Pediatric Sleep Topics
Bedtime Problems
By: April Wazeka, M.D. March 2011
Bedtime Problems
Sleep problems are very common in children. Getting a child to go to bed is a frequent problem that many parents experience and will discuss with their pediatrician. Some children use stalling and excuses to resist going to bed, whereas others go to bed initially but do not stay there. Bedtime problems can be one of the most frustrating parts of a parent’s day. Bedtime problems can occur at any age, but are most prevalent between 3 and 6 years of age.
First of all, it is important for parents to realize that they cannot “make” a child go to sleep. However, they can help their child improve his/her bedtime behavior and help them to get to sleep more easily and quickly.
Some good tips for parents:
- Stick to firm bedtime limits. The first step is for parents to be convinced that their child needs to change his/her bedtime behavior, and that setting and sticking to firm bedtime limits is in everyone’s best interest. Setting limits is an important part of parenting, and it is helpful to emphasize that children benefit from the structure of limits that parents set for them. This helps them to learn self-control. In addition, limits relieve anxiety in children. Prepare them that it may be hard work. Changing behavior is always difficult; reinforce that they need to be consistent and persistent.
- Explain the new rules to the child. Before they start the new nighttime program, they should sit down with their child during the day and let him/her know what they expect, without making the conversation too long or involved and avoiding overexplaining. They should try to ignore any negative comments by the child and avoid arguing about the new rules.
- Set bedtime. Once parents have decided on their child’s bedtime, they should be consistent about it, and establish a regular bedtime to help set their child’s internal clock. They should be sure that their child is ready for sleep before putting him/her to bed. This may seem obvious, but sometimes parents set a bedtime for their own convenience. For example, some children’s biological clocks make them more likely to be “night owls.” These children may have difficulty with an earlier bedtime.
- Bedtime fading. Putting children to bed when they are not tired increases the likelihood of bedtime struggles. Therefore, for some children it is best to start by setting the bedtime at the time they usually fall asleep and gradually make the bedtime earlier. When they start, parents will first need to determine when their child is naturally falling asleep and set this as his/her temporary bedtime. For example, if they would like their child to go to bed at 8:30p.m., but he/she usually does not fall asleep until 10:30p.m., choose 10:30p.m. as his temporary bedtime. This will make it easier to teach the child how to fall asleep within a short time of getting into bed. Once he/she is falling asleep easily and quickly at his temporary bedtime, then parents can start making his/her bedtime earlier by 15 minutes every few days. They should be counseled to be patient. If they move the bedtime back too quickly, they may have problems with their child not being able to fall asleep.
- Bedtime routine. Parents should be counseled to establish a consistent bedtime routine. A bedtime routine should include calm and enjoyable activities, such as a bath and bedtime stories. They should avoid stimulating high-energy activities, such as playing outside, running around, or watching exciting television shows or videos. They can make a chart of the bedtime routine to help keep the child on track. Also, having the last part of the bedtime routine be a favorite activity will help motivate the child to get ready for bed.
- Ignore complaints or protests. Ignore the child’s complaints or protests about bedtime, such as not being tired. Discussing or arguing about bedtime will lead to a struggle with the child, thus maintaining bedtime problems. They should firmly and calmly let the child know it is time for bed and continue with the routine.
- Putting the child to bed. When the bedtime routine is complete, they should put the child to bed and leave the room. It is important that they leave the room while the child is awake, as this helps the child learn to fall asleep on his/her own.
- If the child cries or yells. If the child is yelling or calling out to the parents but remaining in his/her own bed, remind them one time that it is bedtime. If they continue to be upset, parents can check on their child. For some children, checking frequently is effective; for others, checking infrequently works best. They can continue returning to check on their child as long as he/she is crying or upset. The visits should be brief (1 minute) and boring. They should not soothe or comfort their child during these visits and avoid getting into a discussion. It works best to calmly tell the child that it’s time to go to sleep. The purpose of returning to the room is to reassure the child that the parent is still present and to reassure the parent that their child is okay.
- What to do if the child gets out of bed or comes out of their room. If the child gets out of bed or comes out of his/her room, they should firmly and calmly return him/her to bed. For some children, simply returning them to bed multiple times works. For others, letting them know that if they get up again the parent will close the bedroom door can be effective. If their child gets out of bed, they should put him/her back in bed and close the door for a brief period (1 minute to start). After the allotted time, they can open the door. If the child is in bed, they should praise him/her and leave the door open. If they are up, they should be put back in bed and the door closed again, but left closed for a longer time, increasing the time by a few minutes each time they gets up.
- Don’t lock the child in their room. Locking the door may be scary for the child. The goal is to teach the child to stay in bed, not to punish or scare.
- Reward the child. Soon after the child awakens in the morning, they can be rewarded for what they did well the night before. Don’t dwell on misbehavior from the previous night. Give attention to the child’s successes. Stickers, praise, and breakfast treats are good ways to reward the child for even small improvements.
- Be consistent and don’t give up. The first few nights are likely to be very challenging. The parents should start to see major improvements within the first few weeks.
