Expert Advice for Common Sleep Problems

Penelope Leach offers her suggestions on getting your little one to rest easier.

Introduction

Q: My 16-month-old naps about 2 times a day for only 30 minutes each time. Needless to say, it's not enough for him or me! He was sleeping well at night until recently, but he's got a cold/virus and has been waking up about 3 to 4 times during the night. Is it possible to encourage him to lengthen his naptimes?

Penelope Leach: I can think of three main reasons for your little son's current nap pattern. Unfortunately, they're all contradictory, so all I can do is pass them on and leave you to see if any one of them makes sense to you. The first is that this is the way he is right now, and although we can say "it's the virus" or " it's his molars coming," there's not really much point looking for a reason because there's isn't one specific one. (The positive side of that is that the pattern will change as inexplicably as it began!)

The second "reason" is that he's reached a stage where two naps are too many, although one nap wouldn't be enough. One and a half naps? Tricky -- in another year you may find one nap is too many and none isn't enough, so you'll be looking for how to arrange half a nap. Seriously, it just may be that things will work out better if instead of a conventional first-half-of-morning and then after-lunch nap, you put your son down at a new time (late morning, for instance) and let him sleep as long as he likes. There are problems because your personal life may rely on him napping in his car seat or stroller so you can be out and about. And you may prefer him to eat lunch at 12 rather than 11 or 3 p.m. What's more, it may be tough keeping him going from the end of that one nap until bedtime.

Which brings me to the third reason: It's possible that he needs more, not less, sleep. Sometimes toddlers sleep better at night if they go to bed earlier rather than being kept up in hopes they'll sleep later in the morning. And sometimes they nap better if they have more nighttime sleep. If you try the one-long-nap idea and it works, putting him to bed at 6.30 p.m. might actually make him wake less often.

If none of that works, I hope time does. That's the one that's always on your side with babies and toddlers.

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Q: My son is 22 and a half months old. Several months ago (just about the time that he started taking longer naps of two hours or so) he began to wake during the night. He opens his bedroom door and cries for us up to three times a night. I don't feel this is a nightmare, but more of a separation issue. My husband and I both explain to him that we have to sleep in our own bed and reassure him that we are there. He will ask us to stay, but again we comfort him and leave the room. He'll go to sleep, but still wakes three or four hours later. Do you have any suggestions or steps we can take to limit and hopefully stop these sleep disruptions?

Penelope Leach: It sounds as if you've figured out that these night wakings are a separation issue. It may have been made worse by an early move from crib to bed: being able to get out of bed is a somewhat scary accomplishment that often makes toddlers aware of the big home around them and anxious about where parents are. One simple change that might help: leaving his bedroom door open. I respect your wish to keep all members of the family in their own beds, but if your toddler is waking up lonely for you, it makes sense to do everything you can to make him feel connected. Open doors (yours as well as his, if possible) with lit space between the two rooms (a light on the landing) might really make the difference. One household I know well even rearranged the toddler's room so that he could get a glimpse of the parents' bed from his own.

Q: I'm the father of an 8-year-old-girl who's having trouble sleeping in her own bed. My wife and I sleep downstairs, along with our 2-year-old twin daughters. Jessica sleeps upstairs in her newly decorated room. It looks great, but she's still afraid of something. We've tried monitors, gifts, rewards, and we're still stumped. One of us has to lie down with her until she falls asleep. Usually one of us falls asleep up there, and the other one has to get him or her. Any suggestions?

Penelope Leach: If an 8-year-old tells you she's afraid, I think you have to accept that it's true, however illogical it seems. The fact that the room looks great really isn't relevant. She may be overwhelmed when she thinks of those twins snuggled close to you while she's left out upstairs.

How long are you going to have the twins sleep in your room and is there any other space you could use for them at night? I also suggest totally stopping the gifts, rewards, etc. This isn't about discipline, it's about love and security.

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Q: My 12-month-old has slept through the night since she was 3 months. Bedtime is 7:30 p.m. and she's never had a problem. The very night we changed the clocks last week, she decided to protest bedtime. For the last week she's been going to sleep at 9 p.m. and with a lot of fussing. She's also stopped her daily two-hour nap. Why the sudden switch just because of a time change? She's exhausted. Help!!

Penelope Leach: Bad luck! Time-changes (and travel across time zones) sometimes have an unreasonably marked effect on babies' sleep patterns. But I think the fact that she's also fighting daytime naps is just an unrelated coincidence. She's at an age when she could be cutting a molar. She's also at an age when she could be having trouble separating from you --- either in the sense of being left in her room or letting herself go away from you into sleep. There's no way a 9 p.m. bedtime with no nap could possibly be right for her. If she was 2 years old, maybe, but as it is you're right to persist with both bedtime and naptime.

Q: My 4-month-old has refused to sleep in his bed ever since he was 2 weeks old. He insists on sleeping in his infant seat. He looks so uncomfortable, but he sleeps most of the night. When he wakes up for his 3:00 a.m. feeding, I put him in bed with me where he stays for the rest of the night. Is this going to confuse him?

Penelope Leach: Although your baby stays asleep in his infant seat (he obviously doesn't feel as uncomfortable as he looks) it would be physically better for him to sleep flat and with room to stretch out. Is there anything associated with the seat that he doesn't get in his bed, like being rocked, maybe? Or does his bed (I assume it's a crib) have a very different look or feel? If so, you could try putting him in his infant seat inside the crib as a first step to making the transfer. Sometimes babies are put off being laid in their own beds because the tight-stretched sheets over a firm mattress feel cool and hard compared with a lap or seat. The fact that he's happy to sleep flat in your bed makes me think this might be relevant. It might be worth experimenting with warming the sheet before you put him in (a hairdryer does it quickly -- make sure the sheet's warm, but not hot to touch) and/or laying him on a shawl or cot blanket. If that works, he may be baby who will always settle better if you use a baby sleeping bag. There are low-TOG, all-cotton ones available that avoid any extra risk of overheating.

As for having him in your bed for the last part of the night, I don't think it will confuse him, but he may decide he prefers it -- and tell you so loudly!

Q: Our nearly 6-month-old daughter has used a pacifier to get to sleep since she was 1 month old. We made it a practice to only give it to her to get to sleep and removed it from her crib after her eyes were closed. She has exhibited the ability to fall asleep without it, but we have recently noticed that she may actually have identified its comforting properties. We would like to remove the pacifier from her sleep-time rituals. What is the best way to do away with it? Or do we need to remove it at all?

Penelope Leach: If your daughter can fall asleep without her pacifier and you want her to give it up, this is probably the last possible moment to phase it out without much fuss. You might like to start by "forgetting" it at naptime. If she can manage that for a few days, she'll manage nighttime too.

If there is a fuss, do you need to do it at all? Only if it's important to you that she shouldn't go on using it all through babyhood.

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Q: My son is 23 months old. About 2 months ago we put him in a "big-boy bed" because we're expecting another child soon and wanted him to be over the transition prior to the arrival of the baby. He was doing great until about 3 weeks ago. He now gets up in the middle of the night several times a week. His bedroom door is open and so is ours and there are plenty of nightlights. When he wakes up he walks down the hallway into our room. If we put him in bed with us, he goes right to sleep. But he's all over the place and my husband and I are unable to sleep with him there. If we put him back in his bed, he cries all night unless my husband sleeps with him. I don't want this to become a habit. How do we get him to sleep in his own bed on his own? Naps have been a problem lately too. He won't take his afternoon nap at home, but does fine at daycare during the week.

Penelope Leach: The transfer to a big bed is always a crossed-fingers business and it sounds as if it was a bit soon for your little boy. It's also possible that he's aware that things are changing with your pregnancy and therefore he's extra anxious to stay close. With a new baby due so soon it seems that all that really matters is finding nighttime peace (there are enough broken nights up ahead). So if having one of you stay close while he goes back to sleep in his own bed won't do, you might like to try putting his bed (or a mattress, if space is short) beside your bed so that he can be with you but out of kicking range. Good luck.

Q: I have a 13-month-old daughter who doesn't sleep during normal sleep times. In the day, she averages 30 to 90 minutes and at night only 5 to 7 hours. Any suggestions to help her sleep more? She doesn't seem to be too fussy, except around 5 to 6 p.m.

Penelope Leach: There's no amount of sleep that's right for every baby so although the hours you give are surprisingly low, they're not necessarily a problem if your little daughter -- and you! -- are flourishing. But if you feel she needs more sleep you might try giving her an early dinner and putting her to bed when she gets fussy around 6 p.m. Although people often assume that putting a child to bed earlier will mean she wakes even earlier, it sometimes works the other way.

Q: We need help! My 27-month-old has recently moved into a new bed. We did this because she refused to sleep in her crib anymore and the bed worked really well -- -up until now. She's been using every stall tactic in the book, including getting out of bed and refusing to return. This is very difficult for us as we have to pick her up and put her in her bed. Then she cries and asks for milk, more stories, and for us to lay with her, etc. We've been really consistent with our bedtime routines and what we allow. I don't like the idea of being harsh with her at bedtime and have tried to be very patient and understanding, but I don't know how much longer I can do this. What's the appropriate action here? I would love her to have a peaceful, happy bedtime.

Penelope Leach: I don't think being "harsh" will help any of you -- and of course, there's nothing you can do to keep your toddler in her big-girl bed against her will. You could try making it clear that she has to stay in her bed but that she doesn't have to go to sleep if she's not ready. Give her a low light, books to look at, a toy she's chosen to take with her. And tell her you'll be back to tuck her in and give her a kiss in 15 minutes.

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All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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