Friday, July 6, 2012

Help! My baby/toddler won't stay asleep!

This is a common topic that we address with parents -- probably because sleep issues are common AND distressing to parents, who are sometimes at a loss when it comes to solving the issues surrounding sleep and nighttime for young children.

Waking during the night is normal at 3-6 months old, and 30% of babies are "signalers" who cry and expect a parental response to their crying.  By 8-9 months old, 60-70% of infants can self-soothe when they wake at night, giving them the ability to put themselves back to sleep.  20-30% of toddlers are night wakers.  When problems are not addressed at this age (and self-soothing behaviors taught), sleep problems will continue for many children -- into early elementary school.

The goal when approaching any sleep issues is to help your infant/todder or child be able to fall asleep on their own without "props" or excessive parental strategies.  All children need a bedtime routine, and this can be started and maintained from a young age.  It is important to be consistent at bedtime - doing the same things every night, putting children to bed at the same time every night.  We often refer to the "bedtime routine" and this is family specific - it may include a bath, bottle or feeding for young infants, cuddling, story time or soft music.  It is very important to put your child to bed while sleepy BUT not completely asleep.  I repeat: sleepy but NOT asleep.  This is important.  Do not let your baby or child fall asleep somewhere else and move them.  Learning to fall asleep on their own is the most important skill your child needs to acquire.

Dr. Charles Zeanah, a professor of Pediatrics and Psychiatry at Tulane University, recently spoke at a pediatric meeting and outlined his approach which he called a "hardball strategy": Leave your child in the bed at bedtime.  If they continue to cry, go in the room after 5 minutes, soothe the child by using words or gentle touch, but do not get them out of the bed.  Leave again -- and repeat at 5 minute intervals if the child keeps crying.  As your child adapts, these intervals can gradually be lengthened -- 10 min., then 15 min, etc.  In my practice, this "crying it out" strategy takes 5-7 days to work.  As a parent, you have to be "all in" and invested in this strategy and follow it to the letter for it to work.  It is also very important that both parents (or caregivers) be consistent in the approach. 

A more gentle strategy is to respond to the crying but to sit next to the child's bed soothing them - but again, not getting them out of the bed.  You can sit next to the bed until your child falls asleep.  The next night, sit farther away and gradually move farther away each night -- letting your child see you is important in alleviating some fear.  I know personally that this strategy works - especially for toddlers who can either get out of the bed (and love to come to their parent's bed - if they can get away with it) or who continue to call out/cry/cajole for parents to come back in the room.  My husband and I tried this approach when my daughter was 2 years old and bedtime avoidant.  I tried to be as boring as possible in the 5-10 minutes I stayed in her room - I didn't engage with her, and spent the time lying on the floor reading.  Eventually, she gave up needing us in her room in order to fall asleep.

Remember -- your goal is to help your child fall asleep without you :)

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