I'm Dr. Lisa Meltzer, a licensed clinical psychologist and board certified behavioral sleep specialist at National Jewish Health.
And today we're going to talk about bedtime problems and night wakings in young children.
The most common problem we see in young children are bedtime problems and night wakings.
And as a disorder, this is called behavioral insomnia of childhood.
And there's two different types, sleep onset association type and limit setting type.
So sleep onset association type is what we see mostly in infants.
And this is a complaint of multiple night wakings, so babies who wake up every hour, every hour and a half, all night long.
This is not necessarily an issue of the child waking up, it's an issue of how they fall asleep.
And a sleep onset association is something that we use to help us fall asleep, and everybody has one.
And in young children we see, you know, a lovey, a pacifier, thumb sucking, those are all positive sleep associations because children can do those for themselves to help them fall asleep at bedtime.
A negative sleep association is something that involves a parent. So rocking the child to sleep, nursing them to sleep, putting them in the car and driving them around, all of those things are okay at bedtime.
But what happens during the night is at the end of every sleep cycle, we wake up. Everyone does it four to six times a night. So every time your baby is waking up during the night, that's normal.
The issue is that they can't then put themselves back to sleep if they need you or that association of being nursed, rocked, driven in the car, whatever it is to go back to sleep.
And so that can become very problematic in changing it. The other type of sleep disorder is limit setting or combined type.
And a limit setting type is what we see typically in toddlers and preschoolers.
And this is the bedtime stalling and the bedtime refusal, no, no, no, I don't want to go to bed, please just one more drink, please one more trip to the potty, one more story.
And this can go on for two hours.
And once a child finally falls asleep, they sleep fine.
But the issue is this prolonged bedtime that makes everyone in the family very tired.
It all starts with bedtime.
The first is having a very consistent bedtime schedule and bedtime routine.
Putting infants down in their cribs drowsy but still awake is the first step to helping them fall asleep.
Then you can do what we would call a progressive checking method.
So for some families that means you put the infant into the bed, you kiss them good night, you leave, and then you come back and you check on them as often as you want.
Every 30 seconds, every 45 seconds.
But the goal is that the child learns to fall asleep independently.
In terms of the limit setting type, it is important parents have to be consistent and they have to say no, they have to set limits.
And some quick and dirty tricks to help with that is to have a bedtime chart.
And this is a picture chart with a picture of a bath, a book, the pajamas, not necessarily in that order.
So it's a bedtime chart that has a picture of a bath, the pajamas, one book, two books, a drink of water, and the bed.
And you check it off each one as you go along. And when you're done, that's it.
And when the child says one more book, you say, I'm sorry, honey, the chart says no more books tonight.
And then it becomes the chart's fault and not the parent's fault.
Another thing at bedtime when children complain of bedtime fears is to use monster spray, which is a water bottle the child can spray around the room to keep monsters away the same way that bug spray keeps bugs away.
And that gives the child control over their environment. And the last trick that you can use with some of your older toddlers and preschoolers is the sleep fairy, who is a good friend of the tooth fairy.
And she comes at night after you fall asleep and leaves something like a sticker under your pillow.
And the sleep fairy comes every night for two weeks.
And this helps a child learn that they're going to fall asleep in their bed.
And then we don't know when the sleep fairy is going to come because she has a lot of families to visit.
And this keeps the child guessing so that they dive into bed and try to go to sleep because maybe tonight the sleep fairy is going to leave them a prize.