Helping A Toddler Sleep Through The Night

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My 22-month old hasn’t slept through the night for a year. What should I do?@photos.com/BananaStock

DR. RUTHERFORD: There are a couple of things this parent might consider. One is, can she go without a nap?

MOLLY: This was submitted from a mother based in Utah who described that she has a great bedtime routine and her toddler goes to sleep at an appropriate time on her own without any trouble. But inexplicably her little girl “wakes for 2-4 hours every night just talking and playing in her crib. She takes a 1.5 hr nap during the day.” The mom continued to elaborate that she herself is “a light sleeper” so once she’s awoken, even though she doesn’t have to go in her daughter’s room, she can’t fall back asleep and she’s one “exhausted mom.”

DR. RUTHERFORD: I would count that hour and a half nap as part of her sleeping. So her daughter is actually sleeping more than the mom realizes. However it’s not a good pattern to be getting up for a couple of hours each night. Even though she’s entertaining herself, of course the mom is alert and she can’t sleep. The first thing I would do is try taking out the afternoon nap.

When you were 22 months, Molly, you were done napping, too, because you wouldn’t sleep at night. This parent should be prepared to go through a few weeks (or even more) of a difficult pre-dinner “witching hour” until her daughter gets used to not having an afternoon nap, and she may need to put her down for the night a littler earlier than she is used to.

MOLLY: Yes, I would agree that when you eliminate that last nap time for a pre-schooler you have to almost expect that 5 -7pm span of time to be winey and miserable for a while.

DR. RUTHERFORD: That’s what I would suggest this mom start with, and it may be all she needs to do the trick.

MOLLY: The other thing I was thinking that she could do is to get a baby monitor and use it in conjunction with ear plugs. Then she’ll still be able to hear when the child is in distress and making loud noises, but won’t wake up to the light sounds of her playing in the middle of the night. I’m a light sleeper, too, and this set-up worked really well for me.

She also may want to take most of the toys out of the crib so that there isn’t any entertainment available in the middle of the night. Of course don’t take the “lovey” or security blanket/favorite animal. All the sleep experts advise promoting better sleep habits at any age by designating the bed exclusively for sleep.

DR. RUTHERFORD: I would have suggested ear plugs, too, although some parents may not feel comfortable with that idea.

MOLLY: Another thing she might want to consider, maybe not right now but in a few months, is to transition the baby out of the crib and into a toddler bed.

We had the same problem with my little guy when he was two and he began to wake up randomly in the middle of the night. We moved him out of the crib and into a larger toddler bed and he started sleeping through the night again. I wondered if he was simply too big for the crib and would wake himself up when he touched one of the sides.

Fear of Spiders Is Keeping My Child Up At Night

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My toddler is afraid to sleep alone in her bed after seeing a spider.

DR. SUSAN RUTHERFORD: Let’s look at what’s going on here in order to solve the problem. A toddler had the traumatic, scary experience of seeing a spider and now she is afraid more spiders will come get her when she goes to sleep.

MOLLY: This question came to us from a mom in Boston, Massachusetts. She added that she has been “checking the bed, laying with her daughter, comforting her but nothing seems to be working.” And now her daughter doesn’t want to nap alone or go to her bed at night. Is there anything else the parents can do?

DR. RUTHERFORD: I think what she is doing so far is great! I would have done just the same things, so her instincts are right on there.

Her daughter, however, isn’t completely “settled” by her Mom’s actions. That tells us the child continues to hold on to a fair amount of anxiety from the initial event of seeing the spider. It’s important to keep working with her about this so that it doesn’t stay with her for too long a period of time.

MOLLY: Since this was so traumatic for the child, is there anything more the mom can do?

DR. RUTHERFORD: I would suggest that the mom continue her ‘routine’ of checking for spiders and also ask her daughter to take an active role in the ritual. This will help to empower the child. Because she sleeps alone, she needs some ways to be able soothe her own anxieties as she moves forward.

Additionally, mom could imbue one of her stuffed animals with a special power to watch over the girl at night and prevent spiders from coming into the room. If we remember that characters in the dreams of children usually take the form of animals, this strategy makes more sense.

Mom should ceremoniously gift powers to the stuffed animal while the child watches. Then, she can either post the stuffed animal somewhere on the side of the bed to stand guard, or snuggle it into the child’s arms and assure her that the stuffed animal will keep her safe all night long.

MOLLY: Do you think there are any possible long term implications for the child?

DR. RUTHERFORD: Unresolved anxiety has a way of growing and becoming generalized anxiety, which can take over someone’s life. At this point in development, the trick is to keep the child’s emotion focused on the spider rather than allowing it to generalize to all insects and then to other things in life that seem daunting and unfamiliar. In psychology we call this “generalization of the trauma,” meaning it can latch onto more than just spiders.

It’s best to deal with new anxieties based in traumatic events right away so that the originating event doesn’t get lost from memory while leaving unexplained fear behind. This mom is at least half-way there!

How To Help A 2-year Old With Sleep Issues

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My 2 year old child continues to wake up during the night crying, what can I do?

MOLLY: This question came from a reader in Boston.

Dr. Susan Rutherford (Molly’s Mom): First, of course, this mom would want to check on the obvious things in her child’s environment. Is the child overheating at night from too much heat in the room? Or, is it too cold in the room?

MOLLY: If she’s still using a night diaper, I’d think she’d want to check to see if the child was wet, too.

DR. RUTHERFORD: Yes, yes: is the diaper wet or dirty? Is there a noisy appliance disturbing the quiet? Is the child hungry when she wakes, or thirsty? Is she having acid reflux?

These things are all fixable and I wouldn’t be surprised if the parents have already gone through this checklist, though acid reflux or GERD in a toddler is harder to distinguish and treat. So, now we have to look at the psychological aspects and wonder why she is waking.

If the child is waking because she is frightened about being alone in the dark, a small night light can do wonders, along with saying something like, “Mommy (or Daddy) is in the other room, everybody’s here, there’s no problem, but you’re going to wake everyone else up with your crying. Go to sleep now and in the morning we’ll get together and have a big hug.” This gives the child something to look forward to in the morning.

If a kid is really shrieking every night and can’t be calmed quickly it can be a miserable time for both the parents and for the child. It’s obviously quite disruptive to an entire household. She might want to sit on the edge of the child’s bed and just sit with her for a few moments while she goes to sleep. This routine might take a few minutes to carry out but it might be worth it in the end.

MOLLY: It’s hard to know because you have to determine if it is a physical problem or is it an emotional issue. One thing that really helped me that you told me when I went through this with when my little guy was 18 months old was to straight up tell him, “You really need to sleep through the night and Mommy will be here for you in the morning.” You told me to talk to him as if he were an adult and tell him my expectation.

DR. RUTHERFORD: Absolutely. Children understand way more than parents give them credit for. I would say those things in a very soothing voice when he goes down for the night. Both the tone of voice and the words used are important.

MOLLY: I’m wondering if you think the mom should back up and do some formal sleep training?

DR. RUTHERFORD: She may have to do that. If it becomes a pattern then that might be a good solution.

MOLLY: We used a book called, The Sleepeasy Solution: The Exhausted Parent’s Guide to Getting Your Child to Sleep from Birth to Age 5.  I found really helpful to for sleep training. The book lays out a very precise schedule of the age of the child and how much sleep they need and when they should nap and when they should go down for the night. It also helps with a step-by-step strategy of how to do the actual training. I wasn’t comfortable with the hard core tactic of letting my kids cry for a long time but I also wanted to teach them how to soothe themselves back to sleep. I used it with both my kids and it only took 3 nights for each.  I never let them cry for more than 5 or 6 minutes, but even that short amount of time felt like an eternity!

DR. RUTHERFORD: She may want to try some other behavior modification tools in addition to or instead of a rigid sleep training protocol. She could make a sticker chart and each morning after the child has slept through the night she could get to place a sticker on the chart. For a two-year old, an instant reward, like a sticker or a cookie, can be a good motivator.

Another idea is to get a special stuffed animal for sleeping with and imbue it with powers to keep the bad dreams away.
Chronic interrupted sleep leads to sleep deprivation and can negatively affect growth, mental development, and emotional well-being in children. This mom wants to set her child up for a lifetime of beneficial sleep patterns, and that can start now.

Experience this? Comment below if you’ve had success dealing with sleep issues with your toddler using other strategies. Or Contact US if you have other parenting questions you’d like to see addressed.