The NeverEnding Bedtime

I am very excited to have Dr. Craig Canapari here on My Two Hats this week as the blog’s first guest. Dr. Canapari is a board certified pediatric pulmonologist and sleep specialist at Massachusetts General Hospital for Children, where he cares for children with sleep and breathing problems. He is here today with great advice regarding bedtime resistance in toddlers. I think his thoughts will prove very helpful for many families, as they did for us. So, check out the post, and then head over to his great blog for more fantastic tips about sleep and children.

The Scenario

Our little guy, now 29 months old, has been a pretty great sleeper for a long while now. It didn’t start out that way, and we’ve had our blips and bumps along the way, but for the past year or so we can pretty much count on sleeping through the night and a good nap.

A couple 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.

After consulting Dr. Canapari’s blog, I realize that we have a case of the “behavioral insomnia (limit setting type).” But now, what to do about it? Given that my husband and I are both sleep softies I don’t think that we’ll be able to just put him down in his crib and walk away. So, what options are out there for a couple of sleep softies and a very creative little insomniac who need to get some rest?

Dr. Canapari’s Advice:

Dear Heidi

I have a couple of thoughts on this. First, I wonder what prompted the change in your son’s sleep habits. Some causes can be new incipient developmental milestones (I think of walking and toilet training as being two milestones associated with sleep disruption). Any disruption in routine such as vacation, moving, or starting a new school can result in these issues. Sometimes, it is unclear what prompts the change. Everyone (even a child) is entitled to a bad night of sleep. In some children, a single off night with some unexpected but welcome parental accommodation can lead to sleep problems, which is what I suspect happened with your little boy.

The most likely cause of your son’s difficulties are behavioral insomnia of childhood, limit setting type, given the frequent curtain calls, lack of nocturnal awakenings, and lack of leg complaints to suggest a restless leg component. Fortunately, this is not terribly difficult to treat. Now, taking into account that you and your husband are self professed softies, I would make a couple of recommendations as I would if we were discussing this in clinic.

1.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 deferring this to after returning from your trip.

2. Prior to starting spend some time playing with your son in his room, especially in his crib or bed. Frequently kids become averse to the sleep environment. Make it fun again.

3. Bedtime in this context should be brief (30 minutes), predictable, and goal directed e.g. don’t make multiple trips downstairs if the bedroom is upstairs.

4.Two major reasons that parents fail are inconsistency, and failing to push through an extinction burst, which is a brief escalation in sleep difficulties during training.

5. An important part of minimizing fussing with training is bedtime fading. This means moving your son’s bedtime later than is typical for a few days to increase sleep drive at bedtime. If your desired bedtime is 8 PM, 9 is okay, but may need to be later if he consistently falling asleep later. The keys to successful bedtime fading include not letting your child sleep later than usual in the morning, and avoiding sneaky sleep in the late afternoon either in the car, stroller or other venue. Once your child is falling asleep within 15-30 minutes you can move this earlier by 15 minutes a day to the desired bedtime.

6.
I would absolutely avoid taking him into your bed as doing so drastically worsened your issues.

7.
Now here is the hard part. Your son needs to relearn falling asleep on his own, in his room. You could either go straight 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, so I as a parent have generally chosen the shorter approach.

8. In a 29 month old, rewards e.g. via a sticker chart, may be helpful.

9. Avoid working on sleep if you are working on another major milestone such as potty training.

10. 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.

I have more about the scientific rationale for these techniques here.

-Dr. Canapari

I’m happy to report that about one week after implementing a number of these strategies our little guy is falling asleep in his own bed after a much shorter bedtime routine. And, with very few tears from anybody at our house. 🙂 Thanks, Dr. Canapari!

12 thoughts on “The NeverEnding Bedtime

  1. I also recommend the book “The Sleep Fairy.” We read it to our 3 year old every night and before her nap and reward her when she doesn’t get up at all. It works wonders!

  2. Pingback: The Never-Ending Bedtime: A Concrete Plan for Addressing Bedtime Resistance | Craig Canapari, MD

  3. Heidi, I ran into the same issue that you faced with my daughter. We brought her into bed with us when she was sick with the stomach flu, which resulted in a crib aversion (“mommy, my cozy bed is a no-no”). I’m happy to report that Dr. Canapari’s method seems to have worked for us also. The 2nd night was rough (up from 11-2 am in her crib and jumping almost the whole time), but she slept in her crib all night every night for the last week. She’s 22 months old now and also bought into the sticker chart. She’s going to sleep much easier after following the plan as well.

    I sitll hear her wake up at least once or twice a night and cry, but she goes back to sleep. Any thoughts on what’s vexing her in the night?

    • I’m really happy to hear that this worked for you. I think that it is sometimes hard to know what is going on in a child this age. Often brief episodes of crying out represent confusional arousals (like a night terror but milder) and not true distress. I think that the important part is ignoring these events if they are mild, because otherwise you may reinforce them.

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  6. I’m in desperately need of help! My 26 month old boy was sleeping thru the night since he was 13 months . He was moved into a toodler bed when he was 22 months and still slept thru the night with no issues. 9 days ago he got sick for the first time ever with strep throat and he was better after 2 days of antibiotics. However ever since then he is getting up several times at night and takes about 1 hours or so to go back to sleep. But refusing to be put back in bed. He stays on the floor or the couch ! We place him back on his bed once he is asleep. But Is gotten into a point on where he gets up every 2 hours he ocassionally ask for water or bottle which he takes sometimes once before going to bed ( but won’t take the bottle to bed ). Plus we have an infant that also gets up to eat every 3 Hours that sleep in our bedroom . Please help!!!!!!!!!! Nothing has change his father travels for days since he was 12 months old , he used to cry in the middle of the night once he wasn’t home but after a while he got used to it. He is not coughing or feeling sick, his molars are out …. Any advice will help

    • Dear Fiorella, So sorry for what you are going through. As Dr. Canapari mentioned in the post, vacations or illness can lead to change in sleep routine, and I suspect that although your son is feeling better, he is still readjusting to a routine after not feeling well. I highly recommend the approach Dr. Canapari outlines. Sticking to a consistent bedtime routine has been the most important part of getting back on track when my son has sleep difficulties. I also recommend the “silent return to sleep” method for when he wakes up and gets out of bed at night. Take his hand, lead him back to his bed, and return to your own bed without talking to him or engaging with him in any way. If he gets out of bed again (which he probably will), repeat the same procedure. It may take any number of times, but he will eventually realize that it is nighttime and time to sleep. It is really hard, but resisting the urge to interact with him helps reinforce the importance of him sleeping in his bed. If your son has fever or is acting ill in any way, then it is time to consult with your physician.

  7. Pingback: The Never-Ending Bedtime: A Concrete Plan for Addressing Bedtime Resistance - Craig Canapari, MD -

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