Getting children to fall asleep and stay asleep

Overall, studies indicate that 15 to 20 percent of one to three year olds continue to have nightwakings. Stephanie Zandieh, M.D., director, Pediatric Sleep Disorders and Apnea Center at the Valley Hospital, says, "Inappropriate sleep associations are the primary cause of frequent nightwakings. Sleep associations are those conditions that are habitually present at the time of sleep onset and in the presence of which the infant or child has learned to fall asleep. These same conditions are then required in order for the infant or child to fall back to sleep following periodic normal nighttime arousals."

Sleep associations can be appropriate (e.g., thumb sucking) or problematic (e.g., rocking, nursing, parental presence). "Problematic sleep associations are those that require parental intervention and thus cannot be reestablished independently by the child upon awakening during the night," adds Dr. Zandieh.

Here are some helpful tips to help your child sleep through the night:

1. Develop an appropriate sleep schedule with an early bedtime. Ironically, the more tired your child is, the more times she will awaken during the night. As such, be sure your child continues to take naps during the day and set an early bedtime.
2. Introduce a security or love object to your child. A transitional object, like a stuffed toy, doll or blanket, helps a child feel safe and secure when you are not present. Help your child become attached to a security object by including it as a part of the bedtime routine. In addition, try to include this object whenever you are cuddling or comforting your child.
3. Bedtime routine: Establish a consistent bedtime routine that includes calm and enjoyable activities, such as a bath and a bedtime story.
4. Consistent bedroom environment: Make sure your child's bedroom environment is the same at bedtime as it is throughout the night. (e.g. lighting)
5. Put your child to bed awake: After the bedtime routine, put your child into her crib awake and leave the room. Remember, the key to having your child sleep through the night is to have her learn to fall asleep on her own, so she can put herself back to sleep when she naturally awakens during the night.
6. Checking method: If your child cries or yells, check on her. Wait for as long or as short a time as you wish. For some children, frequent checking is effective; for others, infrequent checking works best. Continue returning to check on your child as long as she is crying or upset. The visits should be brief (one minute) and non-stimulating. Calmly tell you child it's time to go to sleep. The purpose of returning to the room is to reassure your child that you are still present and to reassure yourself that you child is okay.
7. Respond to your child during the night: In the beginning, respond to your child as you normally do throughout the night. Research indicates that the majority of children will naturally being sleeping through the night within 12 weeks of falling asleep quickly and easily at bedtime. If your child continues to awaken during the night after several weeks, then use the same checking method during the night as you did at bedtime.
8. A more gradual approach: Some parents feel that not being present when their child falls asleep feels like too big of a first step for them and their child. A more gradual approach is to teach your child to fall asleep on her own, but with you in the room. This approach may take longer, but it can feel more comfortable for some families. The first step is to put your child into her crib awake and sit on a chair next to it. Once she is able to consistently fall asleep this way, sit farther and farther away every three to four nights until you are in the hallway and no longer in sight.
9. Be consistent and don't give up. The first few nights are likely to be very challenging and often the second or third night is worse than the first night. However, within a few nights to a week, you will begin to see improvement.

If you are concerned about your child's sleeping habits or would like support in helping your child to develop healthy sleeping habits, please visit Valley Medical Group's Pediatric Sleep Disorders and Apnea Center's website.