanding childhood fears and anxieties. HealthyChildren.org. (n.d.). Retrieved November 4, 2021, from https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/pages/Understanding-Childhood-Fears-and-Anxieties.aspx
- Orgilés, M., Fernández-Martínez, I., Espada, J. P., & Morales, A. (2021, February 13). The Nighttime Fears Scale: Development and psychometric evidence of a standardized self-report scale to assess nighttime fears in children. Journal of Anxiety Disorders. Retrieved November 4, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0887618521000165
- Centers for Disease Control and Prevention. (2021, March 22). Anxiety and depression in children: Get the facts. Centers for Disease Control and Prevention. Retrieved November 4, 2021, from https://www.cdc.gov/childrensmentalhealth/features/anxiety-depression-children.html
- Nighttime fears in children: A practical guide for the science-minded. PARENTING SCIENCE. (2021, May 31). Retrieved November 4, 2021, from http://www.parentingscience.com/nighttime-fears.html.
- The Children’s Hospital of Philadelphia. (2014, August 24). Phobias in children and adolescents. Children’s Hospital of Philadelphia. Retrieved November 4, 2021, from https://www.chop.edu/conditions-diseases/phobias-children-and-adolescents#.
- Bedtime fears: Helping overcome them. Cincinnati Childrens. (n.d.). Retrieved November 4, 2021, from https://www.cincinnatichildrens.org/health/b/bedtime-fears.