Awakenings during the night (nightwakings) can occur at any age but are most commonly problematic from late infancy through the preschool years. Natural and largely unnoticed normal awakenings actually occur between four to six times a night in all children. These awakenings are not a problem when they are brief and your child is able to fall asleep on his or her own. It is only when these nighttime awakenings result in your child crying or leaving his or her bed and venturing into your bedroom that they result in a problem.
What causes nightwakings?
As stated above, nightwakings can be a completely normal occurrence, happening several times per night in nearly all children. Younger infants awaken due to the need for feeding. Generally, this need fades away in the second half of the first year of life. Other causes of nightwakings include illness, night terrors, nightmares and fears. Delayed bedtime, sleeping too late into the morning, napping at the wrong times, not getting enough sleep overall or even insufficient napping for age may have a role. Sometimes sleep disorders such as difficulty breathing during sleep from sleep apnea can also be a cause. Commonly held beliefs that are NOT causes of night awakenings include teething and growing pains.
What can you do to help your child sleep through the night?
There are a number of steps you can take to help your child sleep through the night. These include:
- Set up (and stick with) an appropriate bedtime schedule. Establish a bedtime appropriate for your child’s age and similarly allow daytime naps in the younger child. Think again if you believe ‘wearing out’ your child by cutting back on naptime will make it easier for them to fall asleep at night. Sometimes this will have the opposite effect and make them more irritable and keep them up.
- Control the wake up time. Establish and be consistent with a wake up time for your child. This sets the schedule for the rest of the day’s sleep events – the naps and bedtime.
- Maintain a consistent bedroom environment and introduce security objects. To provide comfort and sense of security, keep your child’s bedroom the same at bedtime as it is throughout the whole night. For example, if your child sleeps with the lights on, leave them on in their dimmest setting for the entire night. It is also helpful to introduce your child to a soft toy, doll, or blanket to sleep with throughout the night – something to help your child feel safe, secure and comfortable when you are not present. Always leave the bedroom door open too.
- Keep the bedtime routine 'light', happy, and fun. In the 30 to 60 minutes before bedtime, don’t expose your child to scary movies, TV shows, frightening bedtime stories, scary music or videos, or other stimuli that may be upsetting to your child. Keep the activities calm and enjoyable, such as a nice calm bedtime story or a bath. Also, the quiet time activities should take place in the room where your child sleeps. Ideally, after the bedtime routine, put your child in his or her bed or crib in a drowsy but still awake state and leave the room. In this way, your child will learn to fall asleep on his or her own at bedtime and is more likely to fall back asleep on his or her own if awakened in the middle of the night. Finally, after about 6 months of age, avoid making feeding part of the bedtime routine. At this age, the child seldom needs the nighttime nutrition and is quite capable of making up the required calories in the daytime. The feedings are therefore just a means of getting attention and comfort. Besides, this practice may be unhealthy for newly erupted teeth due to risk of baby bottle tooth decay.
- Check in on a screaming or yelling child. It is okay to check in on your child if he or she is crying or upset. How long you wait and how often you need to visit is not written in stone and some judgment is needed. However, the purpose of your visit is to reassure your child "that he or she is fine and that it is time to go back to sleep." Make your visit unexciting and brief, and then leave the room. Keep lights off and the night theme in place. If your child continues to cry, space out the time between visits to the bedroom, but when you do return, do not do anything but talk calmly and then leave, making minimal contact. The purpose of your visit again is to let your child know that you are present and to reassure him or her that he or she is okay. Do not engage your child into an interaction. Your child will learn to calm down and go to sleep if you stick with this routine.
Should a guardian or parent be present when their baby or child first falls asleep?
Although an adult or guardian does not need to be present, this method is certainly one that makes some families feel more comfortable. Some families, for instance, have a strong desire to be present when their child falls asleep on his or her own for the first time. For these families, the suggestion is to sit in a chair next to the child’s crib or bed until he or she falls asleep. Then, every three or four nights, move your chair further and further away until you are no longer in the room.
Don't forget about rewarding your child. If you are having trouble keeping your child in bed – e.g., your child wakes up and says he or she needs to use the bathroom or needs a drink of water – you may want to create a reward system for staying in bed all night long. Here is how such a reward system could work: Tell your child that for each night that he or she stays in bed, your child can place a sticker (or something similar) on a chart the next morning. Then, for a predetermined number of accumulated stickers your child can expect to be rewarded with a favorite toy, meal, movie ticket, gift, or another token of your choosing. We recommend the reward be consistent, healthy and relatively inexpensive. This positive reinforcement strategy should assist in keeping your child in bed all night long.
Patience, persistence, and consistency. It may be very challenging at first and may take several nights to get your child used to the new sleeping plan but with some persistence and consistency, you will succeed. Remember too that not every plan you implement is going to work. As a parent or guardian, you have to decide what feels right for your situation. Then execute your plan, be consistent with it (this means all caregivers agree to stick with the plan), and give it sufficient trial time and effort.
Additional Sleep Information and Suggested Readings
- Sleepeducation.org and other educational links at American Academy of Sleep Medicine
- The National Sleep Foundation
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/16/2013…#14296