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Tackling Toddler Sleep Problems

toddler sleeping

Your 1-year-old cries so hard when you put him to bed that he actually throws up. Your 2-year-old still doesn't sleep through the night. Your 2-and-a-half-year-old shares your bed, or perhaps your 3-year-old wakes in the middle of the night screaming bloody murder.

Sound familiar? If these toddler sleep issues don't ring true yet, they may soon. While most toddler sleep issues are related to ages and stages, sometimes underlying health or psychological problems may be at least partly to blame. Regardless of the nocturnal nuisance that's disturbing everyone's sleep, there are sound sleep solutions.

Waking throughout the night (again and again)

Getting your child to sleep through the night is a common and challenging toddler sleep problem. Susan Zafarlotfi, clinical director of the Institute for Sleep and Wake Disorders at the Hackensack University Medical Center in New Jersey, says finding a solution for this one depends on your child's age and whether your child not sleeping through the night has suddenly occurred out of the blue.

"Young toddlers may wake up from teething or they may be sick," she says. "Parents need to step back and see what has happened in recent weeks in their toddlers' lives. Is there a new bed? A new sibling? A change in caregivers? Is the child taking a longer nap?"

If waking up is just a habit and unrelated to teething or any other health issues or changes, Zafarlotfi says to intervene by delaying bedtime. Delaying by 15 to 20 minutes could make your toddler more tired, she says.

If your tot calls out to you during these middle-of-the-night episodes, Zafarlotfi advises going into the room to comfort your toddler with a lullaby, soft music, or any other soothing routine that you use at nighttime. "Assure them that they are OK and then leave their room," she says.

If this scenario happens night after night after night, she says, you should delay going into the room to soothe your child by five minutes each night.

Crying at bedtime to the point of being sick

Should you really just let your toddler cry it out? Often called Ferberizing, this method may seem cruel to some parents, especially if the child cries himself or herself sick. Other parents swear by it.

"It's very hard to do," says Mary Michaeleen Cradock, clinical psychologist with St. Louis Children's Hospital in Missouri. "But we know of no negative effects of using the Ferber method."  Often times, one parent can handle the wailing and the other one simply cannot, she says. "If you are letting your child cry it out, one of you may want to go to the gym or put on an iPod while the other deals with the crying." If you choose this approach, you need to be prepared to stay committed to it for four to five nights.

Ferberizing is really all about changing your toddlers' sleep associations, which should solve this toddler sleep issue. "If a mom rocks her toddler to sleep, this is that child's sleep association. If the goal is to get the toddler to go sleep by herself, you need to shift the association to one that she can do herself -- the Ferber method is one way to do that," Cradock says.

If letting your child cry until she vomits seems too barbaric, go into the room after your child cries for a set amount of time, rub her back, and say, "Mommy is going to sleep, too," and then walk away, Zafarlotfi says. You may have to do this a few times a night before your toddler is comfortable. If this cry-it-out method is not something that you or your partner (or toddler) can stomach, discuss alternative methods with your pediatrician.

The bedtime routines that never end

Sleep specialist Rafael Pelayo, MD, an associate professor of sleep medicine at Stanford University School of Medicine, says, "The goal is to make bedtime a positive experience." In two-parent households, bedtime can become tumultuous. "Either one parent says, 'I put her to bed last night and now it's your turn,' or one parent is better than the other at putting the kid to sleep and resentment comes in to play," he says. "This is more related to family dynamics than the child. But kids pick up on their parents' stress and anxiety around bedtime, and that gets them stressed out and prolongs bedtime." 

Pelayo recommends the following solution.  "Both parents should go into the room, dim the lights, and chat amongst themselves for about 20 minutes or so because there is nothing more boring, yet more reassuring and safe, than having both parents there," he says. "Instead of saying, 'Let's get this kid to sleep,' just hang out, talk, relax, and think about how lucky you are to have such a great kid."

Preferring your bed over his or her own

Some parents may enjoy sleeping with their children, but this can be a toddler sleep problem in other families. Whether you call it co-sleeping or bed-sharing, this is primarily a cultural or economic issue, Pelayo says. "You can only put baby in a crib if you can afford a crib, and your baby can only have their own room if you can afford it," he says. "It is really a cultural thing to have kids sleep in separate rooms or beds." 

But if both parents agree that bed-sharing is a troublesome toddler sleep issue, "try telling them that mom and dad are happier when they sleep alone because children innately want to please their parents," he says. "Or say, 'There is no such thing as a three-person bed, just two-people beds.'"

Children may be scared to be alone, so you need to let them know that they are safe and secure wherever they sleep.

Breaking this habit can be hard, Zafarlotfi says. It usually starts innocently enough. "A child may have had an earache and slept in their parents' bed and gotten used to it," she says. "If they are accustomed to your bedroom, you need to reverse it and spend more time in their bedroom. Stay in their room on a recliner, dim the lights, and act as if you too are dozing off or relaxing at bedtime or naptime so they know that you are present," she says.

Be positive. "Say, 'Mommy needs her time, but she will come to your room for a while.'" While you are there, "play soothing music and have fun in their room so they know that their bedroom is not for punishment or abandonment," Zafarlotfi says. "When they fall asleep you can say good-bye or sneak out."

Consistency counts too. Zafarlotfi says, "You can't take them to your bed one night and then not let them in the next night."

Nightmares

"The first thing you can do is to look for any physical problems that may be disturbing their sleep," Pelayo says. Snoring, acid reflux, heartburn, or even allergies may be waking your child up at night, not nightmares. "If there doesn't seem to be anything physical causing them to wake and stir," he says, "then it's time to talk about the nightmares. Tell them that they are always safe and that nightmares and dreams are like paintings and drawings, meaning that they can paint a nice picture or scary picture," he says.

Dream rehearsal may also help children take the sting out of nightmares. Here's how it works: "Discuss what happened in the nightmare and come up with a new ending," he says. If your toddler dreamed that he was falling off of a cliff, tell him to imagine that he can fly. Or if the nightmare involved a monster, perhaps the monster could be made of marshmallows, he suggests.

Night Terror

"Night or sleep terrors are not nightmares," Pelayo says. These two toddler sleep disorders differ in certain important ways. "Sleep terrors occur in the first third of the sleep and nightmares tend to occur in the last third of the sleep," he says. Sleep terrors or night terrors are characterized by a bloodcurdling scream, crying, a racing heart, and no memory the next day, he says. By contrast, a nightmare is a dream, and your child is reassured that it was only a dream when he wakes.

"The first thing to do for night terrors is to rule out snoring, because snoring destabilizes sleep, and this can make night terrors, or even sleepwalking, more likely. Destabilized sleep is not deep sleep," Pelayo says. These toddler sleep disorders tend to occur in light sleeps. Once snoring has been ruled out, try waking your child 15 minutes after he or she falls asleep. "They will respond to this scheduled awakening by going to sleep more deeply," Pelayo says. Abide by the 15-minute rule, though, because waking a child much after that may actually cause night terrors.

Toddler Snoring

This toddler sleep problem could be associated with sleep apnea, a potentially dangerous condition in which your child stops breathing repeatedly while asleep. Take your child to a pediatrician, who may recommend your child be evaluated by an ear-nose-and-throat (ENT) specialist.

Thrashing and banging with outbursts of sudden crying

"Safety is the first thing to look out for in situations like these," Zafarlotfi says. "Make sure the crib or bed is as safe as it can be so children can't hurt themselves. If this continues to the point that the child is disturbed, see a sleep specialist for a sleep study," she says. There are many potential causes of this toddler sleep disorder. "It may be a psychological issue, it may be something that they will outgrow, or maybe they are having seizures while they sleep." Depending on the cause and the severity, medication may be in order.

Trying to climb out of the crib

"It may be time for a toddler bed," says Zafarlotfi. "If your child is really trying to climb out, they can end up hurting themselves so you have no choice." This switch can be done in several ways. "Some parents make a big fuss and buy a huge bed, but some parents just buy the bed, place it in the child's room and ask the child whether they want to sleep in the bed or crib."

If your toddler won't stay in his or her bed, "get a safety gate by the door that is too high to climb over and one that they can't crawl under and catch their neck," Zafarlotfi says. On average, children are transitioned to a toddler bed around age 2 or when they are 35 inches tall.

Reviewed on September 24, 2013

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