Behavior: Ask the Experts: Shining a light on nyctophobia

Q: How seriously should I take a young child's complaint of "fear of the dark"? What are the best ways to help parents deal with this issue? And when should I be concerned that this fear is a symptom of a serious psychological disturbance or a physiologic disorder such as congenital stationary night blindness?

Douglas G. Olk, MDDubuque, Iowa

A: Fear of the dark is one of the most common fears that pediatricians encounter in toddlers and, less often, in school-age children-although for different reasons. A toddler's wild imagination flares in the dark, when he (or she) is not distracted by things the eyes can see, and he may, for example, envision monsters coming into the room. The fear then develops into a phobia about the dark. A complaint of fear of the dark may also be a way for a toddler to seek attention. As a child grows older and realizes what is real and what is not, fear of the dark may no longer arise from monsters but from worries of an intruder entering the dark house or the child's room.

Children who are afraid of the dark need to be reassured that they are safe. They can be asked what kinds of things will make them feel safe. Often, the answer is something as simple as putting a nightlight in their room or showing them that the house is securely locked for the night. It may help to give a child some control, such as the ability to turn a bedside lamp or nightlight on or off-or, better yet, to adjust the level of brightness of any light. A flashlight in bed may be appropriate, depending on the child's age.

Advise parents whose child is afraid of the dark to avoid having the child watch scary television shows or movies. Even the evening news may make him anxious and fearful of the dark. You can also recommend children's books-such as Mercer Mayer's There's a Nightmare in My Closet-specifically about fear of the dark that might help the child deal with this situation.

If the family has a history of impaired night vision or other visual concerns, consider the rare diagnosis of congenital stationary night blindness, an inherited (possibly X-linked, although autosomal-dominant and -recessive forms have been reported) disorder that should be confirmed by referral to a pediatric ophthalmologist.

If routine suggestions such as those just discussed do not work, or if fear of the dark appears to be interfering with the family's everyday life, it is useful to investigate external events in the child's life. What might be triggering these fears and anxieties and do they warrant psychosocial evaluation and counseling?

To sum up: All children develop one fear or another. The important things a parent, and you, can do are:

Lewis R. First, MD

DR. FIRST is professor and chair, department of pediatrics, and senior associate dean for medical education, University of Vermont College of Medicine, Burlington.