Many parents have experienced bedtime problems with their children which are often a result of parental difficulties in setting limits and managing behavior. Some of these problems may include stalling and refusing to go to or stay in bed. Sleep disturbances of this type are referred to as behavioral insomnia of childhood, limit-setting type.
These types of sleep problems typically develop after the age of 2, or when the child is able to climb out of the crib or have graduated to a “big bed”. Examples of these “curtain calls” include stalling behaviors such as watching more TV, “read me another story”, “I need a drink of water”, “I need a back rub”, etc. This can ultimately lead to insufficient sleep at night resulting in bad daytime behavior and parental frustration. Successful behavioral intervention for bedtime resistance will not only result in improvement in the child’s sleep problems but has also been shown to alleviate parental stress and improve parental sleep.
Implementation of behavioral management strategies for sleep may also lead to improvements in parenting
skills and management of daytime behaviors. Treatment for this disorder includes the following management strategies:
- Establish a consistent bedtime and awakening time and avoid late afternoon naps.
- Establish a consistent bedtime routine that is approximately 20-45 minutes and includes 3-4 soothing activities (warm bath, putting on jammies, stories, etc). Avoid stimulating activities before bedtime including TV, games, playing or high energy activities. Establish clear bedtime rules.
- Ignore any complaints or protests about bedtime, such as “I’m not tired” or “I do not want to go to bed”. Avoid discussing or arguing about bedtime as this often leads to a struggle – calmly let the child know that it is time for bed and be consistent.
- Put the child to bed drowsy but awake, as it is important for the child to learn to fall asleep independently.
- Check on the child if he/she is upset or crying, but these visits should be brief and non-stimulating with minimal interaction other than these “check-ins” providing reassurance for the child.
- Return the child to bed or room if he/she gets out of bed, being firm and calm if the child comes out of the bedroom. Parents should praise the child for staying in bed.
- Use positive reinforcement to increase appropriate behaviors (star chart, reward that is deemed appropriate by the parent and child’s developmental level). Punishment is not an effective way to change a child’s behavior. Be CONSISTENT in parental responses, focusing on increasing positive behaviors rather than decreasing negative behaviors. Consistency is the key to any behavior change.
- State facts rather than ask questions – “It is time for bed” rather than “Are you ready for bed?” Parents can provide acceptable choices to give the child some control, but bedtime is clearly delineated – “Do you want to go to bed now or in 5 minutes?”
- Consider a “bedtime pass” that can be as simple as a decorated index card that allows the child one or two requests to be granted at bedtime when he/she redeems it (drink of water, one story, bathroom, etc), but no further requests are allowed once the pass is used up. This allows the child some control and a way to make a reasonable request while setting clear limits.
- Expect an “extinction burst” after initiation of a behavioral program. Warn parents that the behavior will often become worse for several days before significant improvement occurs. This burst can also occur days or weeks later and parents should be prepared for future testing of limits. Hold to your guns!!
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