Introduction
It is an all too common scenario: Mrs. Lewis brings in her daughter, Samantha, for her two-year-old checkup. Mrs. Lewis looks terrible; her eyes are red and she seems to be dragging around with little energy. Samantha, on the other hand, is as happy and active as she could be—a delightful little girl. I begin by discussing the usual things that I discuss at checkups: safety, diet, behavior....When I get to that last one, I hear the question that comes my way more than any other question about the behavior of young children: “Doctor, when will my child sleep through the night?”
It seems that Mrs. Lewis has not had an uninterrupted night's sleep for the past two years and it definitely shows.
One of the most frequent problems that concern and aggravate parents is the battle of the bedtime. Many of us find ourselves unable to get the kids to bed at a reasonable time without an unending struggle. Persistent crying and frequent nighttime awakenings further frustrate us. Let's take a look at how the problems start and some possible solutions.
Rock-a-Bye Baby
The problem often begins in early infancy. Most parents of very young infants will feed them at night while rocking them to sleep. They will then quietly tip-toe to the baby's crib and gently lay the child down, praying to all the powers that be that the baby will not wake up. This bedtime ritual is common and perfectly appropriate for the very young infant. I repeat, for the very young infant. Unfortunately, a great many parents mistakenly continue this same technique as their child grows older. It is not unusual for me to see a two-, three- or even a four-year-old put to bed in this fashion. The problem arises when there is a brief awakening in the middle of the night. We all wake up like this several times a night. However, when this child awakens briefly, she has not only no idea where she is or how she got there, she also has no idea how to fall asleep again without the same rigmarole needed to get her down into bed in the first place. The end result is the crying, inconsolable child who must be repeatedly rocked to sleep all night long. Children need to learn to associate being in the crib alone with going to sleep, as opposed to being fed or rocked to sleep. Somewhere between the ages of four and nine months, you must begin to teach your child how to fall asleep on her own.
Rituals are Important
Health
Any of you who are parents will realize how important the bedtime ritual is for kids. Woe be it to the parent who deviates from it in any way. A bedtime ritual, however, is quite important in helping kids know what to expect as bedtime approaches. Kids, believe it or not, like their lives to be orderly and are comforted by such rituals. However silly it may seem, it serves the important purpose of providing the child a smooth and predictable transition to bedtime. The ritual should end with the child in the crib or bed falling asleep on her own.
One must establish a reasonable bedtime and put your child to bed at the same time every night. Remember, bedtime is for parents, not children. You need time at night to act like an adult, without children present. It is in both your and your child's best interest to get the kids to bed at a reasonable time.
How to begin
The start of quiet time begins about 30 minutes before bedtime. This serves both to alert the older children that bedtime is imminent and to end the playing of "monster games" and other rough-housing. Such a time can be soothing for infants. Quiet time is reading or coloring or playing quietly. As the end of quiet time approaches, provide a countdown for the older child: "Ten minutes to bedtime," "Five minutes to bedtime..." Once quiet time is over, the bedtime ritual should begin. Depending on age, this may involve anything from baths, stories, drinks, bathroom trips, and kisses, to searching the child's room to make sure there are no monsters under the bed or in the closet. Whatever the ritual is, it should be repeated without deviation every night.
Going to Bed vs. Going to Sleep
There is a distinction to be made here. There is a difference between bedtime and sleep time. Parents determine bedtime. Children determine sleep time. You can put a child to bed, but you can't make him sleep. So don't try. If the child wishes to sing quietly or look at books for seemingly endless periods of time, that is his choice, and there is really nothing wrong with that as long as the child remains in bed. Despite your wishful thinking, you cannot force a child to sleep.
Have your child in bed at the established time. Tell him good night and that you will see him in the morning. Turn off the light, leave the room, and close the door. Door closing is optional, but I happen to be a big fan of this practice. If your bedroom door is closed, the child should knock before entering. If the child's door is closed, you should do the same. Closing a child's door and allowing a child to close his own door affords him a sense of privacy and personal space that I find quite valuable.
What About the Crying?
Now comes the hard part. You've gone through your ritual, put the child down to bed, and left the room. Some very easy kids will just amuse themselves and go to sleep. If you have one of those, you are not likely to be reading this article. Most kids will test you to see if you mean it. The best way to test you is to cry. In my years of caring for children, I have noticed that there are two types of people in the world, those that can listen to a child cry, and those who cannot. There are techniques to use for both types of parents. For the select few who feel like they can handle listening to their child, who is older than the age of eight to nine months, cry, I suggest the “cold turkey” method of dealing with bedtime crying. In order to use the cold turkey method, one must really mean it. Parents must be prepared for long periods of crying the first few days. Many parents, however, are pleasantly surprised that the children give in remarkably easily and without a lot of fuss. This is especially true if time-out techniques have been used previously, you mean what you say, and you have been consistent in dealing with your kids' behavior. But there is no question that some kids will test you to the limit.
Let Them Cry
Once the door is closed, do not go back in the room. Once you have left, you must ignore all crying, whining, and pleading that may emanate from the room, no matter how pathetic or distressed it may sound. Research studies have shown that parents who are willing to do this will, in most cases, have good results within one week. Be warned however, that these same studies have shown that crying time will markedly increase the first few days that you use this technique. Thereafter, crying time will diminish rapidly and dramatically. How long do you let the child cry? As long as it takes. The last thing you want to do is to say, "I can't take this any more, I'm going back in there." If you go back in after 45 minutes of crying, you have just taught your child that not only don't you mean what you say, but that he has to cry for 45 minutes before you come back in.
How long do kids cry? Depending on the temperament of the child, as little as 10 minutes, or as long as two to three hours. Don't get discouraged, as it will quickly taper off. This method is more useful for older kids and I would not recommend using this technique for children younger than eight to nine months of age. The older child has already established a solid basic sense of trust, and the extended crying will not be a problem. And no child has ever been physically hurt by crying alone. Indeed, most parents suffer more in the listening than the child does in the crying.
A Kinder, Gentler Approach
If you know that you fall in the latter group, and that you would simply be unable to listen to your child cry, then there is an alternative. It is a bit more complicated and it takes a lot longer to see results, but many people prefer it. It involves gradually increasing the crying time over a period of weeks, with the parent initially leaving the room and then returning to comfort the child and be there while he gets to sleep. You are not allowed to pick the child up or to feed him, and he must be put in the crib while awake. This method was popularized by Dr. Richard Ferber and is described in detail in his wonderful book, Solve Your Child's Sleep Problems.
Once the child is put down to bed after the ritual is completed and you leave the room, you wait for the child to cry. The first time the child cries, you should immediately respond by coming back into the room and soothing the child by voice and touch. However, you cannot pick the child up nor feed her. You should stay with her until she falls asleep. At the next awakening, wait one minute before responding, at the third, wait three minutes, and so on. Each few nights you should increase the amount of time it takes for you to respond to both the initial bedtime and to each of the awakenings. You should never pick the child up or feed her. Eventually, when you are up to 15, 20, or 30 minutes or so, the child will simply fall asleep without you and then you are on your way. As I said, many people prefer this method, despite it taking longer. I guess it depends whether you like your discomfort all at once, or in little bits for a longer time.
A Good Night's Sleep
As I said earlier, bedtime is for parents, not for children. It is important for you as well as your child to defuse the battle of the bedtime. It's hard to be a good care giver when you are sleep deprived. The best way is to use these techniques at the beginning, before a problem arises. Put your young infant in the crib while awake and teach her how to fall asleep on her own. But even if you're too late for that, don't despair; these techniques work quite well even in older kids with years of experience of having figured out that you don't mean what you say. The key to all of these behavioral techniques is consistency and calm. Once you prove that you mean what you say, either gradually or cold turkey, life with your children can improve dramatically.
