Behavioral Treatment of Bedtime Problems in Young Children

Quick Facts

Healthy sleep is important for a child's growth and development. Bedtime resistance and night wakings are common problems in young children. They occur in about 20 to 30 percent of infants, toddlers and preschool children. Behavioral strategies can treat these problems in young children who are under 5 years of age.

Key Points

• Disrupted sleep and insufficient sleep can have a negative effect on a child's health and well-being.
• Untreated sleep problems in early childhood can persist as children get older.
• Bedtime problems and night wakings can frustrate parents and disrupt family routines.
• Behavioral treatment can help children sleep better, which also can improve parents' well-being.

How Can I Learn More?

• Talk to your board-certified sleep medicine physician.
• Ask your care team for patient resources.

Is My Child at Risk

Bedtime resistance is more common when parents or caregivers fail to enforce consistent bedtime limits. Night wakings are normal and common in children. These awakenings can become a problem when the child depends on a parent's help to return to sleep.

General Overview

Bedtime resistance occurs when children stall or refuse to go to bed. These behaviors test the limits established by parents. When parents enforce consistent bedtime limits, children tend to fall asleep quickly. Bedtime resistance in children can include:

• Verbal protests - Getting out of bed
• Crying - Attention-getting
• Clinging behaviors

Infants are not expected to sleep through the night with regularity until they are 3 to 6 months of age. As children become toddlers, night wakings remain a common and normal part of sleep. Problems can arise

when children are unable to return to sleep without help from a parent or caregiver.

Sleep problems that first appear in infancy may persist as the child grows older. Sleep problems can affect a child's learning, mood, attention, behavior and health. A child's sleep problems also can cause stress for parents, caregivers and siblings.

Ongoing sleep problems may be a sign of a sleep disorder. Behavioral treatment of bedtime problems can have positive effects on how the child acts during the day. Treatment also can improve the well-being of parents or caregivers.

Treatments

The goal of treatment is to help children learn how to fall asleep and return to sleep on their own. Research supports using these methods for children under 5 years of age:

• Unmodified extinction and extinction of undesired behavior with parental presence: The parent puts the child to bed at a regular bedtime.

The parent then ignores the child's protests and crying until morning, unless there are concerns about the child's safety or an illness. Extinction with parental presence allows the parent to remain in the child's room during the process.

• Parent education and prevention: The parent learns how to help his or her child develop positive sleep habits. This method includes information on bedtime routines and sleep schedules.
• Graduated extinction of undesired behavior: Parents ignore bedtime crying for a set period of time. The parent then returns to the room and briefly checks on the child. The parent leaves the room and repeats the process.

Tips

• Create a calm, soothing sleep environment in your child's bedroom.
• Set a consistent bedtime for your child.
• Develop a relaxing bedtime routine to help your child get ready for bed.
• Positive bedtime routines: The parent develops a regular routine to get the child ready for bed each night.

This method usually is combined with another treatment.

• Delayed bedtime with removal from bed: The parent delays the child's bedtime until the time when the child normally falls asleep. The parent gradually moves the bedtime earlier as the child gets used to falling asleep quickly. The parent also removes the child from bed for a set period of time if the child is unable to fall asleep.
• Scheduled awakenings: The parent keeps track of when the child normally wakes up during the night.

Then the parent begins to wake the child prior to those times. The parent provides the usual response, such as feeding or rocking. Then the parent returns the child to bed. Over time the parent gradually stops the scheduled awakenings.

• Don't let your child drink sodas that have caffeine.
• Keep the TV and other electronic devices out of your child's bedroom.
• Turn off the TV, computer, video games and handheld devices at least 1 hour before bedtime.

Next Steps

• Help your child develop healthy sleep habits.
• Talk to your child's doctor about any ongoing sleep problems.
• Your child's doctor may refer you to a sleep doctor for help.
• The sleep doctor may schedule your child for a sleep study if your child has symptoms of a sleep disorder.