Behavioral insomnia in children, part 2
“Bedtime” conjures up images of warm milk, cuddles, footie pajamas, and Goodnight Moon. It should be a lovely capstone for parent and child. For some families, however, bedtime is a pitched battle of wills between parent and child. This phenomenon is pretty common and is known as bedtime resistance, but may go by the unwieldy term “behavioral insomnia of childhood, limit setting type”. 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. This is why switching from a crib to a bed if your child is having sleep problems is a bad idea— it can worsen preexisting sleep problems.
Why won’t my child go to bed?
Previously, I described 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.
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). If your child is afraid, here’s my favorite technique for night time fears.
- “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”
- In perhaps the best curtain call ever, a little boy would regularly throw his prosthetic eye on the floor
Now, every parent has had a child try to delay bedtime a bit or encountered a rare curtain call. That is perfectly normal. Bedtime resistance 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
How can I fix bedtime so it isn’t a disaster?
The most important thing is consistency. If you sometimes give in to your child’s requests, and other times don’t, this provides intermittent positive reinforcement. This is analogous to a slot machine.
It’s also important to be aware of issues such as restless leg syndrome or anxiety which can also cause difficulty falling asleep. An inappropriately early bedtime can also cause issues– if you are expecting your ten year old to go to sleep at 7:30 PM, you may be disappointed.
Otherwise, techniques such as bedtime fading and the bedtime pass can be very helpful. Here’s a link to my complete inventory of sleep training techniques.
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?