How a sleep expert solved three families' common sleep problems.
When it comes to getting babies and toddlers to sleep -- whether it's through the night or just for a nap -- most of us have read the advice. But sleep problems come in all sorts of variations, and are enmeshed with a family's other issues, such as siblings, schedules, and tolerance for crying. A one-size-fits-all solution just doesn't apply to a vast number of exhausted parents' concerns. With that in mind, we decided to give three families the opportunity to consult sleep expert Jodi Mindell, PhD, associate director of the Sleep Disorder Center at the Children's Hospital of Philadelphia and author of Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep (HarperCollins).
Her goal: To find a solution for each child's entrenched sleep problem. Her advice may work for you too!
Family #1: Sharon and John Magner with their sons Ian, 28 months, and Dylan, 12 months, of New Milford, Connecticut
The problem: Twenty-eight-month-old Ian will not go to bed without a fight.
On a typical night, the Magners finish dinner around 6:30, then have half an hour of playtime, followed by a bath. After that, it's downstairs for stories and upstairs to listen to a soothing CD. "Then the demands start," says Sharon. "He wants more books, or for me to get a CD that's in the car. He'll stand at the door and scream, 'No Bed!'"
Because the Magners don't want Ian to wake up his 1-year-old brother, Dylan, they give in to his demands, taking turns going up and down the stairs to see what he wants and to calm him down. On a good night, the process takes an hour. On a bad night, it could take two.
Dr. Mindell weighs in: "The Magners are in good shape; their routine just needs a bit of tweaking and they need to set more limits." Her first recommendation is that they not go back downstairs for stories, instead reading them in Ian's room. "That's derailing him from the goal, which is to get to bed." She also suggested that they become very firm on sticking to the routine, by deciding how many books they'll read, for example, and not giving in when he asks for "just one more." She warned them to expect things to go from bad to worse, as Ian tests the limits.
How it went: "The first two nights were a nightmare," Sharon says. "He wanted all the books. When we said no, that it was time to go to bed, he cried and screamed for half an hour. We took turns going up every five minutes, and he would cry for the one who wasn't there." The same thing happened the next night.
But after that, things improved greatly. "Not going back downstairs has made a huge difference," says Sharon. "Ian put on his pj's, kissed his brother goodnight, and picked out two books. He didn't ask for anything, and we were out the door at eight, wondering what we were going to do with all this time," says Sharon.
The setback: Ian upped the ante. Problems began the second week. "The first time things went downhill, everything was going smoothly until it was time for us to leave," says Sharon. Then Ian announced he had to "go poopy." He had already gone before his bath, so it didn't seem like he really had to go but they took him into the bathroom. Nothing happened. The next night, he wanted to get out of bed twice to go to the bathroom. When they said no the second time, he screamed. But when they finally took him to the toilet, again, nothing happened.
Dr. Mindell weighs in: "Little ones often pull this trick during potty training because they know you have to respond. So that the attention doesn't encourage him more, be really boring. Calmly lead him to the bathroom and back to his room, saying as little as you can on the trip."
How it went: Things weren't getting better -- they were getting worse. Ian was still saying he had to go to the bathroom just as it was time for his parents to leave his room. They allowed him to go, and then tucked him back into bed. But the latest twist was that he insisted on a second back rub after stories. And the minute they got downstairs, Ian was out of bed running around. "One night he was still awake at 10:30! Last night, we went up at nine and Ian was standing next to Dylan's crib, holding his hand in the nursery," says Sharon.
Dr. Mindell weighs in: "Include going to the potty after books as his last step. This way there is no request you are responding to, it's simply part of the routine. After that, do not fulfill any more requests. If he gets out of bed, be really boring about it. Lead him back saying as little as possible and ignore any screaming or whining. He may wake up the baby for a couple of nights, but once he learns that it's not working, he should stop. Finally, tell him after you leave the first time that if he's quiet and stays in bed, you'll come back in five minutes. When you go back, praise him profusely for being such a big boy and staying in bed. Then say, "Now it's night-night time, I love you, and I'll see you in the morning." Using praise is much more effective than scolding."
How it went: "We went into Ian's room within five minutes of putting him down and praised him thoroughly, saying, "You're such a good boy. Keep up the great work," and he stayed there! He was so focused on being good, he fell asleep!" Sharon says. "The praise really works."
Baby Won't Nap
Family #2: Karen and Doug Williams and their children Taylor, 13, Alyson, 4, Nicholas, 3, and Christian, 7 months, of Elkridge, Maryland
The problem: Seven-month-old Christian won't nap, although he sleeps well at night, falling asleep on his own in his crib. He gets up around 6:30 a.m., has a bottle, plays, and eats some cereal around 8:15. By 8:30 he's rubbing his eyes. He'll fall asleep in his mom's arms or in his swing, but as soon as she puts him in his crib, he wakes up. He'll sleep 20 to 30 minutes at most. "I know he's still tired. In the afternoon, it's the same. I put him down around two and he's up 20 minutes later, tired and cranky for the rest of the day," says Karen.
Dr. Mindell weighs in: "There are some easy steps to take that will make a big difference," says Mindell. First, Christian needs to go down for both of his naps earlier. Most babies are ready for a morning nap one-and-a-half hours after they've woken up. If he got up at 6:30 and he's rubbing his eyes at 8:30, you've already missed his window. By that time, he is so overtired he can't soothe himself to sleep. He's ready for a morning nap at 8 a.m. and his afternoon nap by 1 p.m., right after lunch.
Second, Christian needs to nap in a consistent place. It's not a good idea to put him down in the swing or vibrating chair and then try to move him. Instead, put him in his crib and let him cry until he falls asleep. It shouldn't last very long.
How it went: Moving the nap earlier took a little bit of finessing on Karen's part. "I used go to the gym at nine since Christian was always up from his failed nap by then anyway. But I rearranged my schedule to accommodate a real nap." Exactly an hour and a half after he woke up, Karen carried him up to his crib. The first couple of days were hard. He'd start crying on the way up because he knew where he was going. He'd shriek for 15 or 20 minutes in his crib, then fall asleep -- and nap for close to two hours for both naps. "I couldn't believe those small changes could make such a difference!" said Karen.
The setback: Three or four days into the new regimen, Christian started waking up from both his morning and afternoon nap after just 40 minutes. This went on for a few days. Unfortunately, Mindell said that once a child wakes up from a nap, there's nothing you can do to get him back to sleep. "Could Christian be sick?" Mindell asked herself. Her suspicions were correct: Christian had an ear infection. He was waking up because he was uncomfortable.
Once the ear infection cleared up, after about a week, Christian was napping like a pro again -- for at least an hour and a half in both the morning and afternoon. "I can't believe it. We had a complete turnaround in less than two weeks."
Sleeping Through the Night
Family #3: Andrea and Mark Gardner and Cian, 17 months, of Quincy, Massachusetts
The problem: Cian will not sleep through the night. On a typical night, he plays with his mother's hair while he nurses to sleep, around 7:30 p.m. (His mom, who is pregnant, lies down with him in her bed and usually falls asleep herself.) On a good night, he'll sleep until 11:30; other nights he's up again at 9 or 9:30. He wakes up throughout the night to nurse. Andrea and her husband want Cian to sleep through the night in his crib. They're tired of the family bed; Andrea also wants to cut out the nursing: "Now that I'm pregnant, it's starting to hurt!"
Dr. Mindell weighs in: All kids wake up between two and six times during the night. So the question isn't, "Why is he waking up?" but "Why can't he fall back asleep?" The fact that Cian needs to nurse to fall asleep is the source of the problem -- because when he naturally wakes up at night, he requires the same conditions in order to go back down. While traditional advice would focus on having Cian learn to fall asleep on his own as the first step, this change would be too drastic, especially since the Gardners said they would not be able to tolerate a "cry it out approach."
Taking a more gradual approach, Mindell told them to rock Cian to sleep in his room without nursing. Later they would wean him from needing his mom's presence to fall asleep. Learning to sleep through the night would also come later; for now, they'd still bring Cian to their room once he woke up.
How it went: The first couple of nights were deceptively easy -- Cian was suffering from strep throat so after Andrea rocked him for a few minutes, he went down without a fuss in his crib. But the third night was a different story. Cian had a difficult time settling down and cried for a long time while his mother rocked him. That was the worst night. The next few nights were better.
Letting Baby Fall Asleep Alone
Dr. Mindell weighs in: After a week of the new regime, it was time to put Cian in his crib awake. To ease the transition, Andrea would sit by his crib, letting Cian hold her hand. The goal was to move farther away from the crib every few nights, until she was sitting in the doorway.
How it went: "The first night he cried for about a half hour," Andrea recounts. "He sat there, trying to catch my eye, but I wouldn't look at him because I knew that would make things worse. It was really hard, but he finally gave up after a half hour and went to sleep." The second night, Cian played with his mom's hair for 15 minutes, then fell asleep. But moving farther away turned out to be surprisingly difficult. Cian liked playing with his mom's hair and was devastated when he didn't have access to it. Andrea stayed the course, sitting on the floor a foot away from the crib for up to an hour while Cian just lay there, looking at her to make sure she wasn't going to leave.
Finally, after a couple of weeks of floor time, the Gardners were ready to try leaving the room after they'd put Cian in his crib and said goodnight. This time, they had a hard couple of nights of intense screaming. But after that, Cian was going down at night with no trouble, sleeping until 12:30. When he woke up, his parents continued to bring him into their bed. Andrea was only nursing him once at night, usually when he woke up at 12:30.
Dr. Mindell weighs in: It was time for the final step: having Cian spend the whole night in his crib. If he woke up in the middle of the night, Mindell warned them that they couldn't bring him into their bed. Instead, she suggested that one of them go into Cian's room and sleep there if necessary.
How it went: Cian slept until 4 a.m. every night for a week. Mark and Andrea took turns sleeping on the floor in his room so he'd go back to sleep. The Gardners were thrilled that things were going so well, but nervous about how Cian's sleep would be affected during their upcoming vacation.
The setback: They were right to be worried. Everything fell apart when they came home from vacation. Cian hadn't slept with them in their bed, but they had all slept in the same room. When they tried to resume their old routine of leaving the room after putting Cian in his crib, he screamed, even if Andrea or Mark stayed in the room. One night, at their wits' end, they brought him into their bed.
Dr. Mindell weighs in: To reestablish the routine, Mindell advised them to take a step backward. "Go back to sitting next to his crib until he falls asleep, holding his hand."
How it went: The first few nights, it took Cian 45 minutes to fall asleep with Mark sitting by his crib; after two weeks they were down to 15 minutes. Now it was back to the same painstaking process of inching out the door. When Mark tried to leave, Cian screamed. Mark was spending 30 to 45 minutes sitting in the doorway before Cian fell asleep. It took the Gardners about six weeks to return to where they were before they left for vacation. "Cian is having more and more nights where he actually sleeps through the night! I can honestly say that I never thought I would see this day," says Andrea.
Originally published in the January 2004 issue of American Baby magazine.
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