Routine, Routine, Routine
As your child grows from infancy to toddlerhood, sleep environment and sleep routines gain increasing importance. Toddlers and school aged children depend on routine. In addition, these routines have the added benefit of helping them learn independence through repetition.
When establishing a bedtime routine, make sure that it is easy, enforceable and perhaps even portable (meaning it can be used on vacation and at grandma’s house as well as at home). The American Academy of Pediatrics recommended a “4 B’s” approach—bath, brush, book, bed. This routine emphasizes a brief bath or shower, brushing hair and teeth, then a short book shared before lights out. Add in a ‘b’ for bathroom break for the older child, and you have a routine. Anyone who has negotiated ‘one more story’ or ‘one more drink’ might also include a ‘B’ for brevity. A routine should encompass 30 minutes at most. Set up a shelf of short ‘bedtime only’ books, have fixed choices of stuffed animals for sleeping companions, and most importantly, be consistent and do not negotiate.
As with teens and older children, limit toddler and preschooler screen time before bedtime. Even if your child is sitting quietly on the couch with the teddy bear while watching that 30 minute program, the brain activity and eye movements while watching television or other screens cue the body to ‘stay awake’ rather than calm it down. The same is true for other forms of electronic media. We recommend no screen time within 1 hour of bedtime. And no screens should be allowed in children’s bedrooms.
Cool, calm and quiet are good rules for a sleeping environment. However, work with your child to ensure a comfortable and safe sleeping environment. Allow some input such as ‘’nightlight on or off?” “door shut or cracked?” “teddy or dolly?”. Allowing your child some autonomy both makes him feel a bit more ‘in charge’ plus fosters the idea that he has the tools he needs to sleep comfortably through the night. If at all possible, have your child nap and sleep in the same place. This ensures she associates ‘her’ bed as comfortable and the place to rest.
Reassure your child at night, but resist lying down with your child, or even staying in the room until he or she is completely asleep. The goal is to enable your child to get to sleep peacefully on his or her own, both at the beginning of the night and should they wake. Your presence as they fall asleep initially may mean it is harder to get back to sleep alone later in the night. Let your child know that you are nearby, and that you will check back with them later on that evening.
Remember to pause when you hear the call from your child’s room. You do not necessarily need to return to your child’s room every time he calls out. Call back that you are there and remind him it is time to go to sleep. If you do respond by checking in on her, remember the ‘brief and boring’ rule you practiced when she was an infant.
If your little darling decides that he or she must check on YOU after being put to bed, calmly place the child back into bed, with as few words and little emotion as possible. Do the same if he or she returns out of the room again. Be consistent, be firm (but not stern) and calm. Your message should be clear ‘’It is now bedtime.’’ If very young children continue to come out of the room, you may consider installing in the doorway a baby gate that is tall enough to prevent climbing over. This will enable your child to hear and see you, but keeps the child safely in his or her room. We don’t recommend closing and locking your child’s bedroom door from the outside. This can increase feelings of anxiety and abandonment, which in turn hurt your efforts, and created bad associations between your child and his bedroom. In the same vain, we do not recommend using your child’s bedroom as a timeout location during the day. Keep the bedroom as a safe and calming space, a sanctuary if you will.
Bad dreams and nightmares are often common in the second half of the night for children three years old or older. These may happen more often if your child has been particularly active or busy, or if routine is disrupted (late to bed or skipped a nap, for instance). If you wake to your child crying out, try to comfort and reassure them. Remember, children may cry out in the night without being fully awake. This may make it appear that your child is ‘disoriented’ and unaware of you or the surroundings. This is often more frightening for parents than children. Stay calm and stay nearby your child, but allow him or her to wake on their own. If your child wakes with bad dreams with increasing regularity or severity, contact our office for other ideas on how to help.
If your child expresses fears or concerns over going to bed or over a bad dream, be reassuring but empowering. Often it is difficult to convince a preschooler who has been pretending all day about princesses and knights, that there is, in fact, no monster in the closet. Imagination makes things quite real to children. Instead, reassure your child that he or she has all the tools they need to sleep safely and quietly at night; mom or dad nearby, a favorite stuffed animal, cozy blanket or nightlight. Express your confidence in your child: “You are safe and you are loved and you will sleep well’’ is a good message to deliver.
In recent years melatonin supplements have come into vogue. Melatonin is not safe for all ages. If you have tried all of the above without success and want to discuss if melatonin is appropriate for your child, please call our office.
With your patience, with routine and reinforcement, you will enable your child to get to sleep easily, sleep peacefully through the night and awaken ready for another day of fun with you! Please call our office for more guidance, if needed. Sweet dreams!