Tuesday, January 17th, 2012
I’ve heard from a lot of (tired!) parents about my recent blog post on the sleep challenges you’ll face in the toddler years - many have asked for more specific advice. So I’m offering some tips I received as a parent who took my toddler to a sleep clinic (as I was befuddled by the whole thing and waved the white flag!).
You need to convince your toddler that sleep is not a punishment. This to me is the biggest hurdle. Telling a toddler that it’s time to go to sleep can get translated in their head as “It’s time to stop doing something fun.” While you won’t be able to solve this entirely, you will need to find appealing – but not overly stimulating – things to do before bedtime that will transition them to sleep. Your child loves having books read to them and love it when you tell them stories. The trick is to establish these activities (or a combination of them) as the first stage of the bedtime ritual – and it helps even more if you pick a favorite spot in the house where this happens. Make it fun and something to look forward to and plan on around 15-20 minutes of this. AND STICK WITH IT EVERY NIGHT – NO EXCEPTIONS! You are trying to create a routine. TV and any other electronic device is not advised during this transitional time.
You could make going to bed a bit of a game. Maybe it sounds silly to you, but you could try to put a little fun into that difficult time (for some) of actually making the move to your child’s room. Use your imagination. Put a voice to a stuffed animal who coaches them into their room. The idea is to do something that kids like and will look forward to. Kids love rituals if they are fun – and you want to create a “get in bed” ritual.
You may need to get them a big kid bed. We thought it was too early, but the clinic suggested that it was time and gave guidelines about making sure it was safe. The bigger point here is that change may be a good thing for some toddlers – and a big kid bed might make them feel a little pumped up about their development (which you can then use to your advantage by pointing out that big kids go to sleep at a proper time at night – all’s fair in sleep wars!)
You need to help your toddler handle their new emotions about sleep. Expect to do a lot of soothing. Toddlers start to experience changes in their sleep cycles which make them wake up after a few hours of sleep. They may be afraid of being apart from you. They may remember bad dreams. They may be a little scared about the big kid bed you just introduced! Find a transitional object (I used to use one of my T-shirts) for your kid to cuddle with along with a stuffed animal. And then consider that …
“Graduated extinction” can be a very helpful method for toddlers with sleep issues. We all have our favorite methods. But since the assumption is that nothing is working now (remember, I was at a sleep clinic), we started from scratch following the principles of graduated extinction. Here’s how we did it. Week 1: We sat up on the bed for about 10-15 minutes and then left the room (this was with full disclosure to our daughter). If she woke up crying, we would sit on the bed for 5-7 minutes. Week 2: We sat up on the bed for 5 minutes and then sat in a chair for 5 minutes (if she woke up crying we sat on the bed for 2 minutes and in the chair for 2 minutes). Week 3. Same as week 2, except we sat in the chair for 2 minutes and then left the room (if she woke up crying we repeated the process – the point being we eventually left the room). Week 4: Realized that she preferred if we sat on the bed for 10-15 minutes (the Week 1 routine) and then left the room before she was fully asleep (the sleep clinic clinician loved this on our follow-up visit because our daughter partnered with us to let us know what she liked). We stayed with this for quite a long time and she hardly ever woke up overnight.
Reward sleep behaviors! Find a simple (and cheap!) reward system. Stickers worked really well. Every morning if we met a goal (like getting back to sleep if she woke up or sleeping through the night) our daughter would pick out a sticker to place on a fun calendar in her room. If it’s a bad night for no reason (e.g., she wasn’t sick) – no sticker.
Monitor the naps really closely. Part of the deal was to calibrate the daily nap – 1 hour every day around 2 in the afternoon. We did whatever it took to make this happen. Walked her in a stroller. Drove her in the car. Didn’t care. The point was the nap was from 2-3 every day, no matter who she was with. The sleep clinic endorsed this and wan’t concerned with how we got her to sleep (the faster the better!) as long as we woke her up after an hour. Following this routine, she was tired around 9 at night and slept until 8 the next morning nearly every night.
Be vigilant about changes in the routine. Life happens. Kids get sick. Schedules change. Holidays arrive. Visitors arrive. Whenever you get thrown off, try to get right back into the routine and be really strict about sticking with it.
So that’s it – some tips from a real life visit to a sleep clinic. Will these tips work for you? Some may and some may not. Every kid is different. Some toddlers may seem “hard-wired” to not sleep much. But the principles discussed here are really important, as is the very serious endorsement of talking to your pediatrician about visiting a pediatric sleep clinic if these tips (or others you come across) don’t work. They will come up with a plan for you, your child, and your situation. And you all will sleep much better as a result. One other tip: there may be a wait of several months or more for an appointment at a sleep clinic. So if you are thinking of doing this it’s good to get the ball rolling ASAP.