As part of an ongoing series on behavioral insomnia in children, I discussed sleep onset association problems last week. That problem tends to occur in kids less than three (although it can be an issue in older children as well). The most difficult part of sleep onset association problems is frequent awakenings at night, although the root cause is issues with bedtime.
This week, I’m going to talk about an issue with bedtime that presents with . . .problems at bedtime. (This is a lot easier to get your head around). The technical terms include “bedtime resistance” and “behavioral insomnia of childhood, limit setting subtype”. Kids with this problem tend to range in age from 2-8 years of age. It usually isn’t prominent until children are switched from a crib to a bed.
The first hallmark of this disorder is prolonged fighting and struggling around bedtime. In some kids, this usually starts around the time of transitioning from post dinner activities to bedtime activities. (In my house, this means going upstairs for a bath). Other children wait to start to complain once they are in their rooms. The resistance may be obvious (crying, yelling) but is commonly more subtle resistance that prolongs bedtime and delays sleep onset well past the delayed bedtime.
Once you leave your child’s room, breathing a sigh of relief and dreaming about doing the dishes and then catching up on that episode of Mad Men you recorded, you hear the door open and the patter of little feet. Thus begins a series of curtain calls, the second hallmark of bedtime resistance. These are repeated requests after bedtime for attention. Some classics I have heard:
- “I want a drink of water”
- “I need another hug”
- “Will you rub my back some more?”
- “Another song/story”
- “I need to go to the bathroom”
- “I’m scared” (without any apparent fear or distress)
- “I need to go to the bathroom again”
- “Can you check the closet and make sure there are no monsters there?”
- “I really need to go to the bathroom. I promise it’s the last time”
Now, every parent has had a child try to delay bedtime a bit or encountered a rare curtain call. That is perfectly normal. Behavioral insomnia (limit setting type) is characterized by prolonged delay of sleep onset, often more than an hour or two past the desired bedtime.
What if my child fights bedtime and then wakes up multiple times at night?
In the classic form, kids with bedtime resistance do not have problems with staying asleep. However, many of them may develop inappropriate sleep onset associations. He may fight bedtime until his dad relents and rubs his back until he falls asleep, then he wakes up multiple times needing his dad to rub his back again.
The key to understanding both of these issues is that the problem in either case is bedtime. Next week: How to fix bedtime so your child falls asleep on their own, with a minimum of fuss, and sleeps through the night.
Parents, I’m a connoisseur of creative stalling tactics in kids: any great stories your kids have come up with to keep from going to bed at night?