Condition and Description
- 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.
- 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).