History Taking · Intermediate · Paediatrics

Child Waking at Night with Distress

Practise this PLAB 2 history taking station on Night Terrors. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery. Mr Lawrence Middleton has brought his 4-year-old son Marcus to see you. Marcus has been waking at night screaming for the past two weeks. The episodes last about 15 to 20 minutes, he is inconsolable, and then returns to sleep. The father is worried about what is causing this and whether Marcus could have epilepsy. Please take a focused history to determine whether this is night terrors, nightmares, or something else requiring further investigation.

Background notes: PMH: Born 39 weeks, birthweight 3.4kg, normal delivery. No neonatal complications. Immunisations up to date. Recent cold (3 weeks ago

What this station tests

  • Distinguishing night terrors from nightmares: timing (first third vs second half), awareness (not awake vs fully awake), memory (none vs remembers)
  • Distinguishing from epilepsy: no stereotyped movements, no tongue biting, no post-ictal drowsiness, no incontinence
  • No investigations needed: EEG is not indicated for typical night terrors
  • Scheduled waking technique: waking the child 15 minutes before the usual episode time disrupts the sleep cycle
  • Reassuring that night terrors do not cause harm and children have no memory of them

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, confirm identity, open question. 'What's brought you in today?'
  • 1-4 min — Systematic History: Presenting complaint detail (SOCRATES for pain, timeline, severity). Systems review. PMH, medications, allergies.
  • 4-6 min — Context and ICE: Social history (smoking, alcohol, occupation, living situation). Family history. Ideas, Concerns, Expectations.
  • 6-7 min — Summary and Plan: Summarise findings back to patient. Share differential/working diagnosis. Outline investigation and management plan.
  • 7-8 min — Closing: Safety netting with specific red flags. Arrange follow-up. Check for questions.

Consultation approach

The opening

Night terrors are frightening for parents but benign for children. The candidate must distinguish night terrors from nightmares, epilepsy, and other causes, then reassure the father. Marcus is 4, waking screaming for 2 weeks. His father Lawrence is worried about epilepsy. Open with: 'Mr Middleton, tell me exactly what happens during these episodes and when in the night they occur.'

Core approach

Distinguish night terrors from nightmares and seizures. Night terrors: occur in first third of the night (during deep non-REM sleep), child sits up screaming, eyes open but not awake, inconsolable during episode, does not recognise parents, lasts 5 to 15 minutes, no memory of the event the next morning. Nightmares: occur in second half of night (REM sleep), child wakes fully, remembers the dream, is comforted by parents, may be reluctant to return to sleep. Epilepsy: stereotyped movements, tongue biting, incontinence, post-ictal drowsiness.

Marcus fits the night terror pattern: occurs 1 to 2 hours after falling asleep, screams, eyes open but glazed, cannot be consoled, does not recognise his father, the episode ends suddenly and he returns to sleep, no memory the next morning. He had a cold 3 weeks ago (febrile illness can trigger night terrors). He recently started preschool (life changes can trigger).

Screen for contributing factors: irregular sleep schedule, sleep deprivation, recent illness, stress or life changes, family history of parasomnias.

Closing and safety netting

Reassure firmly. 'Mr Middleton, what Marcus is experiencing is called a night terror. It is a very common sleep phenomenon in children aged 2 to 6. Despite how frightening it looks, Marcus is not aware of what is happening, he is not in pain, and he will not remember it. Night terrors are not epilepsy and they do not cause any harm.'

Management: do not wake the child during an episode (this prolongs it and can cause confusion). Ensure the environment is safe (remove hazards in case he moves around). Maintain a regular sleep schedule. Ensure adequate total sleep (sleep deprivation worsens them). If very regular: scheduled waking (wake the child 15 minutes before the typical episode time to disrupt the sleep cycle). No medication needed. No EEG needed.

Safety net: 'If Marcus has episodes with jerking movements, tongue biting, incontinence, or is drowsy and confused for a prolonged period after, come back as these would suggest something different.' Most children grow out of night terrors by age 6 to 7. Follow-up only if pattern changes.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for night terrors. Domain 1 (Data Gathering) carries the most weight: expect marks for systematic coverage of presenting complaint, red flags, PMH, medications, social and family history. Domain 2 (Clinical Management) requires a clear differential, appropriate investigations, and a safe management plan with safety netting. Domain 3 (Interpersonal Skills) is assessed throughout: genuine exploration of ICE, active listening, empathic responses, and clear communication without jargon.

Domain 1: Data Gathering, Technical and Assessment Skills (Primary focus)

Scores well: Night terror pattern confirmed (timing, awareness, memory, consolability). Epilepsy features excluded. Nightmares distinguished. Triggers identified (illness, preschool). Sleep schedule assessed.

Costs marks: Not distinguishing from epilepsy. Confusing with nightmares. Not identifying triggers.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: No unnecessary investigations. Practical management (safe environment, regular sleep, scheduled waking). Epilepsy safety netting. Reassurance about natural resolution by age 6-7.

Costs marks: Ordering EEG. Advising medication. Advising waking during episode.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Addressing epilepsy fear directly and firmly. Reassuring that child is not in distress during episodes. Normalising night terrors (very common). Practical advice the father can implement tonight.

Costs marks: Reinforcing epilepsy fear. Being vague about reassurance. Not providing practical advice.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Use a consistent framework for every history. After covering the presenting complaint, systematically move through PMH, drug history, social history, family history, and ICE. Keep a mental checklist.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Reserve the final 2 minutes to summarise your findings, share your working diagnosis with the patient, and outline your investigation and management plan including safety netting.

Common mistakes in this station

  1. Ordering an EEG. Typical night terrors do not require EEG. Candidates who investigate demonstrate over-investigation and may reinforce the father's epilepsy fear.
  2. Confusing night terrors with nightmares. Night terrors (non-REM, no memory, inconsolable) and nightmares (REM, remembers, comforted) have different mechanisms, timing, and management. Candidates who conflate them provide incorrect advice.
  3. Advising parents to wake the child during an episode. Waking during a night terror prolongs the episode and causes confusion. The correct advice is to ensure safety and wait for it to end.

Resitting PLAB 2?

If you have previously struggled with history taking stations, focus on building a consistent systematic framework that you apply to every case. Practise structuring your history into clear phases (presenting complaint, systems review, PMH, social, ICE) so that even under pressure, you cover all domains. Many resitters lose marks not on knowledge but on organisation and time management.

Example opening

Good morning/afternoon, my name is Dr [Name], I'm one of the doctors here today. Could I confirm your name and date of birth please? Thank you. So, what's brought you in to see me today?

Frequently asked questions

How do I approach the consultation in this night terrors station?

Night terrors are frightening for parents but benign for children. The candidate must distinguish night terrors from nightmares, epilepsy, and other causes, then reassure the father. Marcus is 4, waking screaming for 2 weeks.

What does a strong performance look like to the examiner in this station?

Strong performances show: Night terror pattern confirmed (timing, awareness, memory, consolability). Epilepsy features excluded. Nightmares distinguished. Triggers identified (illness, preschool). Sleep schedule assessed. Weak performances: Not distinguishing from epilepsy. Confusing with nightmares. Not identifying triggers.

What is the biggest pitfall in this night terrors station?

Ordering an EEG. Typical night terrors do not require EEG. Another frequent error: Confusing night terrors with nightmares. Night terrors (non-REM, no memory, inconsolable) and nightmares (REM, remembers, comforted) have different mechanisms, timing, and management.

How should I prepare for night terrors if I have never seen it in practice?

This station rewards process over personal experience. The skill being assessed: Distinguishing from epilepsy: no stereotyped movements, no tongue biting, no post-ictal drowsiness, no incontinence. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

Related cases