The Toddler and Family : Selected sleep disturbances during infancy and early childhood

        • Selected sleep disturbances during infancy and early childhood

Condition and Description

Management

Nighttime feeding

  • Child has prolonged need for middle-of-night bottle or breastfeeding.
  • Child goes to sleep at breast or with bottle.
  • Awakenings are frequent (may be hourly).
  • Child returns to sleep after feeding; other comfort measures (e.g., rocking or holding) are usually ineffective.
  • Increase daytime feeding intervals to 4 hours or more (may need to be done gradually).
  • Offer last feeding as late as possible at night; may need to gradually reduce amount of formula or length of breastfeeding.
  • Offer no bottles in bed.
  • Put to bed awake.
  • When child is crying, check at progressively longer intervals each night; reassure child but do not hold, rock, take to parent’s bed, or give bottle or pacifier.

Developmental Nighttime Crying

  • Child 6–12 months of age with undisturbed
  • nighttime sleep now awakens abruptly; may be
  • accompanied by nightmares.
  • Reassure parents that this phase is temporary.
  • Enter room immediately to check on child, but keep reassurances brief.
  • Avoid feeding, rocking, taking to parent’s bed, or any other routine that may initiate trained nighttime crying.

Refusal to Go to Sleep

  • Child resists bedtime and comes out of room repeatedly.
  • Nighttime sleep may be continuous, but frequent awakenings and refusal to return to sleep may occur and become a problem if parent allows child to deviate from usual sleep pattern.
  • Evaluate if hour of sleep is too early (child may resist sleep if not tired).
  • Help parents establish consistent before bedtime routine and enforce consistent limits regarding child’s bedtime behavior.
  • If child persists in leaving bedroom, close door for progressively longer periods.
  • Use reward system with child to provide motivation.

Trained Nighttime Crying (Inappropriate Sleep Associations)

  • Child typically falls asleep in place other than own bed (e.g., rocking chair or parent’s bed) and is brought to own bed while asleep; on awakening, cries until usual routine is instituted (e.g., rocking).
  • Put child in own bed when awake.
  • If possible, arrange sleeping area separate from other family members.
  • When child is crying, check at progressively longer intervals each night; reassure child, but do not resume usual routine.

Nighttime Fears

  • Child resists going to bed or wakes during night because of fears.
  • Child seeks parent’s physical presence and falls asleep easily with parent nearby unless fear is overwhelming.
  • Evaluate if hour of sleep is too early (child may fantasize when nothing to do but think in dark room).
  • Calmly reassure frightened child; keeping night light on may be helpful.
  • Use reward system with child to provide motivation to deal with fears.
  • Avoid patterns that can lead to additional problems (e.g., sleeping with child or taking child to parent’s room).
  • If child’s fear is overwhelming, consider desensitization (e.g., progressively spending longer periods of time alone; consult professional help for protracted fears).
  • Distinguish between nightmares and sleep terrors (confused partial arousals).