Elementary

Sleep Training

By: Maya Powers, MD

Remember long, long ago how great it was to get a good, uninterrupted night’s rest? How clear and refreshed and energized we felt? So many of us unknowingly took that gift for granted until we had children…but now we know how good we once had it.

All joking aside, the importance of sleep, for kids and grown-ups, cannot possibly be overstated. Sleep is as important to good health as a balanced diet and exercise. Studies have shown that consistent, quality sleep leads to tons of benefits, including better growth, more balanced appetites, stronger immune systems, less injuries, increased attention span, and improved learning capabilities. In fact, not getting enough sleep can ultimately lead to high blood pressure, obesity, heart disease, and even depression.

So if your toddler is having a tough time falling asleep or staying asleep, this could affect their (not to mention your) overall health. Let’s look at some ways that sleep training could help you and your family get some much needed rest!

The basic definition of sleep training is the process of helping a child learn to fall asleep and stay asleep though the night. While sleep training is something that can be initiated as early as around 6 months of age, we will be talking here about sleep training for toddlers, or children ages 1-3 years of age. As you probably well know, those energetic, talkative, and strong-willed toddlers can create a special set of challenges as we try to teach them healthy sleep habits.

A couple of suggestions for when you decide to start sleep training:

  1. Don’t attempt sleep training during a stressful time for you (e.g., when you have a major deadline at work), in the midst of a major life event for the family (e.g., during a move, right before the birth of a new baby, when a family member is facing a serious illness), or right before a vacation.
  2. Don’t attempt to sleep train if you have concerns that your child might be getting sick or have a medical issue. If that is the case, please call us at Parkside and we will be happy to listen to your concerns and examine your child.
  3. Do pick a date and mark it on the calendar. Sleep training takes commitment, so be intentional about it.
  4. Do agree to mutually support your partner/spouse to follow through with sleep training as a team, even when the nights feel long and the task seems impossible.

So let’s get started, how do you begin?

The cornerstone of effective sleep training is a good bedtime routine. And to be effective, bedtimes need to be three things: consistent, positive, and forward-moving.

Bedtime routines should be consistent in that every single night looks pretty much the same: bedtime should start at the same time, include the same events, and those events should follow the same sequence. Toddlers need a total of 11 to 14 hours of sleep (including naps) per 24 hour period, so in general, most kids should be falling asleep between 7:30 and 8:30 every night.

Bedtime should also be positive and enjoyable and include things that the child comes to expect. For instance, a common bedtime routine starts with bath and brushing teeth, then proceeds to reading, prayers, and then right to bed. It is important that the last couple of activities occur where the child will be sleeping so that there are minimal distractions.

Bedtime routines should also be following a clear, forward trajectory. Toddlers tend to find lots of reasons to stray from the routine (“I’m thirsty!” “One more book!” “One more song!” “Can you stay for 5 more minutes?”), but it’s really important to keep bedtime moving toward sleep at the appropriate time. When your child attempts to distract during bedtime, just calmly but firmly redirect him/her back to the bedtime sequence. In general, you should spend less than 45 minutes from the start of the bedtime routine until lights out.

By implementing a bedtime routine, we are giving our children important skills to not only fall asleep on their own, but also to stay asleep through the night. As humans, we all have micro-awakenings through the night. When this happens, as adults we may wake briefly, realize it’s still nighttime, and then happily fall right back to sleep (or, at times, we may not be conscious of the awakening at all). However, if toddlers are routinely rocked or fed to sleep, they only know how to fall back asleep with those specific activities (being held, rocked, or fed) in place, and this is the reason they cry when they can’t get back to sleep on their own in the middle of the night. They associate falling asleep with those activities, and thus they simply haven’t learned to fall asleep without those activities. If you are invested in the sleep training process, be sure that you are not nursing or feeding your toddler to fall asleep at nap time or bed time. You can certainly cuddle and hold them before bed; simply put them in bed when they are drowsy but still awake. Additionally, be sure that they have no screen time (this includes TV, iPad, or iPhone time) for at least one hour before bed. The light from these devices emit light that can disrupt their sleep.

Sometimes despite the very best of intentions and a consistent bedtime routine, we still face challenges in getting our children to fall asleep and stay asleep. Below are a few additional methods that can help with sleep training…

1. “Bedtime Fading”: If your toddler often fights sleep for an extended period every night, consider temporarily starting the bedtime routine about 30-60 minutes later than usual. This will allow your child to be more tired/sleepy when you put them to bed, and thus he/she will hopefully fall asleep more easily. While this method can be very effective, it is important to keep morning awakening times consistent (i.e., don’t let your child sleep in the next morning) and also try to avoid late day naps in the car or stroller, both of which could derail your sleep training. Once your child is falling asleep within about 15 minutes of lights out, you can move bedtime up by 15 minutes every 2-3 days until you are back to the desired bedtime of 7:30-8:30.

2. “Cry it out”: Some children respond to the Ferber or “cry it out” form of sleep training. In this method, parents put the child to bed, and then when the child starts to call out or cry, parents simply pop their head into the room, lovingly but briefly reassure the child (“It’s time to sleep. I love you. I’ll see you in the morning.”), and leave the room without any physical contact. When the child begins to call out or cry again, the parents wait 5 minutes before returning to the room, repeat the same steps as above, and then leave. With each episode of crying, parents wait 5 minutes longer than before, then return to the room to reassure the child. While this may sound like a taxing and tiresome method for parents, it is effective and usually results in the child falling asleep on his/her own in about one week.

3. “Camping Out”: This method involves gradually moving further away from the child at bedtime as he/she learns to fall asleep without parental involvement. You might start out with the parent in a chair near the child’s bed as they fall asleep. There should be no talking or interacting. If the child seems anxious, simply reassure them with the same, simple but loving script (e.g., “I love you. It’s time to sleep. Good night.”). Every 3 days, the parent moves their chair a few feet closer to the door, until ultimately the parent/caretaker is sitting outside of the room in the hallway, still providing verbal reassurance only when necessary. While this method may take 1-2 weeks to complete, it has been scientifically proven to be effective.

4. “Excuse Me”: A method that is especially effective for children around the age of 3 who may be a bit anxious about falling asleep on their own. In it, as a parent, you complete the usual bedtime routine, tuck your toddler in bed reassuringly, and then excuse yourself to quickly perform some necessary activity (“I need to get something in the kitchen” or “I need to check on your brother” for example), leave the room, and then come back a few seconds later. When you return, be sure to praise your child (“you look so cozy and relaxed in bed” and “you did a great job of being brave and staying in bed!”), then excuse yourself again and return after a few seconds. Continue to repeat this pattern until your child falls asleep. On the first night, you may end up excusing yourself over 30 times, but it will improve. On the following nights, after excusing yourself, come back a little less often, perhaps every 30 seconds or so, and continue to gradually increase your time away every night until your toddler falls asleep on their own.

Want to learn more?

Here are a few more helpful websites…

  1. Dr. Canapari is a Sleep Medicine physician at Yale, read some of his thoughts here
  2. AAP Sleep Guidelines
  3. CDC Sleep Guidelines

Let me close by saying that, while sleep training may not be easy, it is well worth the effort. Remember that quality sleep for your child means quality sleep for you, and that will benefit the whole family. Be assured that sleep training, however exhausting and dramatic it may seem, causes no damage to children. As with many components of parenting (and life in general), we sometimes must make short term sacrifices to attain long term results. Sweet dreams, everyone!

Until next time,

Dr. Maya Powers

Parkside provider, Medical Director (Breast Feeding Center of Greenville), and Thai food fan for life

 

 

RELEVANT TAGS
  • Elementary
  • Toddler