Children and Family | Behavioral Treatment of Bedtime Problems and Night Waking

fussyBedtime wars between adults and children are painful battles in 10 to 20% of families with infants, toddlers, and preschoolers. Many treatment recommendations are confusing and not very helpful.

The Standard of Practice Committee of the American Academy of Sleep Medicine recently reviewed the available scientific literature and studies and came forward with reasonable recommendations about non-medication management of bedtime problems and night time waking in infants and young children. Bedtime problems include protests, crying, and getting out of bed. Attention seeking behavior may include frequent and prolonged night awakenings, running to the parents’ bed, needs for rocking, pressing, singing etc.

The cause of these problems are still unclear, but the consensus is that it is largely due to delay or regression in the neuro-developmental processes of sleep consolidation and depends on a combination of intrinsic (internal) and extrinsic (external, environmental) factors.

What is important is that all researchers believe that such processes might be corrected by behavior modification techniques. Because such problems are brought up by caregivers, there are great influences of the cultural and habitual factors of the caregivers themselves. Among specific recommendations are the following:

– Eliminating reinforcement of prolonged bedtime by shortening the time of the parental presence in the room after the designated time of sleep.

– Education of caretakers about best bedtime routines and sleep schedules, as well as soothing behavior.

– Largely ignoring bedtime crying and tantrums.

– Removing the child from the bed if he/she could not all asleep for a long time.

– Scheduled awakenings (preemptive awakenings) prior to the expected time of the usual awakenings. This technique is not in favor by many parents.

– Positive reinforcement by tokens, verbal praise and any combination of all of the above.

In many cases, these techniques might be really helpful. If not, you should contact your doctor or a sleep specialist.

Reference: Practice Parameters for Behavior Treatment of Bedtime Problems and Night Waking in Infants and Young Children.
SLEEP, Vol.29, 10,2006