By Hiren Muzumdar, MD, FAASM, co-director of the Pediatric Sleep Evaluation Center, and Melissa Milbert, MS, NCC, LPC, Behavioral Health Therapist, Children’s Hospital of Pittsburgh of UPMC
Children over the age of 2 who sleep in a bed, rather than a crib, and refuse or resist bedtime can ignite much family distress. Resistance to or refusal of bedtime can manifest very differently across different ages of children. The child might go to sleep while watching television with a parent, or he or she sleeps in the parents’ bed. In a milder form of bedtime refusal, a child stays in his bedroom, but delays bedtime with ongoing questions, interminable requests, protests, crying, or temper tantrums. The child is often tired in the morning and has to be awakened when it is time to get up for the day.
If the child occasionally comes to the parents’ bed because he is frightened or not feeling well, he should be supported. However, if the child postpones bedtime or tries to share the parents’ bed every night, he might be testing his limits, and not actually be fearful. In contrast, if the child expresses worries during the daytime, reports frequent nightmares, or is fearful of bedtime on a nightly basis, additional help may be required.
How can a parent end bedtime refusal?
These are a few ideas that apply to children who are manipulative at bedtime, not fearful.
- Start the night with a pleasant bedtime ritual.
Provide a bedtime routine that is pleasant and predictable. Most rituals before bed last about 30 minutes and may include taking a bath, brushing teeth, reading stories, talking about the day, saying prayers, and other relaxing interactions. Try to keep the same sequence every night because familiarity is comforting for kids. Both parents should try to take turns in creating this special experience. Never cancel this ritual because of misbehavior earlier in the day.
Before you give your last hug and kiss and leave your child’s bedroom, ask “Do you need anything else?” Then leave and don’t return. It’s very important that you are not with your child at the moment of falling asleep; otherwise he or she will need you to be present following normal awakenings in the night.
- Establish a rule that your child can’t leave the bedroom at night.
Enforce the rule that once your child is placed in the bedroom, he or she cannot leave that room, except to go to the bathroom, until morning. Your child needs to learn to go to sleep in his or her own bed. Do not stay in the room until your child lies down or falls asleep. Establish a set bedtime and stick to it. Obviously, this change won’t be accomplished without some crying or screaming for a few nights.
- Ignore verbal requests.
Ignore ongoing questions or demands from the bedroom, and do not engage in any conversation with your child. All requests should have been dealt with during your pre-bedtime ritual.
When should a parent seek additional help?
Behavioral training takes time, effort, and consistency, and help from a trained professional may be very useful. If may be time to seek additional help if:
- You have tried to stop your child’s refusal for several weeks and he or she still does not fall asleep within 30 minutes.
- Your child’s lack of sleep is causing behavior problems at home or at school.
- Your child has fears about bedtime.
- Your child has frequent nightmares.
- Bedtime problems are making your child sleepy during the day.
- Your child has a change in sleep patterns and another medical or psychiatric problem.
Who can help?
Additional help can include working with a medical professional with specialized training in sleep. At the Pediatric Sleep Program at Children’s Hospital of Pittsburgh of UPMC, we have a specialized team to help with a variety of sleep problems and disorders.
Melissa Milbert, a licensed professional counselor, is a new addition to the sleep medicine team with experience treating a variety of sleep problems, including sleep resistance and sleep refusal. Melissa will work with children, adolescents, and their families around problems with nighttime anxieties, nightmares, and problems initiating and maintaining sleep.
For more information on the Pediatric Sleep Program at Children’s or to make an appointment, visit www.chp.edu/sleep.