Sleep issues in toddlers, preschool aged children

Dr. Jim Troutman In a previous article, I addressed the issues of sleep problems in infancy. There seem to be no shortage of problems relating to sleep that parents are faced with. In the article below, I will attempt to further discuss issues that might arise in the toddler or the preschool-age period.

Parents often ask about the appropriate time to transition out of a crib and place a child in a toddler- or fullsized bed.

My motto to guide parents is, "Let the sleeping dog lie."

If a child is making no signs of attempting to get out of a crib, leave him in the crib.

Some time around age 3 is a good time to make this transition. Babies are safer in a crib and, if they remain content, they are demonstrating that they are comfortable there. There's no reason to push the issue.

Unless, of course, you prefer the idea of waking suddenly and seeing the sight of your child staring at you at three in the morning!

Once children are transitioned to a regular, full-sized bed, parents may face issues with the "Little Darlings" getting out of bed both at bedtime or in the middle of the night.

To avoid bedtime issues, keep the bedtime routine relaxing and consistent. Adopt a firm and reassuring attitude when saying goodnight and hold your breath when you leave the bedroom. It is not at all uncommon for preschool children to find excuses to get out of bed. When they present themselves, remember to first of all, take a big breath, take another big breath and gently address their concerns and "perceived needs."

Then, gently redirect them to their bed, tuck them in again and leave the room. Consider employing a nightlight and make sure your children have nice comfort items like a blanket or favorite stuffed animal. Set a reasonable limit on the number of times your child can get out of bed. This limit should be no more than 2-3 times.

Now for the tricky part.

What do you do if they exceed the limit? Possibilities include threatening to take privileges away the following day or sitting quietly in the room until they fall asleep (or you fall asleep). Avoid at all costs, climbing into bed with them or bringing them into your own bedroom to sleep. Unless, of course, you or your husband want an extra roommate for life. Sticker charts can be used to reinforce positive behavior around bedtime routines and nighttime awakening.

Last ditch efforts include putting up a high pet gate across the door or latching and closing the door until the child is asleep. This last option may seem like "cruel and unusual punishment," but can generally be very effective and is typically a tactic that usually only needs to be employed for a few days before the child understands you are serious about your demands for them to stay in their own bed.

After that, the power of the ability to merely invoke the idea of latching the door usually gains the child's cooperation.

When the child awakens in the middle of the night try to awaken when they enter the room or call for you. Address them calmly and as briefly as possible and allow them to voice their concern (in 50 words or less). Once the situation is addressed, attempt to move as quickly and expeditiously as you can back to your own pillow. Occasionally, it may be necessary to sit or lie quietly on the floor in the child's bedroom until they fall back asleep. Again, avoid at all costs, bringing them into your bed.

Some children sleep well initially, but then awaken early in the morning and are ready to start their day at 4 a.m. Most parents aren't so excited about starting their day at this hour of the morning. One strategy that can be helpful is to set a radio alarm clock for a more "acceptable" hour (maybe 6 a.m.) and inform the child that she may not get out of bed or go out of her room until the alarm goes off.

So, there you have it. All your problems solved, right? Well, I'm sure the answer is no, but at least you have a few more tools for your tool belt to address this universally thorny issue.

Good night to you all and sleep well.

Dr. Jim Troutman is a pediatrician at the Everett Clinic in Stanwood. He welcomes new patients and recently celebrated his one-year anniversary as a provider here.