Fear of the dark in children may have a pathological basis

Fear of the dark is a common complaint of pre-teenage children. 1 2 It should not be confused with night terrors or panics, in which a child becomes acutely agitated and terror-struck at night, appearing to be awake while in fact asleep and unable to be woken. 3 4 In contrast, fear of the dark can be experienced by the conscious child in dimly lit or dark conditions. When such fear is excessive it is often attributed to attention seeking behaviour or assumed to be an irrational fear that will abate with time.

Most people can see a little in very dim lighting conditions after a short period of adaptation. However, a child with no visual problem obvious to the parents and who can see normally in well lit conditions can present as being unable to see at all in the dark even after a period for adaptation. In a child who cannot yet talk this may simply appear as fear of the dark. We describe two patients with congenital stationary night blindness, a diagnosis which may be missed without appropriate history taking from the parents, particularly if there is no family history of visual problems.