Could your child's fear of the dark be more than an overactive imagination? According to researchers from the Gartnavel General Hospital in Glasgow, Scotland, children who suffer from congenital stationary night blindness (CSNB) "can experience a profound fear of the dark." Although rare, CSNB impairs a child's ability to see in the dark and is often misdiagnosed or attributed to common childhood fears. For parents, knowing potential warning signs, seeking medical treatment and providing nightlights are all important steps in coping with night blindness in children.

The Real Monsters in the Closet
As described in the Gale Encyclopedia of alternative medicine, "All of the possible causes of night blindness are associated with the way in which the eye receives light rays." "Most people can see a little in very dim lighting conditions after a short period of adaptation," says Gordon N. Dutton, consultant ophthalmologist for Gartnavel General Hospital. "Children who suffer from night blindness are unable to see at all in the dark even after a period of adaptation."

As Dutton's research shows, for many children, night blindness translates into a fear of the dark and for that reason is often overlooked or missed by medical professionals and parents alike. Dutton provides two case studies of children who suffer from CSNB.

Case One -- A 3-year-old girl who had been frightened of the dark from an early age. "She had complained to her parents of not being able to see when the bedroom lights were turned off," says Dutton. It was not until her younger sister was born visually unresponsive that her parents sought the advice of an ophthalmologist who diagnosed her with CSNB.

Case Two -- The parents of a 2-year-old girl reported that she was frequently tripping over and bumping into objects at night and "had difficulty seeing in the dark." Her parents noticed that when she woke at night she would cry and be frightened but would not go into their bedroom. There was a family history of impaired night vision which prompted testing for the young girl, and subsequently, she was diagnosed with congenital stationary night blindness. An intensity adjustable nightlight was suggested, and within days, she was more confident and sleeping through the night.

In both case studies, the recommended treatment involved providing a nightlight, and afterward, both children showed marked improvement. One child actually began sleeping through the night within days, and the other child was no longer afraid of the dark.

By providing a nightlight and giving the child control of lighting conditions, parents can transform family life. "I never would have connected my child's fear of the dark with night blindness," says Angie Lee, mother of two from Tacoma, Wash. "After our pediatrician suggested placing a nightlight in the hallway, my daughter has had no problem staying in her own room all night."

A Genetic Link
What causes night blindness in children? Dr. Torben Bech-Hansen, an associate professor in the Department of Medical Genetics at the University of Calgary, was credited with the discovery of a gene causing one form of x-linked congenital stationary night blindness. Additional research by Dr. Kym Boycott found that CSNB had a strong genetic relationship, presumably due to the subject's Mennonite ancestry. Similarly, Dutton's research reveals that congenital stationary night blindness is "an inherited, non-progressive disorder that is three times more common in boys than in girls."

Helping Your Child Cope
Parents should not automatically assume that because their child suffers from a fear of the dark that they have CSNB. However, parents should be aware of the disease and know the possible warning signs. "If your child is consistently afraid of the dark and their fear immediately goes away when given a light, you may want to have their eyes checked," says Dutton.

Assessing your family history and listening to your child may be the first step toward diagnosing night blindness. If parents suspect that their child is suffering from night blindness, they should immediately seek the advice of a medical professional. "Once congenital stationary night blindness has been diagnosed, there are several strategies that parents can adopt to help their children cope with and be in control of their environment," says Dutton.

While there is no cure for night blindness other than avoiding the dark, "recognition of the diagnosis and the simple expedient of giving the child control of lighting conditions can transform family life," says Dutton. Listen carefully to what your child is saying, and watch for the warning signs. Does your child consistently have difficulty adapting to darkness? Do they continuously suffer from a fear of the dark? Does their fear disappear once given a light? If so, talk to your pediatrician or ophthalmologist and find out if night blindness is the monster in your child's closet.

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• Talk about it!