Why does a 15-month-old child wake up from sleep, cry uncontrollably, and then go back to sleep?

Night Waking with Uncontrollable Crying in a 15-Month-Old

This pattern most likely represents either normal developmental night wakings with difficulty self-soothing or sleep terrors (night terrors), both of which are benign and typically resolve without intervention. 1, 2

Understanding What's Happening

At 15 months, brief awakenings between sleep cycles are completely normal—healthy children naturally wake briefly after each sleep state change and typically fall back asleep quickly. 3 The key issue is whether your child can self-soothe back to sleep or becomes distressed during these transitions.

Two Most Likely Explanations:

1. Normal Night Wakings with Poor Self-Soothing

• Between 60-minute cycles in toddlers, brief wakings occur naturally during transitions between sleep stages 3
• If the child hasn't learned independent sleep skills, these normal wakings trigger crying for parental intervention 4
• The child is fully conscious during these episodes and may remember them 4

2. Sleep Terrors (Night Terrors)

• Occur in 1-6.5% of children aged 1-12 years, with peak incidence between 5-7 years (though can start earlier) 1
• Happen during arousal from deep (stage 3-4) non-REM sleep, typically within the first 3 hours after falling asleep 1
• The child appears terrified, may scream, sit upright, have a frightened expression, but is actually not fully awake and will have no memory of the episode in the morning 1
• Autonomic signs include rapid heartbeat, sweating, flushed face, and agitation 1
• The child is difficult to console and typically settles back to sleep on their own 1

Critical Red Flags Requiring Medical Evaluation

Do NOT assume this is benign if any of these are present:

• Bilious vomiting, gastrointestinal bleeding, or consistently forceful vomiting 5
• Fever, lethargy, or signs of illness 5
• Abdominal tenderness, distension, or hepatosplenomegaly 5
• Excessive daytime sleepiness despite apparent nighttime sleep 4
• Signs of breathing problems during sleep (snoring, gasping, pauses) 4, 2
• Any signs of trauma or injury 5

Management Approach

For Normal Night Wakings:

Establish consistent sleep routines:

• Use visual and verbal cues for well-defined sleep times to reduce stress responses 6
• Ensure age-appropriate sleep schedules with adequate total sleep to prevent sleep deprivation 1
• Avoid overstimulation before bedtime from excessive tactile, visual, or auditory stimuli 5

Consider behavioral sleep interventions if wakings cause significant family impairment:

• Insomnia diagnosis requires functional impairment for child or family, not just the presence of wakings 4
• Behavioral interventions improved night waking in 70% of children in structured programs 3
• These should only be attempted when parents are not experiencing significant stress, depression, or feeling overwhelmed 6

For Sleep Terrors:

Do not attempt to interrupt or wake the child during an episode 1

• Attempting to console or wake the child is ineffective and may prolong the episode 1
• Ensure the sleep environment is safe to prevent injury if the child moves around 1

Address precipitating factors:

• Sleep deprivation is a major trigger—ensure adequate, consistent sleep schedules 1
• Identify and avoid other triggers if a pattern emerges 1

Medical intervention is rarely needed:

• Most children outgrow sleep terrors by late adolescence 1
• If episodes are frequent, severe, or cause daytime functional impairment (fatigue, sleepiness), short-term clonazepam at bedtime may be considered 1
• Anticipatory awakening (waking the child 30 minutes before the typical episode time) can be effective for frequently recurring terrors 1

Parental Support and Safety

This is critically important: Crying is the most common trigger of abusive head trauma, and almost 6% of parents admit to smothering, slapping, or shaking their infant at least once because of crying. 5, 6

Counsel parents explicitly:

• It is completely safe and appropriate to put the baby in a safe place (crib) and take a break if feeling overwhelmed 5
• Implement "time-in" with 10-30 minutes of child-directed play during the day to strengthen parent-child connection 5, 6
• Parents should remain calm and serve as an "emotional container" without becoming distressed themselves 5, 6

Common Pitfalls to Avoid

• Don't assume all night waking is normal variation—active screening for sleep problems should occur at well-child visits 4
• Don't prescribe proton pump inhibitors—they are ineffective for crying and carry risks including pneumonia and gastroenteritis 5
• Don't try multiple dietary changes without clear indication—underlying organic causes are found in less than 5% of excessively crying infants 7
• Don't confuse sleep terrors with nightmares—sleep terrors occur during deep sleep in the first half of the night with no memory, while nightmares occur during REM sleep in the second half with recall 1, 2