To Sleep or Not to Sleep: That is the (Nightly) Question by Susan Kassler-Taub, MSW, LCSW

To Sleep or Not to Sleep: That is the (Nightly) Question

by Susan Kassler-Taub, MSW, LCSW

Recently, an exhausted, tearful, and completely frustrated mother walked into my office desperately asking for help in getting her pre-school aged child to sleep through the night.  This adorable young boy had slept through the night for only short bursts in his lifetime, and the wear and tear on his mother (and him!) was obvious. I have met many such parents and children in my years of practice, some like this boy who had never slept through the night well, and others, who had normally slept well, but a recent developmental or life event – a bad cold, a parent’s absence, the arrival of a new sibling – had resulted in a disruption of the child’s sleep pattern.

There are many books available to parents to help them solve the sleep dilemma, many of which are well-written and quite useful. Simply put, these books run the continuum between having the child “cry it out” to having the child sleep in the parents’ bed every night. Some families tell me that they feel it is too traumatic for both the parents and their children to let their young child cry alone for multiple nights, while for other families, the creation of a “family bed” leads to poor quality sleep for the parents as well as the child.

With an understanding of where your child is developmentally, and a concrete plan of action, it is possible for children – and their parents! – to get a good night’s sleep. This can be accomplished without a lot of crying (by either the child or the parents…) and with the child sleeping through the night alone in their own bed.

Here is the first key parents need to recognize if they want to reach this goal: Most young children who do not sleep through the night alone also do not initially fall asleep alone. This basic premise is the starting point for changing your child’s sleep pattern.

If your young child falls asleep in your arms, or with you lying with them in their bed, or they in your bed, when your child later experiences the normal ups and downs of the nightly sleep cycle, they will expect – yes demand - to find you next to them. Sensing your absence leads them to awaken further, and the result is that fearful and feared loud insistent cry in the night for a parent to come to them and soothe them back to sleep – only to be repeated a few hours (or what can feel like a few minutes) later.

If you want your child to sleep through the night without you, they must learn to soothe themselves to sleep at the beginning of the night. Once they can do this, they will have the ability to soothe themselves from lighter to deeper stages of sleep all through the night. If it is your job to soothe them to sleep then they have no alternative but to call for you through the night. Falling asleep needs to become your child’s job – not yours.

In previous posts I’ve stressed the importance of predictability and consistency when working towards any behavior change with your young child. To learn more, please read my March 19, 2010 post entitled “Routine, Routine, Routine” https://princetonol.com/family/polBlogs.cfm?doctype_Code=FAMLIF%20BLOG2&doc_id=1803. Predictability and consistency are in fact of greatest importance at bedtime, as this is when the young child has truly “used up all their good” and is, behaviorally at least, “running on fumes”.

When trying to alter your child’s sleep pattern pay attention to your timing. There are two timing factors at work here: where your child is developmentally, and what else is going on in your child’s life. If your pre-schooler has recently achieved a new developmental milestone, as in starting to speak in multiple word sentences or mastering toilet training, or if your child has begun a phase of separation anxiety or new fears (monsters, dogs, mustaches etc.) then it is not the right time to ask them to make major changes in their sleep pattern. The same is true if there have recently been changes in your child’s or your family’s life, such as starting nursery school or day care, a parent returning to work, or most significantly, the arrival of a new sibling. It is not unusual for me to meet with a parent of a 2 or 2 ½ year old who slept well through the night until the arrival of a new sibling, at which time the parent thought it was a good opportunity to move the child from their crib to a toddler bed, resulting in many sleepless nights for both child and parent.

One of the first questions I ask parents whose child is not sleeping through the night is if the child has developed an attachment to a transitional object or “lovey”. In the majority of cases, the answer is no. For so many reasons, it is quite helpful for a child to have a “lovey” they can count on when “the going gets rough”. For the young child, this “lovey” enables your child to “transition” from being with you, to being without you. I have seen the widest variety of “loveys” appear in my office through the years, from pacifiers, and “blankies”, to stuffed animals, and once a yellow plastic screwdriver. Simply put, it doesn’t matter what the transitional object is, as long as it is easily available, and provides comfort to the child when the parent isn’t there. Even as late as the pre-school years, if you child has not chosen a “lovey” you can attempt to introduce one – often at this age the best choice is a stuffed animal - by consistently holding the object next to you and the child whenever you are having quiet time with your child; cuddling, reading, and as part of the bedtime routine. In fact, you can and should take full advantage of your pre-school aged child’s vivid and active imagination by anthropomorphizing the transitional object towards the desired goal of independent sleep, as we will see below.

The physical surroundings in which your child sleeps are important in encouraging good sleep habits. Our goal is for your child to sleep through the night in their own room, and small changes in the environment of the room can be quite helpful. At bedtime, your child’s room should be tidy, with toys, dolls and books put away, not littered about as an enticement to get out of bed and continue to play. Curtains should be black-out dark, so you can control the amount of light in your child’s room. Most pre-schoolers do best with a limited amount of light, and a light that will cast few shadows. Many parents have sat with a young child after the child has imagined that the shadows they see have turned into scary monsters of all shapes and sizes. Placing a small lamp, with a 25-watt bulb, across the room from your child’s bed often provides the right balance between light and stimulation. Once your child is in their room beginning the bedtime routine, older children and adults should work on keeping the noise from their activities to a minimum, so that the child doesn’t feel as if they are missing out on fun time with their siblings or parents. As the saying in my house goes “You wake her, you play with her.”

Scheduling is of utmost importance – the bedtime routine needs to begin before the child is getting tired or worse yet, over-tired. As one child famously said to me, “I am not over-tired, I am over-awake!” Keeping in mind the pre-schooler’s love of routine, a set time each night to begin the wind-down and bedtime routine is imperative, and in this area, earlier is better than later. I understand that for many families, the busy schedules of the adults and older children can delay the bedtime of pre-schoolers past a time that is optimal, but this often results in that “over-awake” child. Do try to keep to an early and consistent bedtime for your pre-schooler – it will be well worth the juggling of schedules.

Avoid the scenario in which just before bedtime Uncle Bill decides it is time to start rough-housing with your pre-schooler. It is best if all active and stimulating activities end at least 15 minutes before the bedtime routine begins – that means all rough-housing, video games, computer games, exciting TV or movies should be concluded, and quiet activities, such as doll play, quiet singing, books, or simple arts and crafts should replace them.

Pay very close attention to keeping the bedtime routine consistent. Put together a “script” for the nightly routine of what will happen, when, and in what order, and keep to it religiously, and be certain that sitters or other care givers follow suit.

Find the bedtime routine that works best for you, and then absolutely stick to it. If you and your child prefer to brush teeth before bath or after bath, it truly doesn’t matter, as long as it is the same every night. Generally speaking, with your pre-schooler, a routine of brushing teeth, taking a bath, putting on pajamas, and then going into their own room for quiet singing or stories is best. Once your child is in his or her pajamas, they should not leave their room.  If you want your child to sleep all night in his or her own room, then the bedtime routine needs to happen in their  room. This accomplishes two goals – it sets an association for your child between sleep and their bedroom, and it avoids the unrewarding task of trying to cajole the child back into their bedroom after you’ve completed the bedtime routine.

Parents complain to me that their child will ask for yet one more story, or one more song, and then keep asking. By setting a routine ahead that your child can count on, for instance two stories and one song, you can take advantage of the child’s innate desire for consistency. Make certain your child’s transitional object or “lovey” is actively involved in the bedtime routine. Here is where the anthropomorphizing of the transitional object can be quite useful. For instance, if the transitional object is a stuffed bear named Max, then Max will also brush his teeth, put on his pajamas, listen to the song, and listen along to the book being read. Please take every opportunity to involve Max in the routine, talking with your child and Max as a pair together. Make it clear to your child that both he and Max are getting ready for bed, both he and Max need a good night’s sleep, and most importantly that Max will be with the child all night long. At the end of the bedtime routine, after the final story is read and the final song is sung, both your child and Max get a big hug and kiss goodnight, and your child and Max settle down together for a night of sleep.

If your child has become accustomed to you being with them when they fall asleep, I find that once the bedtime routine is concluded, a plan of gradually moving you out of your child’s room over a series of a nights will be successful. You should not start in your child’s bed – remember, it is Max that is sleeping next to your child, not you. Try starting by sitting in the child’s doorway for a few nights until the child is asleep and then gradually over the next nights moving out into the hallway in full view, and then in partial view, and finally no longer needing to wait until your child has fallen asleep.

For many children, using relaxation response/guided imagery type meditation as part of the nighttime routine has great benefit. There are many CDs and MP3 downloads available which will guide your child through the relaxation response process while telling a story that is developmentally appropriate and interesting for your pre-schooler. As a precaution, please do not use headphones for your child at bedtime.

You and your child can listen to the relaxation response together as part of the nightly routine, as the last thing after songs and stories. Follow along yourself to the meditation, and you too can benefit from the relaxation response! Or, you can play the CD or download after you have left your child’s room. Keep in mind that if you play the relaxation response after you have left the room, and your child falls asleep with the relaxation response CD or download playing, then that experience becomes associated with falling asleep, just as falling asleep with you in their bed or room then becomes associated with falling asleep. For many children, if they fall asleep with the relaxation response CD or download playing, they will need to have it on to fall back asleep during a lighter part of the sleep cycle during the night. They will therefore require it be playing on a continuous loop all night; for children who do not share a bedroom with siblings, this can work just fine.

For most children, if you consistently follow these suggestions, a greatly improved sleep pattern will follow. Over my years of practice, I have seem some young children, usually those who have had years of poor sleep pattern, combined with a more willful temperament, who might require a “ramping up” of the protocol. If that describes your child, don’t fear – there are “more rabbits we can pull out of our hat”. For these children, adding a behavioral reinforcement program to the transitional object and bedtime routine can be successful.

Remember, when using behavioral reinforcement with your pre-schooler to improve sleep, the basic rules apply. Rule #1: The target behavior must be singular and clearly defined. In this case sleeping through the night, in their own bed, without a parent. Rule #2: The reinforcer must be of high value to the recipient. If you offer a reinforcer that the child doesn’t like, it won’t reinforce the behavior. Rule #3: The reinforcer must be presented as close in time to the accomplishment of the target behavior as possible. In this instance, that means if the child has followed the plan, the reinforcer is given to the child as soon as they wake up in the morning. Yes, this is one of those times you can have chocolate before breakfast.

You can make a basic behavioral reinforcement chart on your own – no need to purchase anything. Your pre-schooler, as with all children, will feel more ownership of the process if you engage him or her in the task of decorating the reinforcement chart with you. Making a simple chart with the days of the week – one week presented at a time – with a box in which to place a sticker to indicate success in the target behavior is all that is needed. Explain clearly to your child what the target behavior is: The child (and Max) need to stay in their bed all night, without a parent. When choosing a reinforcer, one of two options work well. You can discuss the reinforcer with your child, letting them choose a small item or small food or candy as the reinforcer. This is one of those times in parenting that offering small quantities of candy or chocolate can be very valuable. Alternately, you can capitalize on the child’s love of wrapped gifts, and purchase a number different small items, wrapping each separately. Unwrapping presents is so exciting to pre-schoolers! Place the wrapped items in a large clear container, and tell your child that when they stay in their room all through the night, with Max, then the first thing in the morning they will be able to reach into the container and choose the wrapped surprise they would like. Regardless of the reinforcer you choose, remember that it is of primary importance that your child receive the reinforcer immediately in the morning. If you delay giving your child the reinforcer, you lower its value, and lessen the chance the behavior you want will reappear.

If your child needs yet more assistance to sleep through the night alone in their room (with Max, of course), you can place the reinforcement chart where your child can see it from their bed, as a reminder during the night. Another tactic to help your child remember to stay in their room is for you and your child to draw together a visual representation of the reinforcer – such as a large drawing of a lollipop if that is what the child will receive in the morning – and place it just past the child’s bed on the floor, or near the doorway.

For all of us, adults and children, a restful and full night’s sleep is a key factor in regulation of mood, attention, and energy throughout the day. If you give your child the tools they need to self-soothe, put together a “script” that works for you and your child, and consistently stick to your plan, your can help your pre-schooler successfully and independently sleep through the night.

Susan Kassler-Taub, MSW, LCSW 
Psychotherapy: children, adults, couples 
330 North Harrison Street - Suite 6 
Princeton, NJ 08540 
609-921-1994 

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