BEDTIME: GUIDELINES FOR PARENTS
By Rebecca L. Mandai, PhD
The Hammond Learning Center
Ultimately, all parents want their children to succeed with the bedtime process. It not only directly influences the quality of their own sleep, but also how children feel and function during the day.
In an ideal bedtime scenario, children independently or in response to the parent"s first prompt happily perform their bedtime routine, including undressing, washing up, and brushing teeth. After a story is read to them and the light is turned off, they fall asleep quickly and sleep through the night. If they wake up in the middle of the night, they put themselves back to sleep without interrupting other family members" sleep.
In reality, though, bedtime can be a struggle between parents and children. While some bedtime hassles reflect significant problems, usually parents can achieve something close to the ideal scenario with a few simple strategies.
Typical and Atypical Sleep Problems
Developmental: Almost all children go through a period of sleep problems, and some may persist over time. Child sleep difficulties (and parents" lack of sleep!) are the most frequent parent complaints to their primary care physician during a child"s first two years of life.
Toddlers" resistance to sleeping may be due to separation anxiety. This is a normal developmental stage characterized by a child"s fear that something will happen to their parents while separated or that their parents will not return.
Early school-age children typically experience bedtime-related fears such as monsters, the dark, or having a bad dream. Common sleep problems at this age include bedtime resistance and delay of sleep, morning wake-up problems, complaints of being tired, and waking in the middle of the night. Resisting bedtime in these children is often related to inconsistent bedtime, falling asleep away from their bed, and the amount of parent presence and involvement in the bedtime and sleep process. Less sleep at night is strongly associated with behavioral problems in children.
Adolescents have different problems, and insufficient sleep and difficulty falling asleep are primary sleep difficulties. This is associated with more signs of anxiety, depression, inattentiveness, and behavior problems than for those with no or only occasional sleep problems.
Serious sleep problems. While most problems with bedtime and sleep reflect developmentally normal challenges, parents should be alert to signs of less common but significant sleep disorders that may require professional intervention.
Primary insomnia, the difficulty in falling asleep or staying asleep, and primary hypersomnia, excessive sleepiness, are the most common sleep disorders that are both highly related to inadequate sleep schedules or poor sleep habits. They cause significant difficulties in social situations, at school, and at work and are not the result of other factors such as another sleep disorder, a mental disorder, medication, or health problems.
Less common sleep disorders include nightmares, sleep terrors, and sleepwalking. About 10-50% of children age 3-10 have nightmares, with most peaking around age 10 and decreasing in number over time.
Another sleep problem known as sleep terrors occurs when children wake up within two hours of sleep very upset, with piercing screams or cries, and often confused and unresponsive to parent attempts to soothe them. This is most common in ages 4-12 and tends to be related to genetic factors and difficulty awakening.
Approximately 1-6% of children experience chronic sleepwalking, with up to 15% experiencing at least one episode. This most commonly occurs between ages 4 and 8. Similar to terrors, sleepwalkers often appear confused and are difficult to awaken.
Assessing Bedtime Problems
The side effects of common sleep problems call for practicaL, effective solutions. Most often, parents acknowledge their child"s sleep problem only after they themselves are sleep deprived and exhausted. With their energy and patience depleted, sleep-deprived parents usually want to skip the whole assessment process and just fix it. However, it is necessary to look at the factors potentially contributing to your child"s sleep probLems. Consider the following questions:
In addition to considering these issues, you might benefit from keeping a sleep diary for a week or so to help in identifying contributing factors and patterns, as well as ideas for addressing those factors contributing to sleep problems. The diary might include wakeup time in the morning; times, places, and lengths of daytime naps; when and where your child went to bed in the evening; and the frequency and lengths of times the child is awake during the night. Also, record issues that come up at any given point during the bedtime routine, how you responded to the situation, and how your child reacted to your response. Sleep diaries are particularly helpfuL to bring to appointments with your doctor or other professional to help you develop a treatment plan.
Ruling out medical problems. Although common sleep problems are rarely the result of a medical problem, ailments such as cold or flu symptoms, ear infections, or medication side effects may create sleep difficulties. In addition, night waking owing to frequent urination may be related to medical disorders such as urinary tract or bladder infections or diabetes. Dietary issues such as food allergies may also interfere with normaL sleep patterns. Parents often can tell when their child is coming down with something and should report all symptoms and suspected medical problems to their doctor.
In some cases, children have received medication such as over-the-counter or prescription sleep-aid medicines or melatonin for sleep problems. Most research studies have found that, although such medications usually work at first, these improvements are temporary and problems recur when children stop taking medication. Of course, consult your child"s physician before giving your children any over-the-counter medication or herbal treatments for sleep problems.
"Good Night, Sleep Tight"
Various behavioral strategies have been found to be effective in treating sleep problems. Here are some ideas you can try with your child.
Establish a bedtime routine. Set your child"s bedtime and wake time, considering what seems to be the right amount of sleep for your child as well as when they need to wake up. A four-year-old shouLd get about 11 1/2 hours of sLeep; school-aged children should get 9-11 hours of sLeep; and teenagers should (and rarely) get about 8 hours of sleep. Start a healthy sleep routine, which may include bathing, brushing teeth, washing face, putting on pajamas, going to the bathroom, and choosing relaxing bedtime objects such as blankets, stuffed animaLs, nightlights. Avoid giving them something to drink right before bedtime so they do not wake up to urinate in the middle of the night. Children with sleeping probLems shouLd avoid caffeine (cola drinks and chocolate). At bedtime children should go to sleep in their own bed.
Give a bedtime prompt. Give your children a prompt (simple reminder) about 15-30 minutes before bedtime, which helps prepare them for the change in activity. Children should then be told that it is bedtime and asked to begin their bedtime routine. After they finish, lights go out and say, "Good night," with the understanding that you will see each other in the morning.
Daily habits to fadlitate quality sleep. Encourage your children to get involved in activities that require a good deaL of energy. This will not only reinforce the importance of fitness, but also help your children tire so that they are ready for sleep at bedtime. Help your children learn how to calm down by setting up quiet times during the day. You may choose to quiet the whole family or just designate one room as a quite space. Also reinforce your children"s ability to calm themseLves when unhappy, angry, frustrated, or scared, all of which are feelings likely to be associated with bedtime at one time or another. Teaching your children to calm and reLax themselves are valuabLe coping tools to use for the rest of their lives.
Fostering positive coping, courage, and selfconfidence. It is typical for children to have bedtime fears. In response to and even before such problems have developed, it may be helpful to read bedtime stories that address bedtime feelings and promote positive solutions, bravery, and confidence. Several books are listed at the end of this article (see "Resources"). It may also be useful to teach your child positive self-statements such as, "I can take care of myself at night," and "I am brave and I can take care of myself when I"m alone or in the dark." Give your child a developmentally appropriate sense of control, such as having a nightlight, choosing to leave the door open, choosing a book to read, or allowing background noise such as a fan.
Prepare not to respond. Postponing bedtime and sleep is an art acquired by the majority of children. "Please, just one more story," "One more drink," or "I gotta use the bathroom one more time," probably sound familiar. To the defense of parents in this situation, it is really easy to give in to avoid a struggle, and we also truly want to have another treasured moment with our child. It is important to set an expectation and stick to it. If it is perceived as giving in, children"s radar quickly registers their behavior as successful and prepares them to use these same behaviors in the future.
Given the evidence that your child"s behavior is strongly related to your reactions, it makes sense that you keep from attending to your child"s negative (and delaying) bedtime behaviors. Do not pay attention to your child"s crying and requests after saying "Good night." If your child leaves the bed, you should return your child to bed with little attention (like hugs or discussions) about the behavior. It is likely that your child will temporarily show an increase in negative behavior, so be sure to expect it and prepare to not give in. Your child is testing you for your response. When you consistently do not respond, children learn their behavior does not work. They also develop confidence with the experience of several successful independent nights of sleep. It may seem unsupportive or mean to respond in this manner, but young children are usually unable to negotiate a treatment plan with you. Therefore, your consistent responses and inner strength are important for solving sleep problems.
Give your children praise. It is important to tell and show children what we want and like them to do, and then tell them again. It is particularly helpful to tell them the specific behaviors that they exhibit that we value. For example, "I really like the way you went upstairs and did your bedtime routine right when I asked you. Thank you." Or, "I really like the way you used courage and slept in your own bed all night. Way to go!" Some parents also like to give their child a special privilege or toy for learning to follow sleep routines, and professionals can guide you in picking the most appropriate rewards for your children.
When to Get Help
Always keep your child"s safety in mind. Ongoing sleep problems tend to interfere with children"s relationships with family and friends and with their school performance. If you experience severe or ongoing bedtime problems with your children, contact your school psychologist, school nurse, or primary healthcare provider for assistance. Most often, children"s sleep problems are resolved quickly when parents are guided in using effective behavioral interventions.
Books for Children
Bourgeois, P. (2000). Franklin in the dark. New York:
Scholastic. ISBN: 0439194253.
Edens, C. (1992). If you"re afraid of the dark, remember the night rainbow. New York: Aladdin Library. ISBN: 067176053X.
Hazbry, N. (1990). How to get rid of bad dreams. New York: Scholastic. ISBN: 0590434748.
Hoban, R (1995). Bedtime for Frances. New York:
HarperTrophy. ISBN: 0064434516.
Mayer, M. (1992). There"s a nightmare in my closet. New York: E. P. Dutton. ISBN: 0140547126.
Peck, R (2003). Monster night at Grandma"s house. New York: Dial Books for Young Readers. ISBN: 0803729049.
Resources for Parents
Christophersen, E. R, & Mortweet, S. L. (2002).
Parenting that works: Building skills that last a lifetime. Washington, DC: American Psychological Association. ISBN: 1557989249.
Kvols, K., & Hall, H. Bedtime without struggling. Positive Parenting.com website. Available: www.positiveparenting.comjresourcesj
feature_ article_ o12.html
Mindell, J. A. (1997). Sleeping through the night: How infants, toddlers, and parents can get a good night"s sleep. New York: Harper Resource. ISBN: 0062734091.
Resources for Professionals
Christophersen, E. R, & Mortweet, S. L. (2001).
Treatments that work with children: Empirically supported strategies for managing childhood problems. Washington, DC: American Psychological Association. ISBN: 1557987599.
Mindell, ]. A., & Owens, ]. A. (2003). A clinical guide to pediatric sleep: Diagnosis and management of sleep problems. Philadelphia: Lippincott, Williams, & Wilkins. ISBN: 0781740126.
National Parenting Center-www.tnpc.com
Rebecca L. Mandal, PhD, is a school psychologist with the Hammond Learning Center, Hammond, LA.
is) 2004 NationaL Association of School Psychologists, 4340 East West Highway, Suite 402,
Bethesda, MD 20814-(301) 657-0270.
Last Modified on September 21, 2010