Children's Fears and Nightmares

Artwork: Child with a Dove, by Pablo Picasso (1901).

What is fear?

Fear is an innate and essential emotion in all human beings, which keeps us on our guard, avoiding and running away from dangerous situations. It is also an emotion that can be associated with different contexts or objects, ranging from fear of stimuli that have evolutionarily represented a threat to the human species, such as fear of snakes, being left alone, the dark, among others, to fear of stimuli that are harmless in principle, such as fear of dogs, horses, clowns, etc. But what exactly is fear?

Fear, like all emotions, has three components: a neurophysiological component, a behavioural component and a cognitive component.

1) On a neurophysiological level, there is the activation of biological responses in the body regulated by the nervous system and, in the case of fear, these responses are aimed at preparing the individual to fight or flee (e.g. accelerated heartbeat, rapid breathing for greater oxygenation and inhibition of the digestive system so that blood is irrigated more to the muscles, release of hormones such as adrenaline, feeling more agitated and tense, shivering without being cold, dry mouth, dizziness, feeling a lump in the throat, tightness in the chest, sweating, etc.).

2) On a behavioural level, fear is expressed through actions of fight or flight, as well as facial expressions that make this emotion explicit (e.g. facial expressions of astonishment, shouting, hitting, fleeing/avoiding a situation).

3) On a cognitive level, there is the processing of information about what is happening, allowing us to recognise and name what we are feeling, as well as establishing relations between what we are feeling and its causes and even consequences (e.g. verbally expressing ‘I'm scared!’, saying that you are afraid of horses, asking to leave a nightlight because you are afraid of the dark, saying that you don't want to leave the house because of the dogs that will attack, among others). On a cognitive level, when you're afraid your attention is also restricted to the feared object, focussing on how to escape or avoid the situation.

However, in order to detect and help children manage their fears, it is important to take into account their level of development, since while some children can verbalise their object of fear, younger children who do not yet have this level of understanding of the emotional response or sufficient language skills will manifest their emotion mainly on a physiological and behavioural level, for example with great anxiety and tantrums. Other times, because children don't have enough resources to elaborate on their emotions, they can often be somatised, i.e. expressed as symptoms in the body. Fear can, for example, also present itself in the form of migraines, stomach aches and so on. Often, these same symptoms arrise in order that the child, defensively, doesn't need to face the feared situation, which is a great relief for them (after all, they are free of the sensations of anxiety and the imagined bad consequences), so that, even if they are unaware of it, the symptoms can recur more often in the child. For example, Maria is afraid to leave her mum, to whom she is very attached. As the headaches and stomach aches keep her at home and prevent her from leaving her mum, they may recur more frequently. It is necessary to keep an eye on the child's behaviour and symptoms and try to detect what stimuli may be triggering these behaviours and/or symptoms. Other times, in the absence of symptoms, the same child could throw huge tantrums when it comes to separating from their mother, so that the mother gives up, thus reinforcing the tantrum behaviour because the child has succeeded in their goal.

How can we identify?

Sometimes fears are easily detected, for example when a child is distressed in front of dogs after having seen or experienced a dog attack, or afraid of water after having had a bad experience in the swimming pool; however, at other times, the nature of a child's fear may be more symbolic, requiring an interpretation to understand it or a careful observation of their play, since when playing, children enact distressing situations in order to deal with fears and anxieties that they wouldn't otherwise be able to. For example, a child who has spent a long time in an incubator may express their fear of loneliness through a fear of empty places, or closed places that prevent them from going to those they love. In another case, a child who is afraid of his father's authority can express this by playing with the figure of a large lion chasing a cub or dramatising situations with dolls. There is also another fear, common in the early years, which is the fear of nightmares. There is a peak in the occurrence of nightmares (especially monsters and evil men who chase them) in children between the ages of four and six. These are common unconscious mechanisms in which children symbolically express their fear of punishment for some of their thoughts. For example: the child is very angry with their father and wishes him to be ill, but then fears punishment because they may not yet be able to discern their thoughts and fantasies from reality.

What to do?

The solution will always be to help your child face the situation, as avoidance will only make matters worse. However, exposure to the feared stimulus or context should be done gradually and carefully, so as not to generate too intense an emotional response of fear and stress.

1) Be patient and reassure them: one of the most important aspects is to give your child confidence in their ability to cope with the situation, by being positive and encouraging, as well as reassuring them that the situation is not really dangerous. However, if the fear is of a specific context, such as school, you need to assure that the child is not being bullied and then intervene with the teachers and offer strategies for your child to better cope with the situation. If your child's fear is separation or entering a new context (such as kindergarden, a new school, swimming lessons, ballet, etc.) a good way to intervene is to reassure them that they will be reunited and that entering the new context will be rewarding: ‘I know school can be a bit scary, but I'm sure you'll be brave and that every day will be easier, you'll make new friends and you'll have fun. When I pick you up I'll be very happy to hear about your day-to-day life and new activities.’

2) Praise your child's courageous behaviour: Whenever your child faces an uncomfortable situation, praise them for their courage. For example: ‘You're becoming a very brave boy! You were very brave today at the doctor's office, I'm very proud of you.’ You need to promote and reinforce behaviours in which your child wants to explore, take risks (as long as it's safe), make new friends or deal with situations independently.

3) Make a sticker chart: A sticker chart or some other reward system or activity, for example collecting a number of stickers for brave behaviour in order to win a gift, can make it much easier for your child to overcome fears. It can be used for brave behaviour, such as the child going to kindergarten and separating without a tantrum. If your child is very inhibited in the classroom, the reinforcement system used at home can also be used by the teacher to encourage interaction. However, this method should only be used as a motivational tool and should never be separated from explanations of the value of certain behaviours and emotional appreciation. By only offering rewards, you're teaching your child to take responsibility not because they understand and want it, but just to respond to an external treat.

4) Ignore tantrums and reduce attention to psychosomatic expressions of fear: tantrums and psychosomatic expressions are ways of avoiding the feared situation, so you have to strike a balance between supporting, consoling and not paying too much attention to these expressions of fear. This part can be difficult for parents, especially when separating from their children when they see that they are distressed, but if you stay long enough to calm the child down, they will learn that tantrums work after all. Here are some examples: when you drop your child off at kindergarten: "I know you're going to like school today (the child starts to tantrum). Look, there's Bruno, and he's with that lorry you like (distraction). I'll pick you up at noon and I want to know what you've done today (if the tantrum continues, tell him you have to go and you want him to enjoy the day and leave)’; when the child always complains of a stomach ache when he has to go to school (and this is of course if there isn't actually a physiological problem)you can try something like this: 'I'm really sorry your stomach hurts. You'll have to eat a sandwich at school soon. That helps me feel better when I have a tummy ache (from then on, ignore other references to tummy ache and help the child get ready for school)’. The same applies to when the child goes to bed ‘I'm going to put a little light on and go into the living room. I know you're very brave and grown up and you're going to stay in bed and fall asleep (even if he whines, he should leave the room and ignore the crying)’. In the latter case, it can be good to leave the child something to remind them of you and to know that nothing bad will happen to them. One strategy that can be used is to leave something in the child's room that can be changed during the night so that, when the child wakes up, they realise that you have been there to look after them, for example, when you put the child to sleep, put a teddy bear out to look at and say that you will come back later to see them asleep and also put the teddy bear to sleep. When the child wakes up and sees the teddy bear lying with them or in a bed made for them, they will be happy and more confident of their mothers presence.

5) Provide children with predictable separation and reunion routines: Stable routines help children feel more secure and in control of the situation. It's very important to always anticipate moments of separation: ‘Dad's going out in 15 minutes, until then we can play a bit’ and also to ensure the reunion: ‘But I'll be back in the evening, when we have dinner together’ or ‘You'll be asleep by the time I get back, but I'll see you tomorrow for breakfast’. It's also important to always show enthusiasm and joy when you meet your little one again, even if you have other worries on your mind, as they may think your discouragement has something to do with them. Whenever possible, interact with the people and carers who spend the day with your child, so that they feel more at ease in that setting.

6) Set an example and don't be afraid: Even when you're anxious, don't show it in front of your child. Children learn a lot by observing behaviour. The same applies to your own relationships, whether marital or with other family members. You need to maintain an atmosphere of family harmony and avoid complex discussions and conflict in front of your child, as this will make them insecure.

7) Reinforce exposure: If your child is afraid of a certain situation (e.g. fear of dogs), try exposing them to these situations in small doses, reinforcing them each time. For example, start by watching dog films in which the dogs are loving, then, when walking with your child in the street, comment on how other children pet the dogs and seem happy about it, then look for a friend who has a small, very sweet dog to be in the same environment as your child, pet the dog, until gradually, on their own initiative (never force or ask the child to approach what they fear), your child approaches to pet it, having realised from previous situations that their fear was not shared by others and that they could actually have good experiences with dogs. Afterwards, praise your child for having managed to approach the dog, despite their fears.

8) Teach positive self-talk: Teach your child some self-affirmations to help them deal with their fears. For example: ‘I'm brave and I can do this’, ‘I'll do it, everything will be fine’, ‘I'm a big girl, I don't need anyone to look after me in the dark’, ‘I'm brave, at kindergarden I'll first play, sing, have a snack and then Mum will pick me up for lunch’.

9) Positive imagery and relaxation exercises: Teach your child calming breathing techniques (breathe in slowly through the nose and out through the mouth) and the strategy of visualising positive images in their mind, from imagining a pleasant place and situation (like the beach), their ‘happy place’, to imagining themselves happy and successful in the context they fear (playing with friends happily at school). In order to do this, it's essential to teach children to identify feelings of fear and anxiety so that they can then adopt these strategies. You can also help the child find other self-regulation strategies, such as squeezing a soft toy they like.

10) Educational resources: There are some books and activities that teach children how to identify, understand and deal with emotions, including fear. One of them is the book ‘I control my emotions!’ by Paulo Moreira and another is ‘The Book of Emotions - A book that explains emotions and how to deal with them’ by Filipa Sáraga.

11) These last strategies refer to ways of dealing with nightmares: Children have difficulty discerning their fantasies and dreams from reality, so nightmares are very frightening for them. Bearing this in mind, it won't be possible to console the child by saying ‘it was just a dream, it's not real’, which will only make them more distressed at not having their fears recognised and having to deal with them on their own. Therefore, the best solution is to enter the child's fantasy and modify it so that it is no longer threatening. Imagine that the child is afraid of a monster, ask them to describe and draw the monster and then, together, add elements to it so that it becomes funny and non-threatening. For example, add funny make-up, a clown's nose, colourful skates, funny clothes and so on. You could say ‘I know who the monster is, it's the funny monster! He only comes round wanting to play. He's not dangerous.’ It's essential to reassure the child that nothing bad is going to happen. Another strategy is to take advantage of children's great imagination by telling them that they can have powers, such as disappearing, flying, casting spells and becoming very strong in front of the monster. You can also create rituals with the child to ward off fears, such as making a water spray to ward off monsters, sweeping monsters out of the room, praying to ward off ghosts. If the child comes to your room when they have a nightmare, it's essential to take them back to their room and comfort , they need to know that they can face their fear on their own. Alongside this, it may also be important to add a small night light with a dimmer, decreasing its intensity over time.

Finally, it's essential to point out that if you're finding it very difficult to manage your child's fear, and if it's very intense, impacting on their learning, attention, well-being and socialisation, the best thing to do is to seek help from a psychologist and/or child psychotherapist.

References

Moreira, P., & Zapruder (2009). Emotions and Feelings Illustrated: For Working with Children aged 4 to 10.

Webster-Stratton, C. (2010). The Incredible Years: A problem-solving guide for parents of children aged 2 to 8 (MI, Donnas Botto, Transl.; MF Gaspar & MJ Seabra-Santos, Scientific review). Braga: Psiquilibrios Edições (Original published in 2005).