Health Library

Bedtime and Sleep Problems

What Are the Most Common Sleep Problems in Young Children?

What Is Sleep-Onset Association Insomnia?

Sleep-onset association insomnia occurs when your child closely connects their ability to fall asleep with something in the setting (such as being held by a parent; being rocked to sleep; nursing, drinking or eating at bedtime; watching television; or even sleeping in a parent or sibling's bed). When this "something in the setting" is absent at bedtime or after night wakings, your child will struggle to fall asleep.

All of us wake up briefly a few times each night, but often we are not aware that we wake up because we fall back asleep very quickly. For children with sleep-onset association insomnia, when they wake up during the night, they are unable to fall back asleep if their "something in the setting" is not present.

If your child is only able to fall asleep with the help of a parent and has trouble returning to sleep on their own after waking during the night, it is likely possible that they have a sleep-onset association insomnia.

What Are Nighttime Eating or Drinking Problems?

Nighttime eating / drinking problems are more common among infants and toddlers and involve the need for "excessive" nighttime feeding (often nursing or bottle-feeding) for the child to fall asleep or return to sleep.

For infants, feeding during the night is a normal part of development. However, by the age of 5 or 6 months, most infants are not drinking more than 8 ounces of fluid during the night (or nursing more than once or twice).

What Are Limit-Setting Sleep Problems?

Limit-setting sleep problems are more common for children who are walking, understand basic instructions and can tell you what they want/need (typically after age 2). With limit-setting problems, children refuse or stall bedtime (like saying they need to go to the bathroom, to get a drink of water, one more hug, to tell you something, really important, etc.). They make it hard for the parent to leave their room without the child getting out of bed. Attempts to have the child return to bed may result in behavioral outbursts (like crying, screaming, destruction of property, or aggression).

How Can Bedtime Problems Be Treated?

The following steps can guide you in creating healthy sleep habits and helping your child learn to fall asleep on their own.

• A consistent sleep routine is helpful for treating and / or preventing the most common childhood sleep problems. Routines that combine relaxing pre-sleep activities and a setting free of over-stimulating or distracting activities are best for your child.
• Spending time with your child before bed each night is a critical part of the bedtime ritual. Do not replace personal time with television or videos. Positive parent-child interactions before bed help calm your child and help them feel comfortable with the transition to bed.
• For children with sleep-onset association insomnia, a bedtime routine that helps your child fall asleep by themselves is important. You can use the same routine anytime your child needs to sleep, including naps.
  1. Create a setting at bedtime that does not require a response from you. Some suggestions are to play music, put on a nightlight, or provide comfort items.
  2. Avoid having your child fall asleep in your arms or while you are rocking them. Place them in their own bed before they fall asleep.
  3. For the young child that is still napping, it may be easiest to start the process of learning to fall asleep independently at night.
  4. It is common for children to cry, whine, plead or argue at first during this process.
  5. You are not abandoning your child when you ignore mild distress for set periods. When you allow your child to have increasingly longer periods alone in bed followed by brief encouragement and reassurance, your child can learn to fall asleep without your presence.
  6. Place your awake or drowsy child in their bed after you have completed a calming and quiet bedtime routine.
  7. Say goodnight and leave the room. You may keep the door open to allow some dim light into the room or use a nightlight.
  8. If your child begins to cry and is still crying after a few minutes, return to the room and provide brief words of comfort or lightly touch them (placing your hand on their back or belly). Do not pick up your child, turn on the lights, or respond to requests (like another bedtime story). Do not stay in the room longer than one or two minutes. Repeat this process, extending the time that you give your child to fall asleep by themselves (for example, two minutes, then five minutes, then 10 minutes, then 15 minutes). Increase the time that you are out of the room in increments of five minutes to help your child slowly become more comfortable being alone in their bed.
  9. On the following nights, increase the amount of time that you allow your child to self-soothe. For example, on the second night, start at five minutes and on the third night, start at 10 minutes.
  10. The first few nights are going to be the hardest for you and your child as you learn this new routine. The time that you spend away from your child when they are upset can be very hard for you. However, it is important to keep in mind that you are teaching them a very important developmental skill (falling asleep by themselves).
• If you can use this approach consistently on consecutive nights, you are likely to see results in five to 10 days.
• If your child becomes sick or there is some other event that interferes with this process, you will likely have to start the process again.
• If you feel you have been consistent with this approach for two weeks and you are not seeing results, you should consider having your child evaluated for another underlying sleep disorder.
• For a child with nighttime feeding problems, it is important to gradually wean your child from this habit by reducing the number of nighttime feedings (that is, increase the time between feedings). It may help to set defined time intervals to offer your child their bottle (for example, every two hours) and slowly increase the time between feedings until you are no longer offering the bottle at night. If your child wakes up and signals hunger before the time you have set for feeding / drinking, reassure them, and give them an opportunity to fall back asleep without providing food / drink. (See above for guidelines on helping your child to self-soothe and fall asleep by themselves.)
• For a child with limit-setting problems at bedtime, it is important to have a consistent bedtime routine as well as very clearly defined behavioral limits for bedtime. Focus on having a relaxing pre-sleep ritual each night, but the transition to bed may require a more "no-nonsense" approach. A firm and consistent response to your child's delay at bedtime will prevent you from inadvertently reinforcing your child's "delay behaviors." Limit-setting during the day and night is important. You might find it useful to set up a reward system to encourage your child to go to bed and stay there all night.