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?
Having quiet time/sitting still with out television and play at intervals during the day helps children and adults learn to settle themselves at night.
Great post, Dr. C. Our 2 year old’s most creative stall tactic so far is calling from his room, “I’m dreaming, I’m dreaming” accompanied by pretend crying. When we go in to calm him, he is sitting up, clearly fully awake, and smiling. 🙂 Look forward to your next installment.
My niece Julia would famously say, “Julia’s hurt” until someone came in, or, when her Aunt Loli was babysitting, “Loli! I have a present for you!”
True story ….
My son always asks to get ‘cozy’. He’ll lie down and want us to put all of the blankets on him and tuck him in. He’ll fight this by refusing to lie down, so we’ll just drape the blankets over him and tiptoe out.
Hey Jason. Good to hear from you. Sounds like you guys are playing it exactly right. Acknowledge your child’s concern but ignore unreasonable requests.
The stall tactics are impressive. Sometimes, when I step back from my frustration, I’m impressed by their creativity. Negotiation skills point to some solid cognitive function going on those little heads. One recent one is fixating on any random owies from the day and begging for a bandaid or an extra kiss to make it feel better. My absolute fave though is when they call out “mommy, I love you so much… I missing you.” Boy that gets me every time. 🙂
But you know what’s been the most challenging actually? Having my kids (3.5 yrs and 2 yrs) share a room. The love-hate antagonism has affected our bedtime process as well. It was our choice to have them share a room, but now sometimes I wonder if it’s more trouble than its worth for the sake of encouraging closeness. Do you have tips on bedtime with shared rooms?
@Yolanda. I’m not aware of any research RE best practices for shared bedtime. Obviously, a shared room has positives (freeing up an extra room, perhaps some improved closeness with siblings) if it is an option. Your children have comparable ages to their sleep schedules are likely compatible. Certainly, siblings close in age can struggle with sharing parental attention. If both parents are available for bedtime, at least for a transitional period, it may be helpful. Can you elaborate more on the problems you are having?
They do have similar sleep schedules (at least we keep it that way). We have consistent bedtime routines and they know when it’s bedtime. I think the main issues are 1) one or the other might try to bother the other, such as climbing into his/her bed, 2) they don’t want to miss out on anything if the other is still awake, so they end up riling each other up into a fit of giggles, and 3) there is a residual desire for more attention since the day has been spent sharing/competing for my attention and energy. I suspect I have hit a stage in life when I just need to tire them out more (both kids are very active) and I may need to find more one-on-one time with each of them. Their hearts seem to just crave it, and it hits hardest at bedtime. The difficulty with the attention issue is that once one wants it, then the other feels the need to demand it as well. I don’t stay with them until they fall asleep though, and they do eventually fall asleep on their own. But it’s a bit of a drawn-out process due to various permutations of the above on any given day.
Sibling dynamics are a new thing for me since I am an only child. The ways they love each other one minute then hate each other the next is just as new to me as I’m sure it is for them. I want them to share a room, but some nights I do wonder if it just makes the sibling rivalry worse. 🙂
I have an upcoming post on sleep training techniques, but you might find that moving bedtime 30 min later (bedtime fading) may help you out a bit. Being a bit more tired can help with these issues.
Just left a comment on Part 1– but my 3 year old (2 at the time) came up with a great excuse– at nap time he drew a picture of himself and suggested I put the picture to bed instead, that he himself had playing to do and didn’t need a nap. The excuses and stall tactics I’ve heard…
Oh my gosh! YES! This is exactly what we’ve gone through.
My son was a fantastic sleeper until he quit sucking his thumb cold-turkey when he turned 3 years old. I was so proud of him for that, but ever since (for the last 6 weeks) he’s had real troubles falling asleep – it’s been more and more excuses (the curtains aren’t hanging right, i’m afraid of the dark, I’m scared without you, I need you here). At first I thought it was fine to just whisper him a calming story until he fell asleep, but he’s been waking in the middle of every night since SCREAMING for me frantically. We caved and put a pile of blankets at the foot of our bed so if he needs us he can come in and lie down at the foot of our bed, but that doesn’t solve the problem of the night waking and even worse he wakes us up when he wakes up (which is now before 6am wherease with the thumb he used to just lie in bed calmly until at least 6:30 or 7).
It’s clear from your post that he now has an inappropriate sleep association of me being there while he sleeps. I need to re-sleep train him.
This is a great post, but it fails to mention that many battles are a result of a bedtime that is too LATE. These kids are wound up and overtired; it’s no wonder they can’t fall asleep. I agree that older children (like 10 yrs) may need a post 8pm bedtime, but in really young kids (like 2-6) earlier bedtimes will solve a lot of problems.
Thanks for the comment, Stephanie!
My two year old will occasionally throw her lovey/blanket/pillow out of the crib and then cry that she needs it. Then when we call her out on it she chuckles….
Classic move! The chuckles are the best part.