QUESTION: My 21-month-old baby has never been the best sleeper but recently it has been getting worse. He always used to wake up at night but we could generally placate him quickly and get him back to sleep in his cot, or occasionally by taking him into our bed. However, recently, he has been waking up in a much more distressed state and won’t settle easily. Frequently, he demands to get up and out of the bedroom and if we stop him he can throw an almighty tantrum. As we have two other young children (three-year-old twins) who can be easily woken, we give in to him and take him downstairs to try to settle him. If he has had a tantrum, it takes a long while to settle him and it is all very disruptive to my wife’s and my sleep. I know the problem stems from how he goes to sleep in the evening. He tends to fall asleep in either my wife or my arms downstairs, but it is very hard to settle him any other way. We know his night waking is not due to teething or sickness as he is fine in other respects. Do you have any suggestions?

ANSWER:
It sounds like you are dealing with two combined problems. On the one hand, you have a young child who has a long history of unsettled sleep at night – an exhausting problem for any parent to deal with. On the other hand, you are dealing with a toddler who is displaying his independent will and expressing himself with tantrums. This is a difficult combination.

Toddler tantrums are stressful enough in their own right but when they occur in the dead of night when you are barely functioning as a parent, this moves to a whole new level of stress. Unlike day tantrums where you have the option to stand your ground and to sit them out, this is much more difficult at night when you have other children (not to mention neighbours) whose sleep you don’t want to disturb. It can feel like your toddler has you over a barrel and that you have to give in to his demands, which is not a nice position to be in as a parent.

So how can you move forward and tackle this problem? The first step is to choose your battlefield and to choose where you begin to make a change. In tackling sleep problems such as night waking, the middle of the night is almost never the place to start.

It is too hard to implement behaviour strategies in the middle of the night when you are likely to be tired and fractious yourself. Instead, the key is to change the daytime and bedtime routine and thus tackle the problem when you have more energy and are fully awake.

I think you are right when you say that the problem stems from how he falls asleep at bedtime. Currently, he depends on the comfort of being in your arms to get himself to sleep – this is his sleep association. When he wakes in the night, he then looks for your comfort and your arms to get back to sleep and is frustrated when this is not possible.

To tackle this you need to establish a bedtime or naptime routine where over time he learns to fall asleep in his cot on his own resources. Create new sleep associations that are in his cot such as having a special teddy or using a night time soother or a special night light or listening to music, etc.

Follow a consistent bedtime routine that includes a wind-down time in his bedroom (such as story or play time) and which finishes with a consistent ritual of tucking him in his cot, eg kissing him, and wrapping him and teddy under the blanket, making sure to use the same key phrase such as “sleepy time now” or “night night”.

Such consistent relaxing rituals are important in creating good sleep habits. However, being a toddler your son is likely to resist some of these changes and it is important to think through in advance how you will respond.

For example, he may stand up in his cot and cry for you and you may need to gently coax him to lie back down. Occasionally, you may need to take a step back if he is quite upset, for example, take him out of the cot for a minute to soothe him, before replacing him when he is calmer.

Initially, you may have to deal with a full blown tantrum as you stand your ground on key aspects of the routine, eg he has to stay in his bedroom when he wants to go out. In these instances, the key is to respond gently and firmly, balancing giving him some space with soothing and distracting him.

Once he calms down, you restart a short routine of putting him back in his cot with his teddies (or whatever other sleep associations he might have) and tucking him in as previously and then waiting for him to fall asleep.

Establishing this bedtime routine will take time and you need to expect some resistance and tantrums. Factor this in as you plan with your partner putting the older twins to bed so there is the least disturbance for everyone.

Once he gets into the habit of falling asleep within a relaxed bedtime routine, this will reduce his night time waking considerably. You still need to have a plan to respond for night time waking and the key is to manage this with as little intervention as possible.

For example, when he cries you might first wait to see if he can settle himself, or then go to him and hand him his teddy or soother, encouraging him to lie back down. If you need to take him out to calm him, you repeat a similar tucking in routine as bedtime (with the same words and actions) etc.

Finally, addressing sleep difficulties takes time and patience, though with a consistent routine you should make progress in the first week. For more ideas on establishing good sleep routines for toddlers, see the related set of articles here.

Dr. John Sharry, Irish Times Newspaper, August 2012.  John writes in the Irish Times Health+ every Tuesday.

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