This page* offers parenting tips and information condensed from the book
by Dr. Brenda Hussey-Gardner ©1992-2003

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Sleeping through the Night
[ Safety | Sleep Patterns | Sleep Training ]

Sleep problems are a common occurrence in early childhood, affecting about 25% of all young children. Difficulty going to sleep at bedtime, nighttime waking, and early morning waking are the three most common sleep problems. If I have a sleep problem, you may already have a strategy that works well. But if I have a sleep problem for which you have not found a satisfactory solution, you should change my sleep pattern and/or start sleep training. Whether I currently sleep through the night or you need to teach me to do so, you need to ensure that I am safe when I sleep.


Safety Notes [ Top]

Sleep Position for Infants
The American Academy of Pediatrics recommends that healthy babies be placed on their back for sleeping in order to reduce the incidence of Sudden Infant Death Syndrome (SIDS). However, the Academy states that certain babies should still be placed on their stomach (prone) for sleep: For premature infants with respiratory distress, for infants with symptoms of gastroesophageal reflux (spitting up), or with certain upper airway anomalies, and perhaps for some other reasons, prone may well be the position of choice. Always ask my doctor which position is best for me when sleeping. Remember that I should spend some time playing on my stomach during awake times (unless instructed otherwise by my doctor).

Sleeping in a Crib
When I am small and sleep in a crib, make sure that all toys in my crib are safe. Toys should not have buttons or other small pieces that I might choke on, sharp edges that I might get cut on, long ribbons or strings that I might get caught in. Remove large stuffed animals or toys that I might use to climb out of the crib. Remember to use a night light so I can see clearly in the room. (This is essential for children with hearing impairments.)

Sleeping in a Bed
When I am older and sleep in a bed, the entire room must by safety-proofed. Make sure that all toys in my room are safe. Put dangerous toys and items out of reach or in another room. Put safety covers on all electrical outlets. Use bed rails, if needed, to keep me from falling out of bed. Remember to continue to use a night light.


Changing Sleep Patterns [ Top]

If I take too many naps, nap late in the afternoon, or go to bed too early, I can have difficulty sleeping through the night because of a poor sleep pattern. The amount of sleep each child needs does vary. Nevertheless, knowing the average amount of day and night sleep young children need will help you understand how much sleep I need.

AVERAGE NIGHT AND DAY SLEEP PATTERNS

Age

Night Hours

Day Hours

12 months 10 1/2 3 1/2
18 months 10 1/2 3
2 years 10 1-3
3 years 10 1-2
4 years 11 1/2 0
**Adapted from Barnard & Erickson (1976), Coley (1978), Ferber (1985).

If I take too many naps I may resist going to sleep at bedtime because I am not tired. To drop one of my naps, delay my nap by ten minutes each day. At the same time, shorten the length of the nap by ten minutes each day. Continue delaying and shortening my nap until it no longer exists.

If I take a late afternoon nap and have difficulty sleeping at night, gradually change the time of my nap by making it ten to fifteen minutes earlier each day. It is best if my afternoon nap begins before 3:00 p.m. If I refuse to sleep in the afternoon but consistently fall asleep at dinner time, I may be ready to give up my nap. As I make this transition, allow me to take a brief nap before dinner. This nap must be short or it will interfere with nighttime sleep. Thirty minutes should be long enough to keep the "grouches" away, but short enough to allow me to sleep well at night.

If I go to bed at one time but consistently fall asleep two to three hours later, my bedtime may be too early. A simple solution is to delay my bedtime until the time I usually fall asleep. However, this is not an appropriate long-term solution if I go to bed at 10:00 p.m. and fall asleep at 12:30 a.m. If I go to bed late and consistently fall asleep even later, temporarily delay my bedtime. After a few nights, advance my bedtime and the time of my morning waking by 15 minutes each day. Continue advancing bedtime and wake time until the timing of my sleep is acceptable.

If I have trouble sleeping through the night and my sleep pattern needs improvement, adjust my schedule before initiating sleep training. Once I'm on a good schedule, night sleep may improve.


Sleep Training [ Top]

Sleep training involves teaching me to go to sleep by myself and to sleep through the night. This does not mean that I will not wake up during the night. It means that I will have the skills needed to put myself back to sleep without your help. Most children older than six months of age are capable of sleeping through the night, and can learn how to do so if they are not. If I have a central nervous system disorder, I am on medication, or I am ill, discuss my sleep issues with my pediatrician. Follow the guidance of my pediatrician regarding sleep training.

There are four basic steps to teaching me how to sleep. To teach me to sleep through the night as quickly as possible, be consistent with each step. Most parents see improvement by the third night. By the end of one week, I should be sleeping through the night.

Step 1. Implement a Bedtime Routine.

Take from ten to thirty minutes each night to set up a consistent routine that I will associate with getting ready for bed. Examples of appropriate activities include brushing teeth, taking a bath, putting on pajamas, reading a story, singing a song, and saying prayers.

Step 2. Put me into bed using the Gentle or the Regular Technique.

Gentle Technique

In my dimly lit and quiet bedroom, put me to sleep any way that you like. When I am asleep, put me into bed. If I wake up once I am in bed, I must return to sleep independently. Implement the 2-In & 15-Out or the Gradual Method if I wake up or have difficulty going back to sleep. Most young children can learn to go to sleep one way and to go back to sleep another way. The important distinguishing factor is my bed. If I am in my bed, I must go to sleep by myself.

Regular Technique

Put me in my bed sleepy but awake so that I will put myself to sleep independently. This way, when I experience a brief arousal during the night, I will know how to put myself back to sleep without your help. After completing the bedtime routine, put me to bed and explain that it is time for me to go to sleep and for you to leave. Give me one more kiss and leave the room. Implement the 2-In & 15-Out or the Gradual Method if I have trouble falling asleep. Use the same method if I wake up during the night and have difficulty returning to sleep. If I sleep in a crib, use the Regular Technique before changing me to a bed. Also use the Regular Technique if, while using the Gentle Technique, I resist going to sleep or wake up as you put me to bed.

Step 3. Facilitate sleeping through the night using the 2-In & 15-Out or the Gradual Method.

2-In and 15-Out Method

The 2-In & 15-Out Method is the fastest way to teach me to sleep through the night. Using this method most children can learn to sleep through the night in less than one week. When I fuss after you leave the room at bedtime or when I awaken during the night, wait a few minutes to see if I will calm down and go to sleep independently. [Important Note: If I am crying and may be hurt, come into my room immediately. Be sure to know when I am crying to complain versus crying because of pain.]

If I continue to cry, come into my room for two minutes to reassure me that you are there and that I am okay. During this time rub my back, explain that nighttime is for sleeping, and tell me that you love me. However, do not take me out of my bed. After spending two minutes with me, leave the room for fifteen minutes. Continue coming in for two minutes and leaving for fifteen minutes until I fall asleep by myself. Expect me to cry when you leave the room. Crying is a normal reaction--you are not doing things my way and crying is my way of protesting the change. Staying out of my room for fifteen minutes before returning may be difficult for you, but I will need this long to calm down and fall asleep. I may cry for an hour or more before finally going to sleep. Continue coming in for two minutes and leaving for fifteen minutes until I fall asleep. You may want to take me out of my bed and rock me to sleep after an hour of crying, but don't unless I am crying because of pain. Doing this will teach me to cry for a very long time to get what I want. As a result, I may cry longer the next night. If you are consistent with the 2-In & 15 Out Method, we should both be sleeping soundly through the night in less than one week.

Gradual Method

Teaching me to sleep through the night will take longer if you use the Gradual Method. However, this methods feels better to some parents. It allows you to do the 2-In & 15-Out Method gradually. The Gradual Method involves slowly moving farther away from me in three-night intervals. As with the 2-In & 15-Out Method, use the Gradual Method whenever I am in my bed and have trouble falling asleep. On the first night, instead of leaving the room after my good night kiss, sit near my bed until I fall asleep. After three nights, sit near the doorway until I go to sleep. On night seven, sit outside the doorway with the door open until I fall asleep. While you are sitting near me, keep interactions to a minimum. Every fifteen minutes, spend two minutes reassuring me that you are there and I am okay. Explain that you will sit with me until I fall asleep, but that you will not sing, read stories, or lie down with me. Tell me that you love me but that nighttime is for sleeping. Don't take me out of bed during this time unless necessary. After two minutes, return to the spot were you were sitting. Continue to reassure me every two minutes and to sit for fifteen minutes until I fall asleep. Starting on the tenth night, close my bedroom door and use the 2-In & 15-Out Method if needed.

Step 4. Provide a Morning Signal.

A morning signal lets me know that it is time to wake up and get out of bed. It helps me understand when you will and will not let me get up. Examples of morning signals include turning on the light, opening blinds, and singing a good morning song. Provide me with the same signal each morning. After initial sleep training, I will probably go back to sleep with little protest if I do not get the signal when you enter the room.

Teaching me to sleep through the night will be one of the most difficult things you will have to do. But once it is done, you will see it as one of the best things you have ever done. Remember, if I am crying and may be hurt, come into my room immediately. Be sure to know when I am crying to complain versus crying because of pain.

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**Barnard, K. & Erikson, M. (1976). Teaching Children With Developmental Problems: A Family Care Approach. St. Louis, MO: Mosby Co.
Coley, I. (1978). Pediatric Assessment of Self Care Activities. St. Louis, MO: Mosby Co.
Ferber, R. (1985). Sleep, sleeplessness, and sleep disruptions in infants and young children. Annals of Clinical Research, 17, p. 227-234.


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