Tackling the Night Terrors Case in PLAB 2: A Full Breakdown for Exam Success

Summary:

This case focuses on a child presenting with night terrors—a common and benign sleep disorder in children. The station tests the candidate’s ability to differentiate between night terrors and other causes like nightmares or medical issues, reassure anxious parents, and deliver clear, calm, and structured advice while demonstrating sound time and communication management.

Key Points:

Sleep Disorders / Paediatrics

Night terrors are common in children and typically benign.
Main differential: distinguish night terrors from nightmares and serious neurological causes.
Night terrors often involve the child sitting up, screaming, and not recalling the event.
Ask about family history (commonly inherited).
Assess for any psychological stressors or changes in routine.
Inquire about bedtime routine and any stimulating activities before sleep.

Data Gathering

Confirm the patient (child)’s age and identity clearly.
Clarify presenting symptoms: frequency, triggers, duration, memory of event, and behavior during and after.
Ask about bedtime habits, routine, TV use, stimulating activities.
Rule out: infection (fever, neck stiffness), trauma, or psychological concerns.
Explore any recent stressors or changes at home or school.
Include ICE (Ideas, Concerns, Expectations) to understand the parent's anxieties and goals.

Important Considerations:

Do not over-investigate or unnecessarily escalate—this may alarm the parent.
Recognize this as a common developmental issue unless red flags are present.
Avoid medical jargon; explain in clear, simple terms.
Confirm family history to support diagnosis and reassure.
Use time efficiently—aim to move to management by minute 5 in an 8-minute consultation.

Diagnostic Approach:

Identify and confirm the core symptom: sudden nocturnal arousal with confusion and amnesia.
Differentiate from nightmares (child remembers them).
Rule out serious causes (infection, neurological).
Understand behavioral and environmental triggers.
Check for family history of similar episodes.

Management:

Education: Explain that night terrors are common and typically resolve with age.
Reassurance: Emphasize it is not dangerous, and no lasting harm is expected.
Lifestyle Advice:
- Encourage regular sleep routine.
- Avoid screens and stimulating activities before bedtime.
- Consider preemptive awakening if the episodes are frequent and predictable.
Parental Guidance:
- Avoid waking the child during an episode.
- Maintain a calm environment.
- Observe for any change in frequency or severity.
Follow-up:
- Offer a follow-up appointment in a few weeks to monitor.
Safety Netting:
- Advise to return if symptoms worsen, new symptoms (daytime changes, developmental regression), or if concerned.
Provide Leaflets: Educational material on night terrors for further reading.

Communication Skills:

Patient-centered approach—acknowledge and address parental concerns.
Use ICE to shape your consultation and tailor the explanation.
Clarify the diagnosis and explain it using layman terms.
Provide structured, calm explanations.
Display empathy and maintain a non-alarming tone.
Use the “consultation guide” strategy to manage time and ensure completeness.

Ethical Considerations:

Ensure consent when discussing or examining the child.
Maintain a calm and non-judgmental demeanor.
Avoid unnecessary referrals or investigations unless justified by red flags.
Promote shared decision-making with the parent.

Additional Resources:

NICE Clinical Knowledge Summary: Night terrors in children
GMC Good Medical Practice (Domains: Communication, Clinical care, Partnership)
PLAB 2 Consultation Guide
OSCE Workbench practice tools