Fighting Over Bedtime Happens A Lot– Even To Pediatricians
Bedtime battles are a common cause of stress for parents and kids. Sometimes your child may stay calm but use delaying tactics such as asking for another story, glass of water, or the keys to the car. (Just kidding about the last part– that comes later). In other families, the spectacle of a toddler screaming at bedtime and having a full bore tantrum is a nightly occurence.
Dr. Heidi Roman invited me to collaborate with her on a post on her excellent blog, My Two Hats. She writes about some of the difficulties that she and her husband were facing with her 29 month old son.
A couple of weeks ago this changed a bit as, all of a sudden, bedtime became a prolonged affair. Our son usually would fall asleep about 20 minutes after lying down in his crib. Now, he is often falling asleep 1.5-2 hours after the desired bedtime of 8pm. He has found various and sundry ways to delay going to sleep. He would like a drink of water. He needs his blanket fixed. He wants to rock. He has a story to tell or a song to sing. Many of these are actually very endearing, but nonetheless I worry about him not getting enough sleep and admittedly become a little frustrated. On a particularly trying night, I made the mistake of bringing him into our bed to see if he would fall asleep. Fall asleep he did, but he now refuses to go to sleep any other way. Of course.
She notes that this seems to be bedtime resistance given the lack of nocturnal awakenings and the multiple curtain calls at bedtime. I have a long summary post of sleep training techniques, but here is how I would tailor this approach in my clinic. Here is my “prescription:”
Ten Steps to Counter for Bedtime Resistance
- You need to pick a convenient date to address this issue, preferably when you don’t have a big work presentation, vacation, or grandparent visit planned in the next week or so. If a vacation is imminent I usually recommend waiting until after returning from your trip. For more on this, here’s an article on when not to sleep train.
- Prior to starting, spend some time playing with your son in his room, especially in his crib or bed. Frequently kids in this situation really don’t like their room and bed too much when things have gone this far. Make it fun again.
- Bedtime should be brief (30 minutes), predictable, and goal directed. For example, don’t make multiple trips downstairs if the bedroom is upstairs. For more on the importance of bedtime, here’s an article on why you should be a bedtime drill sergeant.
- Two major reasons that parents fail are inconsistency, and failing to push through an extinction burst, which is a brief escalation in resistance after you make a change. Plan on executing the same plan every night for a week, and be aware that things tend to worsen a bit before improving.
- Minimize crying by adding bedtime fading: This means moving your son’s bedtime later than is typical for a few days to increase how sleepy he is at bedtime. A good time to start is the actual time he is a falling asleep. The keys to success include not letting your child sleep later than usual in the morning, and avoiding sneaky sleep in the late afternoon in the car or stroller Once your child is falling asleep within 15-30 minutes you can move this earlier by 15 minutes a day to the desired bedtime. Here is more on how to do bedtime fading.
- Likewise, limit napping after 3 PM. This is critical. If your child is not tired at bedtime, you are going to have a hard time.
- I would absolutely avoid taking him into your bed as doing so drastically worsened your issues. Here’s more on the effects of co-sleeping on sleep. If you have fallen into the co-sleeping trap, here’s a guide on how to stop cosleeping.
- If the steps above have not been effective, you may need to consider a more traditional sleep training approach. Your son needs to relearn falling asleep on his own, in his room. You could either go to an extinction approach (at the later bedtime, expecting him to fall asleep on his own and ignoring his cries) or a more gradual process (having him fall asleep with you in the room nearby x 1-2 nights, then by the door for 1-2 nights, then outside the door for 1-2 nights). Unfortunately, given his age, you are likely to have some tears either way. Personally, we used extinction/ “cry it out” with our sons as it works the quickest.
- If your toddler is in a bed and runs out of his room, you need to bring him back to his room, close the door, and then open it. If he is not in bed, you close it for 2 minutes and then check and see if he is in bed. Rinse and repeat. You will only likely need to do this for a night or two.
- Avoid working on sleep if you are working on another major milestone such as potty training.
- Stay the course. Once you start the process, see it through. Otherwise any tears (yours or your son’s) will have been in vain, and you will have to do it all again later.
Remember, your child’s sleep is a dynamic process. Parents may address sleep difficulties at 7 months but then have sleeping problems come back months later, say, after a vacation, moving to a new house, starting school, or any other major changes. Don’t be discouraged. Once you have achieved good sleep once, you can do it again. Also consider that developmental milestones often trigger sleep difficulties. I always think of walking (around 10 -15 months) or potty training (3-4 years) as being significant triggers. Indeed, Heidi’s son was working on toilet training. Alice Callahan wrote another terrific post at Science of Mom on recent research showing that starting crawling was associated with sleep disruption.
Parents: Are you veterans of the toddler wars? Leave a message in the comments and let us know how you fared.
Thanks so much for collaborating and for your advice, Dr. Canapari. Your suggestions were extremely helpful. All are sleeping well at our house these days. 🙂
Fantastic news!
I was hoping to be able to get some help . My son is 20 months and He sleeps great except when my husband needs to travel for work or someone that was visiting is leaving . He gets up at midnight and constantly cries and won’t calm down for around 3 hours. I tried not picking him up from the crib , talking to him, step out of his room and go back every 10 mins. , reading, singing … Nothing seems to work and will last for 5 days minimum after the person left our home. Is this anxiety separation???? What can we do. My husband is traveling for 6 days next week and I have a 15 days old boy too. Which makes it really hard to have both crying at night. Please help!!
This is an unusual history. I understand why your husband’s absence may generate some sleep disruption but this is quite severe, as you point out. I’m unclear if he falls asleep on his own, or if his dad usually puts him to sleep. If he does, I think that you should alternate bedtime with Dad when he is around.
I would recommend that you review this in detail with your pediatrician. Good luck.
I’m not sure if my last message went thru. He sleeps on his own and I’m the one who put him to bed every night … My husband left town 3 nights ago and still going thru the same issues. He only sleeps his first hour and then he gets up to scream, cry , call us , turns many times , etc. I thought its unusual too. I’ve read articles nothing seems similar to our case. He literally won’t rest the whole night. Even if he goes back to bed after several hours of crying he will keep turning , fussing, talking ,etc until the morning. What can we do. Where can we take him? My husband will be traveling less now because of this matter . It happened when my in laws left our home after visiting for 2 week also.
I would encourage you to meet with a sleep or developmental specialist who can over this matter in detail as it is clearly affecting your entire family in a bad way. Best of luck.
Thank You !!!!!!! Will do
Hello, it’s me. We have a little de-Ferbered being on our hands these days. We are trying to sleep train him again after 3 weeks + of sleep regression. It is getting a little better, but very, very slowly, unlike the first time. Now, he sits up and sometimes stands up in his crib when we let him cry it out. Eventually, he will puke. He has done this every other night now. We let him cry it out a max of 2 hours and then put him to bed – pnly way to get him to sleep is to put a hand on his chest. Any ideas how to get out of this?
The maternal and child health nurse we visited suggested to just do it if that was all he required to put him to sleep. But it’s kind of defeating the purpose of sleep training, which is to get him to self-soothe, isn’t it?
I must also add that he is going through a big stage of separation anxiety at the moment, having started daycare about a month ago as well and still very unsettled when he’s there.
Any suggestions would be most welcomed. I am going to sign us up for sleep school if things don’t improve in a week. The two places I checked out don’t use the Ferber method.
Thanks!
C
That sounds really frustrating. The vomiting is a common issue in this context. It is worth seeing his pediatrician to make sure there is not a medical cause e.g acid reflux or an ear infection. Once you are confident there is no medical cause, you need to ignore the vomiting (change him, change sheets, minimal contact) as relenting after he vomits reinforces the behavior. Moving his bedtime later temporarily may be helpful. Best of luck
Thanks, Craig! That is good to know. C
Dr. C. I have a strange question (maybe). I am a teacher and the first day of school is always a nightmare in sleeping. I was up untl 4:00am in the summer consistently and find that late hours are productive for me. I would wake up about 11:30 or 12:00 so it was only 7 or 8 hours, but in the wrong direction for school hours now. Now (as you might see) it is the morning of school and I am typing to you at 2:15am. What can I do to get backinto a routine. I start to get very panicky when I cannot fall asleep and the strange thing is if I had nothing to do tomorrow, I would be ostensibly out like a light. Now, that I ‘have’ to fall asleep, I am jittery and nervous. Can you offer some help please. Thanks.
This may be a body clock disorder called delayed sleep phase syndrome. There is a little about it on my site. I would recommend that you see a sleep doctor to help you evaluate and manage this.
So glad that I found this website! A coworker of mine recommended that I read your site after I vented to her my frustrations trying to get my 8-month old to sleep through the night.
Here’s our story – If we leave her to cry, within 1 minute, she cries so hard that she vomits. There is no medical reason for her vomiting (I’m a general pediatrician) but she seems to have a very strong gag reflex and just wants mommy lying next to her all night long (doesn’t need milk or to be held).
How do we sleep-train a vomiter? I have heard multiple experts recommend ignoring it and plowing onwards, but she vomits whenever we leave her to cry for more than a minute. That’s a lot of PJ’s and sheets in a single night of sleep training!
Currently, she falls asleep in her crib alone, with me sitting in the corner of her room, just singing a lullaby whenever she cries. As soon as she stops crying, I stop singing. As soon as she closes her eyes and starts soothing herself, I walk out of the room and she falls asleep alone (bedtime takes about 30-45 minutes). Sadly, she wakes up 1-3 times per night and just wants to sleep in bed next to me. I don’t have the energy to repeat the “song-and-dance” all night long and end up bringing her into our bed. That’s all she wants – within 5 minutes she and I are then fast asleep. I thought if she learns to fall asleep in her crib alone at the start of the night, that she would eventually stop with the nocturnal awakenings, but we’ve been in this cycle for about 3 months.
How do I break this routine? Gotta let her vomit? Or just give in and get a bigger bed?
Hi there! You are correct. The conventional wisdom is to allow your child to vomit. Acting otherwise tends to reinforce the vomiting, which is perhaps the most powerful tool your child has available to get your attention. If you wish to proceed with this, you can put multiple layers of sheets on the bed with pads beneath and simply peel them off. When you make the decision to sleep train and your child vomits, you go in, clean her up with a minimum of fuss, and leave. I would guess that this behavior would extinguish itself fairly quickly. If you fix bedtime, you can continue in survival mode in the middle of the night, and the nocturnal awakenings will resolve with time.
Now, many parents have philosophical objections to this approach, which I understand. The alternative is what some have described as the “camping out” method where you slowly remove your presence at bedtime. So, you could stay in her room nearby but not sing the lullaby for a few days, then stand by the door for a few days, then outside the door for a few days. You could go as gradually as you see fit. (This was described in the recent Australian trial which I mention here [http://bit.ly/Q5qU2B].
Another way to minimizing crying is to perform bedtime fading by transiently moving her bedtime later, which I describe here: http://bit.ly/Pvstrd
You know, I wanted to mention this conundrum earlier but my wife (and editor) thought it was too gross to mention. If you would be willing, I would love to share your issue and my thoughts on it, as well as the resolution, in a future post. Let me know.
sure, we’d be interested in hearing more about your thoughts. email me.
Hello Craig, My husband is a surgery resident, and I am a pedi EM fellow. We have been reading your blog for advice and are still having some difficulty getting our 26 month old son to sleep. We had sleep trained him in the past but after we spent the holidays with the grandparents we returned home with major sleep difficulties. Our son was taking 1 and half hours to fall asleep making his bedtime 10:30pm. I therefore picked my week of vacation to re-sleep train him. I instructed his day care not to let him nap more than 1 and half hrs and kept a pretty strict bedtime routine with him. With our new routine lights are out by 9:30pm. But the first night I tried letting him “cry it out”, he jumped out of his crib after 3 hours of continuous crying. He subsequently became pretty proficient at climbing/jumping out of his crib which forced us to transition him to a big boy bed. By the 3rd night he only cried 2 min before falling asleep and woke up once and quickly went back to bed, the following night was a night from hell and was the first night both my husband and I were home together. He cried for 3hrs while i stayed outside of his room holding the door shut. It was awful! Since that night I tried a different approach and stayed in the room on the floor next to his bed until he fell asleep, he still continues to wake up at night and now as the days pass his night time awakening are becoming more frequent and it is becoming more and more difficult to put him back to sleep. When i think he is sleeping and leave the room he wakes up asking for me and as of last night asking to “snuggle”. This is breaking my heart I am loosing my patience and both my husband and I are so tired. I am going back to work this week and therefore trying to decide whether to continue our sleep training efforts and if so using what method? Should I buy a gate instead of holding the door shut? My only concern with using a gate is our house is small and my son’s room looks directly into the living room which is where we tend to do work and relax once he is in bed. Any words of advice would be greatly appreciated. – Frances
Wow, Frances. I feel your pain. Residency is bad enough. A two residency + sleepless child household is hard for me to imagine. Crib jumping is a real problem. Crib tents are no longer approved by the Consumer Protection Agency. Essentially you need to make your son’s room like a crib. I think you are seeing a bit of a delayed extinction burst. Clearly crying it out has proven very painful. I would try the “camping out” approach of gradually moving away from his bed (a little bit more each night– sit next to his bed not touching him, then away from the bed, then by the door, then outside the door (each for 2-3 nights)). Do what you need to survive during the night. I would install a gate AND close the door if possible. If you can’t do both I would stick with the door as you need your downtime, especially if you are on shift work.
In reference to the door opener, i put a twist & grip door knob cover on the inside of his bedroom door. So only an adult can open the door from the outside. Better than holding the door shut. 🙂
Dr. Canapari, do you have any suggestions for an almost three year old boy who is sleep resistant but also awakens several times screaming and crying for no apparent reason? Thank you!