Toddler night wakings are especially painful as they can cry longer than infants, and are harder to reassure than older children. One of the most common causes of night wakings in infants, toddlers, and even older children is inappropriate sleep onset associations. This is a disorder which will respond to behavioral management (or sleep training). For more information, here’s my comprehensive review of sleep training methods. (And for help picking the right sleep training technique, you can check on my Sleep Training Quiz here). The first step to successfully sleep training your child is correctly identifying that your child has a behavioral problem. If your child has a disorder such as asthma or obstructive sleep apnea which is interrupting their sleep, any attempt at sleep training is likely doomed to fail. Behavioral insomnia of childhood is divided into two types: sleep onset association subtype, and limit setting subtype. Toddler night wakings are frequently due to sleep onset association disorder. Frequently children may have characteristics of both. In this post I’m going to talk about inappropriate sleep onset associations. You can also check out my new podcast, The Sleep Edit, where I discuss night wakings in depth.
Let me paint a picture for you. It’s been a long evening in the Smith household. Jimmy is 14 months old. Every night, since he was an infant, his parents have rocked him to sleep every night and then put him in his crib, at around 8 PM. His parents put him to sleep, sit down to watch some television and try to relax, but they are dreading the night ahead. Just when they get into bed, around 11 PM, they hear Jimmy crying out. They rush into his room frantically to try to rub his back so he falls asleep more quickly. These awakenings occur for the rest of the night every hour to an hour and a half. When he gets up for the day at 5:30 AM, Jimmy is quite irritable, and his parents are exhausted. They don’t have the luxury of taking two naps today. Jimmy’s problem is that he has developed inappropriate sleep onset associations, one of the subtypes of behavioral insomnia of childhood.
Inappropriate Sleep Onset Associations Cause Frequent Awakenings
The typical child with inappropriate sleep onset associations is between 6 and 36 months but may be older or younger. This child needs his parent present to fall asleep and wakes up very frequently during the night. Parents view the awakenings as the problem, but they are a symptom of the primary issue: the child has not learned to fall asleep by himself. To understand why this is the case, I’ve created a few illustrations.
First, let’s look at a night of normal sleep, on a graph called a hypnogram, which represents the various stages of sleep that a child goes through at night. Notice that the child falls asleep into very deep sleep at the beginning of the night, then has more REM or dream sleep as the night goes on. (REM is highlighted in red.)
Note that the child briefly awakens after bouts of REM sleep. However, this child is used to falling asleep on his own. Thus, he does not signal to his parents.
Compare this with a child who needs her parents present to fall asleep. She may be held and rocked until she falls asleep. She may need his back rubbed or to nurse to fall asleep. She may even fall asleep with a pacifier in her mouth which falls out during the night. In Jimmy’s example, his parents rock him to sleep.
This child has not yet learned to fall asleep by himself. Thus, every time he has a normal awakening, he will call out to her parents and need them present to fall back to sleep. If your child falls asleep under a set of circumstances that are not present during the night (being held, having his back rubbed, nursing, even having a pacifier in her mouth) he or she will need the same set of circumstances multiple times during the night. So if he falls asleep in your arms, you are likely going to have to get up multiple times during the night. Dr. Ferber used a great analogy in his classic book (affiliate link). Most of us fall asleep with a pillow and blanket. If we woke up and our pillow and blanket were missing, we would get up and go looking for them. We would likely worry about were they had gone.
The key to fixing to addressing inappropriate sleep onset associations is helping your child to fall asleep on their own. For more advice, please see my post on various sleep training methods.
There are a few other situations where you might deal with a flare up in awakenings. Here are some questions you can consider as you are assessing this problem.
Other causes of night time awakenings
Are you dealing with a sleep regression?
If your child has been sleeping well then started waking up out of the blue, you may be dealing with a sleep regression. I have a comprehensive post on recognizing and addressing sleep regressions.
Is your toddler waking up hungry?
Toddlers should not need to eat during the night unless there is a medical reason for him to eat. (If you are concerned about your child’s growth, please talk to your pediatrician about this). If you are giving your child a bottle of milk or breast feeding your child during the night, weaning these feeds will likely help improve your child’s sleep rapidly. Here is my comprehensive post on dealing with night feeds.
Is there a new baby in the home?
Some parents struggle with their toddler’s sleep when a new baby comes into the home. There are several reasons. If the children share a room, this can be especially challenging. (Of course in early infancy, your infant should likely sleep in your room, provided that you can do so safely). If you have a small home, a crying infant in another room can wake up your toddler, so using a sound machine can be helpful.
Sometimes, just the stress of welcoming a new baby to the home can disrupt your child’s sleep. Usually, these awakenings are brief and last less than a week. If you can spend some time during the day with your toddler (and without the baby), that can help your child feel secure and calm as she goes through the exciting process of welcoming a baby brother or sister to the home.
Is a medical disorder waking up your child at night?
Many common medical problems are overlooked as a cause of sleep disruption. If your child coughs frequently at night they may have asthma which needs to be treated. Acid reflux can be associated with belly pain and vomiting at night. Obstructive sleep apnea is a very common problem associated with snoring which can disrupt sleep. I would definitely recommend seeing your pediatrician about any of these concerns.
Is the environment waking up your child?
These tend to be obvious. Is there a TV on in the room? If so, please take it out of there! Is there loud noise from neighbors or the road outside? Does the child share the room with a sibling or parent who makes a lot of noise? Room sharing with siblings can make it particularly tricky to manage toddler night wakings. If one child wakes up, frequently the other does too. Here’s more information on how to navigate the tricky waters of room sharing.
Is your child in bed for too long?
Some kids suffer from “too much time in bed syndrome”. Brett Kuhn coined this term. This may occur in older toddlers whose parents have kept the same schedule they had previously as they need less and less sleep. Imagine a child who was sleeping from 6 PM to 6 AM at age 1. Age age 3, this is likely too long a sleep opportunity, especially if the child is still napping. This child’s sleep needs may have decreased from 14 to 11 hours per 24 hour period. Thus, if you keep the same nocturnal sleep period, your child may be awake for an hour or two at night. Usually in this scenario, your child is happy when she wakes up at night and is well rested in the morning. This may be right time to get rid of a nap or consider a later bedtime. For more information, here’s my post on how much sleep kids need.
Have you struggled with night time awakenings in your child? Why do you think that is? What has helped? Please leave comments below.
Craig! I was just going to email you about this! Caroline is 15.5mos and has recently started waking at least once overnight and then up for the day at 5a…ugh! She is usually great at going to sleep on her own (she does use a pacifier at bedtime and has a lovey). She goes to bed at 7p and takes one nap a day (12:30/1-3:30/4). We have room darkening shades but it can be pretty bright in her room in the evening despite them. I’m not sure if it has anything to do with more daylight, the pacifier or when I work nights if Zac does things differently? How can we prevent it? Thanks!
Mary– the early AM awakenings can be really brutal. As long as the two of you are fairly consistent I’m not convinced that it matters if you are working. I need to know a bit more. What time was she getting up previously? What are you doing when she gets up at 5a?
BTW I wrote a bit about this in an earlier post as well.
https://drcraigcanapari.com/2012/03/20/early-morning-awakenings-what-to-do-about-them/
Hi Craig
My wife and I live in Finland, we found your website after not having luck finding anything to help us and would really appreciate your help.
Our Daughter is 1 month, 3 weeks and is an all round happy, well behaved toddler.. Except night time!
Every night around 7.30 after her evening porridge we wash her, new diaper, pyjamas and then a story. We usually hold her and walk around the room and keep everything very calm before we lay her down to sleep. She’ll always have a little cry when we lay her down but usually within 10 mins of stroking her head shes asleep. The problem is she will wake within 2 hours crying standing in her crib and once we gether back to sleep we can guarantee this will happen at least 3 – 5 more times before morning. To get her to sleep we usually just calm her by laying her back down and stroking her hair by it doesnt always work, sometimes it can be an hour or 2 of crying.
Can you give us any advice on how to start the process of making her self soothe to get back to sleep without crying every few hours?
I think the issue is that you are still present for bedtime. If you move her bedtime a bit later and work on slowly removing your presence at bedtime (e.g. having her fall asleep with you a bit more distant from her at night) I suspect the awakenings will resolve with time once she learns to fall asleep on her own.
Dear Dr. Canapari,
I’m ashamed to say that I never figured this out in time and my 16 year old daughter suffers from this. She never learned to put herself to sleep as I was always present often stroking her head or back. I thought I was doing the right thing but now I can see that I conditioned her to be dependent on me. Consequently, she has a lot of trouble getting to sleep. She mostly complains of lying awake for a long time with a racing mind. Is there a way for her relearn how to go to sleep?
I would not beat yourself up too much as the reason you always consoled your child may have been that she had some inherent difficulty falling asleep. It would be reasonable to take her to a sleep specialist; if there is not a pediatric specialist nearby, most adult sleep docs would be willing to see a 16 year old. In the interim I would consider moving her bedtime a bit later, avoiding screen time in the evenings and caffeine after lunch, and working on relaxation techniques.
Thank you very much Dr. Canapari,
She’s an athlete and she has been trying to get a lot of sleep. I suggested that she is trying to go to bed too early. How many hours of sleep would you recommend for a 16 year old athlete?
Thank you very much Dr. Canapari,
I do think my daughter has been trying to go to sleep too early, which has exacerbated her problem. She’s a student athlete and going to bed early is part of how she’s trying to take care of herself so she can train and compete hard. How many hours of sleep per night would you suggest is adequate rest for a competitive teen athlete? I think it would be much better for her, as you suggested, to go to bed later.
Your average teenager requires between 8-9 hours of sleep. There are rare people who get by on less. When does she get up in the morning?
Hello dr.craig… My son just turned 2 and he will not go to sleep. My husband and I will put him to bed at 8(he takes a 1.5 hour nap at daycare) a she will not go to sleep until 9 or 9:30pm… He refuses… We are exhausted and do my know what to do:(
I think you should temporarily move his bedtime to 9-9:30 and slowly move his bedtime earlier once bedtime becomes easier. Keep his wake time constant in the AM.
What do you suggest for a 2 1/2 year old who goes to bed relatively easy and falls asleep on his own (we aren’t in his room or rubbing his back when he actually falls asleep, but we do incorporate rubbing his back during wind down time, we always leave when he is awake still) yet still wakes up frequently during the night no matter if he’s sleeping by himself or occasionally with his brother or even if he sneaks into our room…. he still wakes up screaming! 🙁 Going on 1 1/2 years of this ….
It would be worth reviewing with his pediatrician to make sure that there is no disorder fragmenting his sleep e.g. asthma, sleep apnea. A sleep study could be useful.
I’m in the same boat with my 2 year old now (27 months). Except she doesn’t put herself to sleep. She’s extremely clingy to me and wants to sleep in my bed. It takes my husband and I and hour to hour 1/2 to get her to sleep. We keep a routine, but she refuses to abide by it. And she wakes every night at the same time crying 🙁
Hi Charisma in your position I would say that your problem (and area you should focus on) is independent sleep at bedtime. You can find more information how to to get there here.
I might mover her bedtime later by 15 minutes. I would also discuss the possibility of acid reflux with her pediatrician if she vomits frequently.
We talked to her Dr. And he suggested going ahead with the sleep training. It took one night and one nap of crying and after that she is now asleep within 5 minutes all her own! I think it comforted her that we went in occasionally. Thank you for this site it gave me confidence to go ahead and try this while not feeling like I would be abandoning her!
Fantastic news!
Hi Dr. My son is 19mths old, a twin and so inconsistent. I have tried to be very routined their entire lives, for them and for my own sanity. My son struggled with reflux/food allergies from 3-9 months when most babies are learning to sleep. He was awake, usually in pain, sometimes every hour of the night. Once we pegged his medical issues things seemed to gradually get better. We are finished teething and healthy. He and sis both go down for naps and and nights without being rocked to sleep. We give them baths, read books, sing songs, pray and rock for just a minute or two (snuggles before bed) and then they both typically put themselves to sleep. He lately has been fighting sleep for an hour at bedtime and then at different random times during the night. We have tried “crying it out” for an hour, sometimes more, with periodic checking on him, assuring him that we’re here, rubbing his back etc. He is very stubborn and screams full force as soon as we leave the room. At the end of his hour episodes the passed couple of nights, I have given in, picking him up to try to rock him to sleep and he has no tears or snot, which means he has basically been yelling at us the entire time, not crying! We haven’t changed anything about his environment in several months. Bedtime is consistently between 8 and 8:30 every night. We are tired, so confused. We want to parent well and see to his needs as best as we can. Any ideas?
Maybe a later bedtime and moving the other twin to another room? Be wary of giving in as it will reinforce the behavior.
Hi Dr. Canapari, I am the grandmother of a 2 and 1/2 year old boy. I’m concerned about him. He has always been a delightful, even tempered little child. He has been going to bed, soothing himself to sleep and sleeping through the night since he was about 5 months old. Often, my son and Daughter in law (along with their 5 year old), go away to visit her parents or on vacation. In those cases, parents and kids sleep in the same room. Once they are home, they all go back to their own routine. No problem til now. Last month, they went on a long weekend trip. They got home on Sunday night…all was well and went well all week. The very next weekend they went away again (from Friday to Sunday). That Sunday night, my grandson didn’t want to go to bed. He complained about something outside his window. He wanted Mommy to stay in his room. She sat in the rocker for almost 2 hours. He finally went to sleep, but woke up screaming several times during the night. It’s been the same every night since. He actually got hoarse from screaming. He stormed the gate, knocking it over and tried to go downstairs to his parents. He is still unsteady on stairs, so my son brought him back to his room and spent the night in the spare bedroom where he was awake half the night trying to tell my grandson to go back to bed. They called his pediatrician who told them to “stay the course.” They always had a bedtime routine and have stuck to it. Things have not gotten better. They had to close the door to keep him in his room. Now my grandson cries that “he wants water…or….there’s a crocodile in my room.” The other morning they found him asleep on the floor near the door. It is heartbreaking. This is going on three weeks now. The day care center says he sometimes cries while he is sleeping during naps. Please offer some advise to help. We are all at our wits end. Toni
Ferber’s book has a great section on nocturnal fears. I would recommend reading it and implementing the suggestions therein.
Here is a link BTW
Solve Your Child’s Sleep Problems: Revised Edition: New, Revised, and Expanded Edition
Dear Dr Canapari,
I am writing from London, UK. We have an 18 mon old daughter and since she was just 6 mos to about 11mos she was a great sleeper – 12hrs at night at a stretch – then just before her first birthday she started waking up at night for a bottle and continues to do so. She has a bottle before she goes to bed, but always is sleepy but awake when we put her down and normally falls asleep on her own just fine. The night wakings now are erratic – some nights she’ll wake up at 10pm, others 2am. She eats well in the day normally, but still cannot seem to drop this night feed. We are at our wits end now. I’m quite convinced it is learned hunger, but my question is how do we fix it! If she’s genuinely hungry, even if it is 2 am, how can we not feed her?
Grateful for any advice you have!
Lindsay
Lindsay this reminds me that I need to right a detailed post on this. Typically the way to do this is to reduce the amount of calories incrementally, either by reducing volume (going down by one ounce a night, then stopping when you get to 1-2 ounces) or diluting the milk (e.g. if you are giving 4 oz of milk, go to 3 oz milk/ 1 oz water, then 2 oz/2oz, etc). Best of luck. As a side note, both my boys sleep with a water bottle and have done so since they were in the crib.
We tried it and it worked! Thank you! Unft she’s started to teeth but the nighttime milk feeds seem to be a thing of the past.
Great news!
Hi Doc!
Our 15 month old has two great naps during the day (2 naps at 2 hours each). He was sleeping through the night, but in the past month or two, he wakes up 3-5 times a night and needs us to:
1. Put the soother in his mouth
2. Lay him down
3. Put the blanket on him.
We tried letting him try to fall asleep but after two hours, we gave up.
We are starting the process to get a sleep study, but it will take time. In the mean time, how can we test removing an inappropriate sleep association with the soother (assumption that there is one)?
I’m unclear if he was falling asleep on his own before this happened. Unfortunately, the best thing may be getting rid of the soother altogether. A sleep study may not even be helpful if it has a behavioral cause. The best way to proceed depends on your family. Here is a good place to start. Good luck!
Our boy IS falling asleep without us no problem at all. The reason I thought sleep study is after his chicken pox, he has been coughing for a month+
He could have a post viral cough. Worth getting him checked out for other causes (infection, asthma, etc).
Thanks Doc! Sending you a ton of good vibes: https://www.youtube.com/watch?v=Rpq5vDccLTg
Dear Dr. Canapari,
I am desperate for advice on how to manage my 2.5 year old’s bedtime resistance. She is a well-loved, well-attached, cheerful kid who is not prone to tantrums (during the day). She was sleep trained at about 4 months and until recently, has been able to put herself to sleep, albeit there have been periods of night wakings. For the past 6 months (which roughly coincides with moving from crib to bed), she has been resistant at bedtime, executing repeated curtain calls and getting out of bed again and again. I feel like I have tried everything: marching her back to bed quietly with no engaging behavior; an incentive chart; closing her bedroom door if she won’t stay in bed (I did this for months, but that invariably ends up in a screaming fit and so I have stopped doing it), darkening the house and playing her bedtime music right after dinner, etc.. Recently, she has started claiming not to be sleepy at night, and adds this refrain to her antics (I don’t believe this reflects a lack of sleepiness; she will say she is not sleepy even if we have had an unusually long day and late night, and no nap). About 5 of 7 nights, bedtime resistance leads to screaming. I am willing to let her cry it out, which I have done in the past when necessary to sleep train, but am very worried she will injure herself while alone in her bedroom as she has taken to throwing things around and finding ways to climb up on her furniture. She naps at daycare (approx. 1-2 pm, with back rubbing) and I attempt to get her to bed by 8:30 although her resistance now sometime pushes her falling asleep time to 10:30, occasionally later. Before these problems began, she went to bed between 7:30-8:30, with no problems. She also comes into my bed in the middle of most nights, and quickly goes back to sleep. Her waking time depends on when she went to sleep, but is usually around 8:15 a.m. She occasionally spends the night with my parents, and goes to and stays in bed without any trouble while she is there. I am a single parent with only occasional respite from my parents, and I am so desperate for help I don’t know what to do. Thank you.
I might try getting rid of that nap and seeing where it gets you. A slightly later bedtime might help as well. Good luck
Thank you for your advice. Naps are required at her daycare, unfortunately. I began an attempt at “bedtime fading” tonight with a late bedtime and was rewarded with a (still prolonged) bedtime with no screaming : ) .
Great news. Keep it up!
Hi, I’m writing this out of desperation after having just had a traumatic time putting down my daughter for a nap. Before I go into the nap incident, I wanted to share some background about her anxiety that I think is contributing to her sleep problems: she generally has strong separation anxiety and works herself up into hysterics the moment I leave the room after putting her in the crib. She does this also if I leave her with a friend or at nursery for an hour or when her dad leaves, so it’s not confined to bed time. I may be wrong, but I think her anxiety is greater than that of a normal baby. Since she was an infant, she would SCREAM in
She just turned 1, and I did not sleep train her while she was younger, mostly because I couldn’t emotionally handle her screams. We also did an international move when she was 3 months, so logistics made some things like a routing challenging. I used to nurse her to sleep, not realizing I caused her to become dependent on it, and I would wake up every time she cried in the night and comfort/nurse her. I’ve now broken the nursing association and she will lay down in her crib at bed time, while I’m there, and fall asleep within 5-15 minutes.
I think
Dear Laura
This sounds really stressful. I’m afraid this is a lot to troubleshoot in this space. Have you reviewed this with your pediatrician? You also seem really stressed about this (which is totally understandable) and your child may be reading this as well.
In terms of anxiety– it is hard to know if a 1 year old is anxious or not, although some kids may have a more anxious temperament.
I suspect the awakenings may represent an extinction burst. Typically, they will resolve with time if you continue on your current course. Alternatively, if you can get him to go back to sleep quickly with the application of a pacifier, I might advocate continuing that for a bit.
Dear Dr Canapari,
My nearly eight year old daughter fights tooth and nail when I try to get her to sleep in her own bed. Though we did have a family bed when she was young, she was transitioned almost completely to her own bed around two. When she was three and a half I gave birth to her sister, who lived only an hour. In my grief and depression I found the struggle of getting her to sleep on her own too much and we reverted back to a family bed. A year ago, her father and I separated and since that time I have been trying to get her to sleep alone. Only this month her father has initiated the plan in his home with her.
She has extremely challenging behaviors around sleep. I have to sit in the room with her until she is absolutely out, but she does typically stay asleep once she’s down. However, her bedtime is MUCH later than I like (sometimes 11 pm or midnight) and it can take more than an hour for her to finally fall asleep. We put on a white noise app, which seems to help but I’m desperate for her to learn to fall asleep on her own and to fall asleep at an earlier hour!
Any advice would be welcome.
Hi Madeline– thanks so much for sharing. This is certainly a trying set up of circumstances. You allude to her father instituting a plan at home. It is really important that the rules and timing of bedtime be in alignment at both homes. It may be difficult to communicate with Dad but consistency is key. I also wonder if you daughter is having some other adjustment issues as well. Talking to a counselor may be helpful for both of you. You also didn’t mention what her wake time is or if she is sleepy during the day; this is critical for knowing what to do next.
Dr. Canapari,
Thanks so much for your website! We have a 2-year old, who has been a great sleeper for most of his life. Due to some inconsistency in his routine this summer caused by vacations, visiting relatives, etc., we violated a cardinal rule and let him fall asleep with us in our bed. Now, our one-time great sleeper will not sleep in his crib. We have tried to let him cry it out, but after several hours, we give in mainly . because we have other children who are kept awake by it, and he makes it so they can’t sleep either. He then ends up in our bed and all we’ve done is reinforce a bad habit. We feel like he’s holding the whole family hostage. Having the other kids hamstrings our ability to be as disciplined as we need to be during the extinction process. We’d appreciate any advice you might have. Thanks so much!
Hi Roger! Sorry it has taken me a while to get to this. Perhaps this has resolved already. If your child was a great sleeper until recently, I suspect you can get back to that situation without much fuss, but it may be at the expense of a night or two of sleep disruption for your other kids. If you focus on bedtime only, that will limit the damage. Good luck.
I have been having sleep issues with my 3.5 year old for almost a year. The latest problem – which has been going on for months now – is waking up at night. At least once and often twice per night, she will wake up, run into our bedroom and try to climb into bed with us. (She goes to sleep at 8:30pm. Her typical wake up times are 1am and 4am. She is awake for the day promptly at 6am.) When she runs into our room, we immediately escort her back to her own bed, where she falls asleep. My husband and I are severely sleep deprived because of these night wakings. I cannot fathom how my daughter is able to function throughout the day; I worry about the long-term effects of this on her. When I asked her pediatrician about it, he kind of shrugged it off and suggested I use an incentive chart for her. I am not keen on doing another sticker chart for her, as we have already used one for potty and meal-time cooperation, and I feel like it is kind of ridiculous to have sticker charts and rewards for basic functions.
Our bedtime routine is this: we try to get her upstairs immediately afterward for pjs/tooth brushing/storytime, but sometimes we’ll give her an extra 20-30 minutes playtime if she is being calm and agreeable. Typically, we do her routine and she will fall asleep on her own within minutes, though we do have some nights where she tries to call us back, asking for a sip of water or claiming that she needs to tell us something. Even on the nights where she tries to call us back, we do not stay in the room until she is asleep. We will check on her briefly and leave. My point is, she falls asleep on her own every night (sometimes easily and sometimes delayed). We have tried a few things to get her to stay in her room: keeping a gate up, buying one of those red light/green light clocks, using room darkening shades when she complained about too much light, and then using nightlights when she claimed it was too dark, keeping a photo of me and my husband by her bed when she claimed she was lonely, etc. Dr. Canapari: TELL ME WHAT TO DO HERE.
Part of my comment got cut-off: the beginning of the 2nd paragraph is supposed to say that we put her 16 month old sister to bed at 7:30, and we start her bedtime routine right after that…
In a situation like this it may be worth screening her for a sleep disorder, say with a sleep test. You could also try a strategy like the bedtime pass
Hi Dr. Canapari,
We have a 15 month old who cannot fall asleep on his own. We have tried sleep training before, but it didn’t work, which I admit probably was due to inconsistency on our part. We started cosleeping at around 7 months because that was the only way he (and my husband and I) would get 8 hours sleep straight. It has worked great for us but we do think it’s about time to kick the cosleeping since we are considering having another child again soon. Plus, we just want him to know how to self soothe.
However… Our son is not a great eater when it comes to solid foods. We had a great feeding schedule before when he was just on milk, but ever since we started the weaning process that has sort of disappeared since we are trying to get him to eat more solids without increasing the milk intake back to what it was before. I have been very consistent with his meals and snack times but he’s just not interested in eating most of the time (which I understand is probably a separate problem on its own). So even though he still prefers milk, he isn’t drinking as much at once as he was before, which means he isn’t as full from his night bottle before bed. For the past 2 months, he has been waking up hungry again, once, sometimes twice, depending on how his eating was before bed. Even though he wakes up, he will still get about 10 hours sleep total, then a two hour nap in the middle of the day.
My question is, if we start sleeping training, how should we go about the midnight/very early morning feeding? Do we need to get him to develop better eating habits first before sleep training that way we know hunger isn’t an issue? Or is the feeding another sleep association that we need to kick I order for him to learn to self soothe? I just don’t know which is the beginning of the cycle and which I should fix first. I know we need to teach him to self soothe either way, but I also don’t want my son to starve if he’s genuinely hungry at 3 am.
I hope this question made sense! Thank you!
-Kristina
Sounds pretty complicated. I think you need to address your child’s feeding issues with your pediatrician because it’s hard for me to comment without understanding his growth, etc. Best of luck.
Hi Dr. Craig
I have a 21 mth old who sleeps in her own from 7pm till 5am. She falls asleep in her own in her crib she naps from 12-2. She was waking at 630/7am (which is ideal) the 5 am is brutal. I started giving a small snack after bath time to see if that would help. She wakes up screaming for snacks and will eat a ton for breakfast. I have moved her bedtime later with no relief. I have let her CIO in the AM but she never falls back asleep. I am at a loss. Advice please !!!
Hard to know exactly what to do here. Worth talking with her pediatrician to see if there is any sort of nutritional or feeding issue.
My son is 8. He has had bedtime anxiety since we stopped co-sleeping at 4. He is absolutely sound asleep and fine once he falls asleep and this usually takes about 5 or 10 minutes, but the anxiety that builds up right before and right after I leave his room is heartbreaking. He has a long list of fears we go through every night and a very set specific routine that has to be adhered to for him to fall to sleep. He has been in therapy, more on than off, since he was 5 after an umbilical hernia operation where his therapist suspects he may have awoken during the procedure. What started at that time was an intense fear of anything shrinking and going inside his body or him shrinking and going inside someone’s body. At about the time of his surgery, his kindergarten teacher showed the class a Magic School Bus video where the bus did go into the body. It became a huge phobia for him and up until this year (3rd grade) we had to request each teacher take all of the Magic School Bus books out of the classroom and not show or excuse him if they were going to show a MSB video. This phobia had a partner and it was the board game, Operation. He was petrified of that thing. It did keep me from any battles in any toy aisle in a store because he didn’t want anything to do with going over to look at toys knowing THAT game might be there.
We have had issues with a custody battle with his dad asking for 50/50 custody but solely to pay less support. That was two years ago and it has been a mess of a 5-2-2-5 schedule where we have tried working on sleep here, but then his dad would let him co-sleep at his house and totally ignore him or shuffle him off all over creation when he was having his parenting time. Finally, about a month ago, his dad got a new GF and decided he didn’t want his son 50/50 and we are now back to only every other weekend with his dad. That has helped some with continuity and generally less anxiety overall, but those ten to twenty minutes surrounding about to go to sleep are torture. It’s so hard to watch him get so worked up about being safe, It’s pretty intense. We have talked with his therapist about a reward system to start to slowly remove one thing at a time. My son likes the idea during the day, but at night he says he can’t do it. We, too, have tried many, many relaxation techniques, meditation, tapping, etc. I have considered melatonin, but his issue is not staying asleep. His issues is clearly fear of being alone to go to sleep. I’m at a loss, too, and am wondering if anyone has had success with EMDR or brainspotting.
His bedtime routine is this: Shower, hair-drying, teeth brushing, a hug and a kiss for his stepfather and off we go to his room. I lie down on his bed with him and read a book from his kindergarten days called “Mama, Do You Love Me?” It has to be that book every night even though neither one of us listen at all to the words I’m saying. He reads at a 6th grade level, but only independently reads in the mornings and during the days. The bedtime story is me and it has to be that book. After that, it’s lights out and he says, “Can I do my list?” I say yes and off he goes always in this order: Are you always going to love me? Are you always going to keep me safe? No spiders? No any kind of bugs? No big bugs? Are you sure? Positive? Swear? (I say “swear, move on” at that point) Am I not going to shrink? Am I not going to shrink and be in somebody’s body? No dinosaurs? No monsters? Are you right across the hall? Is there a little crack in your door? (I answer yes even though there has not been a crack in my door for years and we are both aware of that.) No storms? No any kind of storms? No lightning storms? No thunder? No lightning? No wind? Is that all? What should I dream about? (I give him a list of fun things coming up in the next few days.) He then says, “I’m going to dream about seeing you. Seeing your face in the morning. Hugging and kissing you in the morning.” I then get up and start the arduous process of fixing his blankets to his satisfaction. This involves hooking the bottom sheet over his ear and over his mouth and nose and then pulling the top cover up so you can barely see anything but his forehead and one eye. It often takes two to three tries to get them how he wants them. I then sing around of Frere Jacques followed by Raffi’s All I Really Need and prepare for departure. As I walk out, I first stop so he can say, “Does time mean nothing? Is it just something somebody made up? Is it just numbers and I shouldn’t get worked up about it? Even if it’s 9:05 and I’m not asleep, I’m still safe, right?” I’m then supposed to pause by the foot of the bed while he says, “Are the covers fine? Are they just sheets? Are they nothing to fuss about?” I then get to go a few more steps and he says, “Even if I’m sweaty, I’ll still fall asleep, right? It’s just the stress that’s holding me back and a little bit of sweat.” I then am usually told I can move further and he asks if there is nothing to get worked up about and if his head is hot it’s just a sign he’s about to fall asleep and should he just do his techniques. Finally, I am in the hall and pretty much out of sight when he half shouts, “Everything on my list and not on my list is not true. Everything on my list and not on my list is not going to hurt me. I totally safe and everything on my list and not on my list is not true, I shouldn’t get worked up, and I’m totally safe, right? Promise? Swear?” This ends with him sometimes running through that last part one or two more times and then an “I love you.” and I say “I love you, too.” and go into my room and close the door. Since his return back to me full time about three weeks ago, there has been the resurgence of the one time call back because he’s getting stressed and afraid and thinking he forgot something. We have pretty much put an end to that with my husband being the one to go instead of me.
Typing this makes it all seem so ridiculous.
He’s an extremely bright, social, loving, very well-liked, active, athletic, awesome kid with zero discipline issues. I can see tiny improvements over the years, but I worry that this need to have these lists in the exact order could be signs of OCD. He has no other behaviors during the rest of his waking hours that would cause me concern for this, but I am plain don’t know how to help him. This whole routine takes maybe 10 minutes at night,which is not much, and he never, ever wakes us in the middle of the night. It’s just very difficult to see him get into that state every night. Any advice?
That sounds really stressful and difficult. I have an eight year old and it is quite a challenging time even under the best of circumstances. You are hooked in with a therapist which is great. Has your son’s therapist considering having him see a psychiatrist to see if medication might be helpful as well?
Please could you help me, I have a 3 year old boy who wakes up every night after been in bed 2hours (same time every night) I’ve waited to see if he will settle down on his own but does not. When we go in its like he is having night terrors as he doesn’t seem to recognise it’s me in the room. This continues all night every 40mins-1.5hours. He goes to bed fine doesn’t need settling from me, has a story and goes to sleep on his own. He have star lights on the ceiling all night. Any advice?
It sounds like night terrors but the frequency is more than I would expect. I would ask your pediatrician to refer you to a sleep specialist to investigate.
Dr. Canapari,
My 2.5 year old daughter has been having issues with sleep lately. We usually sit in her room while she falls asleep but we don’t cuddle with her or anything. She goes to sleep well and is down around 830-9pm every night. However, the past 2 months or so, she has been waking up at night. Now it has become a pattern where she wakes up almost every night between 1am and 3am and wants us to be in her room until she falls asleep. Sometimes this takes her 10 minutes and other times it is an hour and a half ordeal. Then she wakes up again at 5:30am and expects to be in bed with us because usually at that point we are both exhausted and my husband has to get up for work soon, that we would just let her in with us.
I found your article on Parents.com and we have been following the Take a Break method you described. The past two nights she has fallen asleep while we have been on our “break”. However, she still wakes up at 5:30am. Should we be doing the same thing at that point in the morning as well? Once she falls back asleep at 5:30am, she sleeps until 7:30-8am.
Also, when we leave the room to go on our “break” we have been tell her that we have to go check on the other parent (ex. When it is my turn to help her, I would say “I am going to check on Daddy, I’ll be right back”. What should we say once she is falling asleep without us coming back? And how do we teach her to self-soothe herself back to sleep instead of us coming in to put her back to sleep each night?
Thank you so much in advance!
Hi there– I think you are on the right track. Your daughter’s sleep will likely improve once she is consistently falling asleep without you at bedtime for a week or two and I suspect the early morning awakenings will improve.
As for what to say, I wouldn’t worry too much. She likely won’t remember it the next day anyway (we usually don’t remember things for five minutes before we fall asleep). Some parents like to leave a small token at the bedside showing they came back and checked– like a sticker.
Please please help me. I can’t cope anymore. Our baby is 16 months old and wakes every hour at night. She shares a room withme as we have space issues but has her own toddler bed. I have tried white noise machines and soft music. I have tried a dark room and one with a night light. I hate the idea of letting her cry it out and if I don’t go to her she gets very upset and/or gets up and comes to my bed. She sleeps for 45 minutes at 11am. She won’t take another nap in the day. I put her to bed at 7 and she falls asleep by 7.30. She lies in her bed and I lie in mine. She does look for a bottle but she is a very bad eater so I’m reluctant to take the bottle. She will sleep for maybe 2 hours at first but then wakes every hour, normally every 40-50 mins. She has to have some bottle, less than an ounce and then falls asleep. She gets up at 6.30 every morning. Things have gotten worse this week. Now when she wakes at 2am she wants to get into my bed and won’t stay in her own. She keeps getting up. When I let her.in she stays awake for approx 2 hours. I can’t take any more and don’t know what to do.
Hi Angela– there’s a lot to unpack here. I would definitely put up a visual barrier so that she cannot see you as well as continuing with the sound machine. I would also work towards having her fall asleep independently at bedtime– perhaps using the “camping out” method. Finally please check in with her pediatrician. Good luck!
Hello, Please help! I have been struggling with my 23month old sleeping habits at night and been going through this since Dec 2019. She sleeps on her own in her own crib. She goes to bed on her own between 830-9pm. Depending on the night and how many times she woke up disturbed, she will sleep in til about 630-9am. Most nights she doesn’t need a sippy cup to go to bed. And she takes one nap at the sitters house around noon for an hour. She consistently wakes up screaming/crying 4-5 times a night since dec 2019. Some nights it’s crying for a few mins, others it’s uncontrollably for up to 2hrs nonstop. It can be anywhere from a whining cry to hysterical cries. Sometimes she’s totally asleep not reacting to me being there. She’ll throw her body, swinging arms and legs etc and it’s not controllable. We have to let it just subside on its own. Other times she’s awake screaming/crying and is well aware she’s up and it can last a few mins or up to again 2hrs. This occurs like I said up to 5 times a night. Very rarely I’ll give her a sippy cup out of exhaustion or take her from the crib and put her in bed with us to help both us at this point with exhaustion but it doesn’t always work either. I can tell she’s exhausted at times from doing this as well as I am. I get a max of maybe 3hrs of sleep a night all together. This never fails, it’s every night. Some nights are easier as they only last a few mins and others are so long and exhausting. There’s some serious sleep disturbance issues here. I thought maybe night terrors as sometimes she’s completely asleep unaware and then can wake up confused. And others she awakens and continues. Not sure what we can do here. We’ve been struggling a year and a half now. We are in desperate need of help!
If she is falling asleep independently I would recommend working with a sleep specialist to rule out a medical disorder. An overnight sleep test may be helpful as well. Best of luck.
My 9 1/2 month old recently started waking 2x at night and fighting her naps to the point of only have one a day and even that may not be long enough. She cuddles or nurses to sleep and wakes up the moment she feels gravity as I put her in her crib. She will roll over and stand up incessantly crying! Please help!!
Definitely need to work towards independent sleep at bedtime. It can be challenging if your child stands to sleep but unfortunately at some point you may need to ignore her. There’s more info here.
Hi Craig,
We have none of the issues you’ve listed above, yet my toddler still wakes screaming her head off several times a night. Today she has been awake since 3:30am and I am at the end of my tether. What would you suggest if the above aren’t a factor?
Typically, if I see a child with these issues in my clinic, I do a couple of things
1. Shorten sleep opportunity at night to reflect true sleep duration
2. Close evaluation to rule out medical disorder
3. Overnight sleep test.
Hi Dr. Canapari,
My 26 month old was a great sleeper. We would put him in the crib (he is still in the crib), walked out and he may have talked a bit but fell asleep independently. He would sleep from 7pm until around 5:45-6:30. He also consistently napped from 12-2. The last 3 weeks have been extremely challenging. Fighting naps, so much so that sometimes he would go with out (those days, we would adjust to an earlier bed time). He also wakes up several times in the night, often 3-4 times and is wide awake between 4:30-5. He now needs us in the room, I just sit on a chair but still will not sleep unless someone is in the room. It usually only takes 5 minutes though, he is still tired at 7 and even naps don’t take too long if I am in the room. Lately, I have also had to wake him up after 2 hours of his nap so he doesn’t have too much day sleep. This tells me he still needs his nap and 10-11 hours of sleep. To add a bit of a mix, we recently traveled and are dealing with a 11 hour time difference. It has been a week though and I don’t think it is jet lag as it is similar to before we traveled. I did read your article, I have tried a variation of the excuse me drill but not always consistently. Should I try that approach? Any other suggestions? Thanks!
A lot to unpack there. Even if the sleep issues predate the jet lag 11 hours is significant and he could take a week or two for the associated sleep disruptions to resolve. He is a bit young for the excuse me drill but you could try. As always, would recommend a check up with your pediatrician to make sure there isn’t anything going on. Best of luck.