Solve Your Child's Sleep Problems
The Sleepless Child
The Problem of Limit Setting
“I want a glass of water.” “One more story.” “Another kiss.” Requests like these, benign though they may seem, can ruin your evening and disrupt your night as well if they are endlessly repeated. The youngster making these demands could fall asleep, if only he would stay in bed and stop calling. This is a problem of limit setting. As you will see, the appearance, causes, and treatments of this problem overlap considerably with those discussed in the chapters on associations, feedings, schedules, and anxieties, and elements of any or all of these can appear in the same child. The problem of limit setting, however, tends to occur more in the toddler and older child than in the infant, and the interactions involved often take place before a child goes to sleep rather than during the actual transition to sleep itself.
Often this problem appears suddenly when a child learns how to climb out of a crib or is moved to a bed. Until then, the bars of the crib represent the parents’ authority: the child can call, but he can do little else to get his demands met. Once this control is gone, parents perhaps just assume that their child will continue to stay in bed at night on his own. But for a two-, three-, or four-year-old, or even for an older child, the impulse to get up can be too strong to resist. There might be something he wants to do or someone he wants to be with. He may hear people talking and laughing; or he may hear nothing and wonder where everyone is. The temptation for your child to be part of whatever is happening outside his room can be overwhelming. He starts to make demands, trying to get you to come back in with whatever else he wants. If you don’t respond, he may come out of the room after you, or he may find another way to get you to come in, perhaps by making enough noise to wake a baby brother or sister. Some children only have to threaten to wake their siblings to get the desired response.
Who’s in Charge?
Children are smart. They do what works and they don’t do what doesn’t. They may run through a litany of requests, but they will settle on the ones that get the most predictable responses. Most children settle on similar “curtain calls,” like the typical ones for more water, stories, or kisses, as mentioned at the opening of this chapter, or perhaps:
“Rub my back some more.”
“I need to go to the bathroom (again).”
“Please tuck me in (again).”
“Sing me another song.”
“I want to say good night to Daddy.”
“I need to tell you something.”
If a child has difficulty with self-control, then it is best if that difficulty can be done away with at bedtime and during the night. Controlling the child is the parents’ job—or should be. Ask yourselves, “Who is in charge?” Frequently, when parents describe to me what happens at night in their household, it is clear that they are not. They tell me that they know they shouldn’t give their child a second full bottle each night at bedtime, then add: “But she demands another bottle.” Or they agree that their child should be away from the television and in bed by 9:00 P.M., then say, “But she insists on watching another show.” Or, after telling me that his wife has to handle all his daughter’s bedtime routines, a father may explain that he tries, “but she won’t accept me.”
If you find yourself explaining away bedtime difficulties with words like “demand,” “insist,” or “won’t accept,” then you are not the one running the show at night. Young children simply should not be allowed to demand or insist on anything that is not necessary, certainly not at bedtime or during the night. If they are given this power, they will use it; the situation goes downhill from there, and rapidly.
For example, Megan, a sweet and generally well-behaved four-year-old girl, turns her bedroom into Mission Control at night. She calls out for a glass of water, but when her father brings it in she sends him out, saying “I want Mommy.” When her mother returns with the water, she, too, is sent out because “it’s in the wrong glass,” and then again because “it’s not full enough.” Soon her parents are running upstairs and downstairs, trying to meet all her demands. The wrong person is in control, and no one is sleeping.
Learning to set limits appropriately is an important part of becoming a parent. All parents do set limits; they just don’t all set them for the same reasons or with the same level of consistency. No parents would willingly let their two-year-old play with matches or run into a busy street, no matter how long he protested. They might not like listening to him cry when he is told no, but they are unlikely to feel guilty about it either. And since these rules are firm and absolute, he will eventually stop trying. He would not think better of his parents if they let him do what he thought he wanted and he was then injured as a result. What lesson would he have learned then?
Setting limits is relatively easy (at least emotionally) when the consequences are life and death. You don’t feel you are depriving your child when you stop him from playing with the electrical outlet, although you might when the consequences are not so dire—for instance, when you refuse to get him an extra glass of water. But to the young child, these situations are indistinguishable: both cases are a matter of “I want this, can I have it?” If you set a limit for a good reason, you have no cause to feel guilty or fear that you are hurting your child or losing his love, whether that reason is to protect him from harm or merely to keep his bedtime habits under control.
Of course, it is also important that you do not set limits capriciously based on how you feel on a given day, and also that two parents do not set limits differently (which can become an unintended game of “good cop, bad cop”). Being overly strict is as bad as being overly lax. You should try to find a proper level of firmness, and that level should not change day to day or parent to parent, from daytime to bedtime, or from bedtime to the middle of the night.
Nurturance and proper limit setting are not opposites: they are different ways of showing your child how much you care. If limits are set properly, a child will learn that they are in his best interest and that they are a sign of your love and concern. Think of the best teachers you had in school. In all likelihood, these teachers were strict enough to keep your class controlled, but they were also able to communicate their love and caring for each student. If a teacher turns over control to the students, chaos ensues—no attention, no learning. That may be fun for a day, but not for much longer.
Difficulty Setting Limits
Some parents are always able to set limits well. Others set them effectively only during the daytime, weakening at night as they try to avoid battles and get to sleep themselves. Still others set limits poorly and inconsistently at all times.
If you are having trouble setting limits, there may be a variety of reasons. You may never have considered how important limits are for your child, and you may never have learned how to go about enforcing them. Aspects of your child’s sleep schedule may be undermining your attempts to control his nighttime behavior. You may have feelings of guilt that make it hard for you to be firm. Your child’s resistance at bedtime may have indirect benefits for you (“secondary gain”), which can in turn make you reluctant to follow through consistently, if at all. Finally, there may be underlying problems at home that interfere with your ability to control your anger and set and enforce proper limits while remaining nurturing and supportive.
Let’s consider each of these issues in turn:
Knowing why limits are important and how to set them. If you think it’s tolerable that your four-year-old son comes into your bed each night, against your will, and kicks you or your partner until one of you has to move to another room, then you may not understand the importance of setting and enforcing rules. The same could be said if you see nothing wrong with letting your child determine when and where he will eat, what television shows he will watch, and when he goes to bed, or if you believe you should always buy him anything he wants (to keep him from throwing tantrums in public, perhaps). If you know these scenarios are wrong but you don’t know how to change them—if you can’t keep your two-year-old in his room after you say good night, or can’t even avoid going back to tuck him in repeatedly—then you need to learn some specific techniques. Later in this chapter, I will describe some techniques you can use at night; although, if you are having trouble controlling your child all day long, you may want to seek some general help in behavior management. First, however, you should be aware of the important considerations of schedule, guilt, and psychosocial factors as well as feedings, fears, and associations.
Schedule. If limit setting at night is the only problem, then when you start to set limits properly, your child will begin falling asleep quickly and easily. But if his bedtime is set too early, before he is sleepy, then he will not be able to fall asleep no matter how strict you are. In fact, at a too-early bedtime he may be more wakeful than at any other time of the day (see below, and “The Circadian System and the Forbidden Zone for Sleep” in Chapter 9). It makes no sense to force your child to stay in bed and try to fall asleep when he feels wide awake and his mind is active.
Guilt. Setting limits at bedtime is often difficult even under the best of circumstances, and it can be far harder if your child has an underlying medical or emotional problem, or if you are unable to spend as much time with him as you’d like. You want to show your love clearly, and you worry about how your child feels when you seem to ignore his crying and pleading. And if your child is deaf, has had heart surgery, or is on chemotherapy, or if you work two jobs or travel a great deal, just how tough do you want to be? There is usually no easy answer. In such situations, setting necessary limits all at once may be too wrenching, and you might find it easier to follow a program that helps you regain control in a series of small steps: for example, at one- or two-week intervals, you could first eliminate extra television, then extra drinks, and so on with back rubbing, sitting on his bed, and sitting in his room.
Secondary gain. If failing to enforce appropriate limits at bedtime, or giving in to your child’s demands at nighttime wakings, has some positive consequence for you, this so-called secondary gain can make you hesitate to change things. For example, you may enjoy cuddling with your daughter on the sofa while she falls asleep at bedtime—you just don’t like having to cuddle repeatedly throughout the night. Secondary gain can also involve more complicated scenarios. In some families, the child’s wakefulness at night keeps the parents from fighting, and his presence sometimes even serves to keep the two of them physically apart all night, which one or both of them may find desirable. One might say that their child is doing them a favor, at least at some level, but even if this is so, family therapy is not a job any child should have to take on.
Problems at home. If limits are to be set properly at night, the child must be given proper support and nurturance during the day. The two go hand in hand. But it can be difficult to provide nurturance in a family experiencing marital difficulties, or if a parent is depressed, abuses alcohol or other drugs, or is otherwise ill. A child who does not get enough proper attention during the day may be willing to accept punishment just to get some sort of attention at night. In this context, setting limits may be difficult, if it’s possible at all. If major problems like these are making it hard for you, or if you are unsure even what limits should be set given the difficulties at home, I urge you to seek help. What is best in these situations varies considerably from home to home and cannot be decided without skillful counseling.
Limits, Associations, Feedings,
Schedules, and Fears
As I mentioned at the beginning of this chapter, several overlapping syndromes can complicate limit setting. If there is a component of associations (see Chapter 4) in addition to the limit-setting problem, the treatment required is basically unchanged. Different approaches are called for, however, if you have a frightened child (see Chapter 7) or if your child’s sleep schedule is inappropriate (see Chapters 9 through 12).
If a child who is clearly not frightened or anxious requests a series of tuck-ins at night, and then goes to sleep alone and sleeps through the night, or perhaps requires at most one or two more tuck-ins during the night, the behaviors in question are part of the pre-sleep routine but not part of the process of actually falling asleep. Unlike the situations where sleep associations become a problem, he falls asleep and wakes under the same set of circumstances. The tuck-ins have become a possibly unwelcome habit, though, and the habit persists (and is reinforced) because limits are not being set.
Another child may request that you sit in the room or on his bed while he falls asleep. He may even hold on to you so that without even opening his eyes he can be sure you haven’t left. You may have to return and repeat the process during the night when he wakes. If that happens frequently enough, you may well end up sleeping in his room part of the night. Now we have an association problem as well as a habit, because you are there when he falls asleep but may be gone when he wakes. Both problems are treated the same way.
Habits and associations may also both be present if a child sleeps with his parents all night and insists that he sleep between them while they move to the very edge of the bed. If the child also demands and receives access to the breast or bottle at each nighttime waking, there is probably an additional element of excessive feedings, which may have to be dealt with (as described in Chapter 6) before the rest of the problem can be addressed. If your child stalls with an hour of repeated requests every night at bedtime but then sleeps through the night, his bedtime may be too early or his time of waking too late. A schedule adjustment may be called for rather than limit setting, or in addition to it (see Chapters 10 through 12).
But if your child wants you in his room because he is truly frightened (not the “pseudo-anxiety” discussed in Chapter 7, where “I had a bad dream” is just one more item on the litany of “curtain calls”), then setting firm limits and refusing him access to you at night could make matters worse. In that situation, you must deal with the fears first. As described in Chapter 7, that may require you to sleep in his room temporarily while the fears are addressed. Taking care of his fears is the main thing that matters at first. You can still limit extra drinks, stories, and even the amount of time you spend lying in bed with him, but you should not insist that your frightened child be in his room alone.
Setting Limits at Night
Whether or not you find setting limits difficult to do, if you have come to understand that limits are important, and that a lack of limits is contributing significantly to your child’s sleep problems, the suggestions in this and following sections should be useful.
You will notice that the treatments of limit setting problems may be similar or identical to those previously described for inappropriate sleep associations. That is because there may be considerable overlap between the two types of problems. If your child keeps demanding you return to do something he wants until he is ready to go to sleep—such as repeatedly tucking him in—that part is a limit setting problem; but if you always end up interacting with him while he falls asleep—perhaps rocking him—that part becomes a problem of sleep associations. The same activity may be both: for example, if your child insists you sit in his room singing to him before and while he falls asleep. The differences between these two problems may be slight, and both problems often resolve with similar if not identical treatments.
Your job is, first, to decide which of your child’s behaviors and demands you would like to end and in what ways you give in unnecessarily or inappropriately at night, and then to develop a plan that will enable you to stop these behaviors. Whichever demands and responses cause protracted bedtimes and nighttime wakings are the ones you must stop.
Your child should have an appropriate bedtime routine, like those described in Chapter 3. It should take place in the room where your child sleeps, and its length should be reasonable and determined by you, not by your child. For young children, five to fifteen minutes is usually adequate, but you may want to allow somewhat longer times if your child is of school age. Don’t let the routine in the bedroom last so long that your child is not sure when it will end. Provide a warning (“Last story,” for instance) and stick to your rules: if you give in to requests for extra stories only some of the time, those requests will still likely be repeated every night. If you want to allow a small drink before saying good night, include it in the formal routine; do not make your child ask for it. You may decide to end with a kiss and a tuck-in, and then leave. If you want to lie down with him briefly—for one minute, perhaps—then, again, it should be a formal part of the ritual, not something your child demands, and you must be prepared to leave when the time is up. If you are sloppy about enforcement, your child will learn that there is always a possibility that further demands will be rewarded.
If your child is still in a crib that he cannot climb out of and he makes demands from the crib, you need only respond briefly at progressively longer intervals, as in the treatment for association problems described in Chapter 4. The process is exactly the same. If he sleeps in your bed but cannot yet leave the room on his own, then you may have to leave the bed yourself for progressively longer intervals (you can move to a chair, for example, or even leave the room temporarily, as discussed below).
If he is able to leave his room (or follow you out of your shared room), the problem becomes a little harder. No matter how much he yells, how strong he is, or how well he can climb, you must be stronger than he is. If he ends up in control instead of you, the only lesson he will learn is that he can always get his way. Thus, if he starts coming out of his room when you refuse to keep going in, you may have to put up a gate. (You may have to do that even if he sleeps in your bed, if he follows you out of the room.) If he can kick down the gate, you may have to screw it into the door frame. If he can climb over it, you may have to put up a double gate—two gates, one above the other—until he agrees to stop climbing. If he can get over a double gate, you may have to start closing the door. Do whatever it takes to enforce the rule, just as you would if he tried to play with matches. You must win because it will actually be scary for him if you do not. Only when you have successfully settled the issue will he see that you are really in charge; only then can he stop trying to find ways to outsmart you; only then can he stop worrying about whether you will respond supportively or angrily; and only then can he see that you are really taking care of him. Finally, then, he can relax, with no job to do except to go to sleep, and the matter is solved.
You should only set limits that are necessary. Some children never come out of their room at night, whether the door is open or not, and they rarely will challenge your control. Children like that do not need a gate, and they are easy to set limits for. Other children will find a way to get out through six inches of open space between the top of the gate and the ceiling, and if they cannot get out, they will set about systematically destroying their room. These children desperately need to have limits imposed. Take from the discussion that follows just those techniques your child needs.
The Barrier or Boundary: General Considerations
The cornerstone of setting limits at night is ensuring that your child stays in the room where he should be sleeping. If he doesn’t stay in the room, you can’t enforce any nighttime rules at all; to enforce them, you must be prepared to use a barrier. Taking him back to his room over and over is not effective—in fact, he will probably perceive it as a game, especially if he has to be chased around the house, or if he can sneak out of the room when you’re not watching. Threats and punishments are counterproductive: a young child should not be punished for a lack of self-control at night, when self-control is hardest. Do not insist that your child take on a job that he cannot yet handle; you must take it over for him.
If you dislike the idea of having a barrier, remember that in any case your young child cannot be allowed to wander freely around the house while you sleep. He may usually go to your room, true, but he could just as easily go somewhere more hazardous, such as the kitchen. He may also be confused in the middle of the night, half-awake and unsure of where he is going and why, and that will put him at additional risk. (Some children consciously and intentionally head away from their parents at night so they can do things that they are not normally allowed to do.) A strategically placed gate at the top of the stairs or in the hallway will keep your child in a restricted part of the house and probably safe. But you are still better off requiring him to stay in the room where he sleeps and putting the gate at the doorway of that room to enforce the rule. One of the worst things you can do is to leave his door open and lock your own: now he is kept away from you but “confined” to the rest of the house, while you’re locked in. Who’s in control now?
Remember, problems such as those discussed here often start when parental controls, symbolically and physically enforced by the bars on the crib, are lost. When that happens, it is entirely reasonable to replace those controls and make his entire room a “crib.” The gate accomplishes that. Your child is free to wander about his room, just as he was free to move about his crib, but he cannot go anywhere else. And the gate ensures only that he stay in his room, nothing more. You cannot keep him in bed, and you shouldn’t try. If at first he falls asleep on the floor by the gate, don’t worry; you can always move him to his bed once he is deeply asleep, and in any case, sleeping on the floor by the gate usually stops on its own before long, unless he can see you from the gate. (If he can, you are providing a temptation for him to stay by the gate instead of returning to bed. It is even worse if he can see you doing something he would like to be doing himself, such as watching television. You will find it easiest to set limits when temptations like these are gone. You would not put jellybeans on the dinner table if you didn’t want your child to eat them for dinner. The gate takes away the temptation for your child to leave the room, since he can’t. Closing the door to your bedroom, or the living room or wherever you are, far enough that he won’t be able to see you takes away the temptation for him to stand there and watch.)
Usually a single or double gate will suffice for a child under four. If your child is a climber, avoid accordion gates with large diamond-shaped holes that he can use as finger holds and toeholds. A nylon mesh gate like a window screen or one with vertical bars will be hardest to climb.
A gate is far preferable to a closed door, for several reasons. Most children like to sleep with their own door open, because an open door helps them feel connected to the rest of the house. That is also why children often prefer that their parents’ door not be completely closed either. For the same reason, being able to hear the sounds of people moving around the house is often more reassuring than disruptive. If your child’s door is completely closed, he can only imagine where you are and what is happening on the other side, and that can be scary, which is not the goal. Locking the door all night is rarely a good idea—probably never, for an otherwise normal child. You may have to close the door for increasingly long periods to help a child who is too big for a gate (see below), but the eventual goal here is to have the door open, and that approach presumes he can develop enough self-control to master staying in his room.
The gate should be presented as what it is: a tool to help your child stay in his room at night and keep him safe. (The word help here is more than a euphemism: many children do want to stay in the room and make their parents happy, but they just cannot overcome the temptation to leave.) Closing the gate should be part of your bedtime routine. When you go into your child’s room to start your stories or songs, close the gate behind you, and begin with an activity he looks forward to; if you close the gate only when you leave or when you are angry, that’s what he will learn to associate with it. When you have finished your bedtime routine, quickly step over the gate (or open it and quickly close it again behind you) and leave. Remember to then stay out of his line of sight. (It is usually a good idea to remain on the same floor as his bedroom, at least until problems have been resolved.)
From this point on, handle the situation just as you would if your child were in a crib and you were helping him break a pattern of inappropriate associations (see Chapter 4). Follow the chart for the Progressive-Waiting Approach in Figure 4. If he keeps calling, yelling, or crying, come back to the gate at the increasing intervals listed in the chart to reassure him briefly, and then leave again. Usually it is best not to actually enter his room, just as you would not climb into his crib, unless something truly needs attention. (If he throws his teddy bear or other special object out of his bed, don’t go in to replace it unless he can’t find it; if he loses it again, don’t go in to replace it until your next scheduled trip back.) There are two reasons not to go into his bedroom. First, you do not want to reward him for calling. Second, if you do go in he may grab you, and then you will have to pull him off and race him to the gate, which is unpleasant for everyone. Check on him until he falls asleep, and repeat the checks during the night as needed.
The Barrier or Boundary: Using a Gate
To properly enforce the boundary, you must first make sure the barrier is effective. If you are using a gate, remove any chairs and stools that your child could use to climb over it. Second, you must behave consistently for this plan to work. You cannot give in on occasion just because your child’s crying is intense or prolonged, and you must not handle wakings in the middle of the night differently than at bedtime, or respond differently from night to night. Inconsistency is unfair to your child. It will be easiest for him to learn if your actions and responses are always consistent and predictable.
Just like the inside of a younger child’s crib, the room must be made safe—windows locked or protected, outlets covered, no sharp-edged furniture. If your child’s behavior escalates to the point of wildness, you may have to go further. For this child, even more than for others, it is critical that you get control back. If he topples dressers, knocks over lamps, and throws toys, remove them from the room. Once something comes out, it does not go back until the nights have quieted down. In extreme cases—which, fortunately, are rare—it is necessary to start with the room empty except for a mattress.
If setting limits is new to you, some of the techniques suggested here may seem harsh. But an out-of-control child is not a happy child. A gate will allow you to remain calm and supportive, since you can set limits without physically restraining your child. If you are fighting with him, controlling yourself is very hard, and if you get angry and lose control, he gets the wrong message. It is much easier to continue talking to your child in a warm, reassuring, and controlled way when you are on opposite sides of a gate than when you are carrying him back to his room kicking and hitting you.
To some extent, the bigger your problems are at the start, the easier you may find setting limits to be—after all, things cannot get much worse. It can be more emotionally difficult to set limits when a child’s requests are almost trivial, like asking you to pull up the covers twice a night. Meeting those requests may take no more than ten seconds each time. But if you cannot get right back to sleep yourself after these nightly requests, your own sleep could be badly disrupted. You might have to do something about these demands for your own sake; but in this case there is a lot of room for things to get worse before they get better, if your child reacts strongly to new limits. In such situations you have to decide whether the problem is important enough to fix and whether the time is right to fix it. On the other hand, when the problem is relatively mild, positive reinforcement, even without firm limit setting, may be all that is necessary (see below), and the cure may prove to be as mild as the problem.
Rarely do normal children actually hurt themselves in reaction to the establishment of clear, firm, and appropriate limits. Occasionally a child will engage in self-destructive actions, such as biting his arm, banging his head into the floor or wall, scratching (if he has eczema), or wheezing (if he has asthma). Obviously, you cannot let truly harmful behavior go on. The goal is to stop such behavior without at the same time rewarding it. If your child reacts in this way, you may need some help in designing an individualized and gradual program; fortunately, however, these situations are uncommon.
Once you have regained control and your child has stopped challenging you, peace returns to the night. The hours before bedtime are free of tension. Your child stops running away when you go to put him in his pajamas. Both you and your child start to look forward to bedtime as the special time it should be. Children find that they can relax, and they are happy that they are no longer displeasing you. All of this happens because you took back control. The gate often becomes a symbol of this change, and the same child who fought the gate initially may now remind you to close it every night. It not only keeps him in his room but it also keeps his emotions in check. The gate is an extension of you, doing what a parent is supposed to be doing: taking care of your child.
If after some days or weeks your child asks that the gate be left open, try it. Some children will now be able to stay put on their own. For others, despite the best of intentions, the open doorway remains too great a temptation. Take care of each child according to his individual needs.
The Barrier or Boundary: Using the Door
For a child who is too big for a gate, probably between the ages of four and six, you may have to close the door. (Doing so with an older child is also possible, but the older and bigger they are, the more difficult it becomes to enforce limits with this approach.) Each time your child leaves his room, take him back and close the door, keeping it closed a little longer than the time before. Because this technique requires the child to be shut behind a closed door, and the goal is to develop control, not fear, we usually start with short times like fifteen seconds, as shown in the chart in Figure 7, and slowly work up from there. If you feel that you and your child can tolerate longer times, you can start on line 3 of the chart or lower.
Close the door only if your child leaves his room, and close it only for the specified time. He should learn that his leaving his room triggers a definite response which increases each time and over which he has no further control. Don’t agree to open the door as soon as he gets back in bed, since as soon as you have opened the door he may get out of bed again, knowing full well that he can get the door opened anytime he wants.
Similarly, closing the door does nothing if he can open it. Stay on the other side of the door and hold it closed as needed. If you have to, you can put a hook and eye on your side of the door so it will stay closed—but just for the designated time. Do not lock the door and leave; stay by the door, where you are only a few inches from your child if he is right on the other side. You can say something through the door periodically to let him know you are there, but do not let him draw you into conversation. Do not answer any questions: he will be trying to take back control, which you cannot allow.
Open the door at the end of the allotted time, whether he is in bed or kicking at the door from the other side. You are using the closed door only to keep him in his room, not to control the rest of his behavior. Keep following the chart. He must learn that he is not allowed out and that nothing good happens when he tries to come out, only longer periods with the door closed. If he does not like the door closed, he will stop leaving his room. (Remember that even if he stays in the room, you should refuse to respond to any of his habitual requests or demands if you want them to stop.)
What if your child needs to go to the bathroom? Usually, if he went at bedtime, he won’t need to go again until the middle of the night, if at all. If he always uses the bathroom (appropriately) at that time, of course you must continue to allow him to go, without it triggering any door closing. (A younger child, for whom you are using a gate to set limits, eventually may be able to go by himself once the gate is no longer needed, although most toilet-trained two-and three-year-olds still need help at night.) But if his request to use the bathroom is only a stalling tactic, if he goes into the bathroom but little or nothing happens, you can refuse.
FIGURE 7. HELPING YOUR CHILD LEARN TO STAY IN HIS ROOM
NUMBER OF MINUTES TO CLOSE THE DOOR IF YOUR CHILD WILL NOT STAY IN HIS ROOM
1. This chart shows the number of minutes for which you should close your child’s door if he will not stay in his room at bedtime or after nighttime wakings (if he is too big for a gate). (The times listed are ones that most families find workable. You may change the schedule as you think best, as long as the times increase progressively.)
2. Keep the door closed for the number of minutes listed, even if your child goes back to bed sooner. You may speak to him through the door occasionally so he knows you are there, but do not let him draw you into conversation.
3. When it’s time to open the door, speak to him briefly, offer encouragement, and leave. If he leaves his room again, put him back inside (no need to tuck him in) and shut the door for the next amount of time listed.
4. Once you have reached the maximum number of minutes for the current night, continue keeping the door closed for that amount of time until he finally stays in his room.
5. If your child wakes during the night and will not stay in his room, begin the door-closing schedule at the minimum time for that night and again work up to the maximum.
6. Continue this routine as necessary after each waking, until a time in the morning (usually 5:00 or 6:00 A.M.) after which you feel further sleep is unlikely. Then begin the day. (If the time of morning waking remains too early for you, it can be adjusted later as described in Chapter 10)
7. If your child wakes and calls or cries but does not get out of bed, switch to the progressive-waiting routine described in Figure 4.
8. Be sure to follow your schedule carefully and chart your child’s sleep patterns daily (see Figure 5) so you can monitor his progress accurately.
9. Remember, your goal with this technique is to help your child learn to fall asleep without your being there. You are using the door to enforce this behavior in a controlled way, not to scare or punish him. Reassure him by talking through the door; do not make threats or raise your voice. Because you are progressively increasing the length of time during which the door is closed, your child is spared the anxiety of having no idea when it will be opened. He will learn that he can keep the door open all night just by staying in his room.
10. For this program to be successful, you must return your child to his room as soon as he leaves it, even in the middle of the night. If you wake in the morning to find him on the floor in your room or outside your door, you will not be solving the problem. If that happens, put a bell or some tin cans on your door, or place a chair in front of the door, to make noise and warn you when he is coming in. If you prefer, or if he tends to go other places than your room, you can put the bell or cans on his door instead so you will know when he is leaving his own room. Or you can put up a gate on his doorway; even if he can open it, you can make it impossible for him to open it quietly.
11. By day three or four your child will most likely be staying in his room, but if further work is necessary after day seven, just continue to add a few minutes to each door closing on successive days.
12. You can try the same routine at nap time. (Bear in mind, though, that most children too big for a gate will no longer be napping, or can stay awake through a nap if they want.) If your child has not fallen asleep after half an hour, or if he is awake again and out of bed after getting some sleep, end the nap period for that day. But if you fail to make progress at nap time, especially in an older toddler, it may be best to focus your efforts at night and work only on having a regular quiet time in the middle of the day, not necessarily in his room. If he still needs a nap, it will come back eventually.
13. The first few nights can be difficult, but with a later-than-usual bedtime, clear resolve on your part, and perhaps support from a sticker chart (as outlined later in the chapter), they can also be surprisingly easy. Children vary in their willingness to struggle. Some will learn quickly that they prefer staying in their room to having the door closed on them even briefly. Other children are willing to accept longer closed-door periods before giving in. Either way, if you persevere, the situation should improve substantially within one week, two weeks at most, provided that you follow the schedule consistently: your child must learn exactly what to expect. If you are lenient at some times and firm at others, your child will always have reason to believe that this time you may give in.
If your child stays in his room and calls for you, switch to the chart in Figure 4, returning to the doorway (but not inside the room) for reassurance at increasing intervals. Go back to the chart in Figure 7 (above) if he comes out of the room again.
Setting Limits When Your Child Shares Your Bedroom
Even if your child sleeps in your room and you want him to be there, he can stall, make unnecessary demands, and otherwise behave inappropriately. He may keep asking for extra stories, additional television, or more drinks. He may demand that you stay and your spouse leave; he may insist that both of you stay; or he may give orders about where on the bed each of you is to sleep. He may insist on twirling your hair, stroking your cheek, or lying on top of you.
Although in this situation the child cannot be confined to his own room while you sleep elsewhere, you still have to remove certain temptations and enforce limits. You may have to make changes, such as unplugging the television or moving it out of the room for a few nights. If your child tries to leave your room at night, you may have to set up a gate or be prepared to close or even lock your door (acceptable in this case because you’d be in the room with him). If he keeps disturbing you at night by trying to get something from you or do something to you, move to a chair for increasingly long periods. (Use chart in Figure 4, as a guide for times.) If your child is old enough to follow you there, or if for any other reason you find it difficult to refuse his demands while you are in the same room, you may have to leave the room for the designated periods with the barrier in place until the demands cease.
If there is only one parent and no partner who can remain in the room to be sure your young child is safe, or if a child beyond the toddler stage is too destructive to leave alone in your room even for short periods, you will have to find another place for him and at least one parent to sleep, somewhere you can enforce limits safely and effectively, until he accepts the new rules and you can all move back to your bed.
Sticker and Point Charts: Positive Reinforcement
When your child is unable to control his behavior by himself, you have to set limits for him and enforce them. But sometimes a child capable of controlling his behavior has simply gotten into the habit of making demands. Such a child frequently can be coaxed into giving up those demands by providing him with motivation in the form of rewards for the desired behavior. For some children, rewards alone are all that is necessary. For others, limits and rewards can be used together: once the child stops testing limits he starts earning his rewards.
Enforcing limits with barriers and other responses that your child perceives as negative may be necessary, but it is certainly not fun. Working out a reward system with your child, on the other hand, can be fun, and reward conditioning is entirely positive. When I use rewards to help a child I see in the office, I enjoy it; and children who succeed in following a reward-based program are as happy as they come.
Start your reward program by negotiating with your child, at least if he is three or older. (Using a reward system with younger children is difficult: their language skills are limited, and although they like getting the rewards, they usually won’t make the connection when they are protesting at night.) For example, ask your child if he would like to be allowed to stay up later (see sections above and below and Chapter 9). He will doubtless say yes. Then ask him if, given the (temporarily) later bedtime, he would be able to stay in his room and stop calling or making other demands. You could also ask him if it would help if you stayed on the same level of the house, or in the next room of your apartment, while he went to sleep.
Next, discuss a sticker chart with him. Set up different award levels for different levels of achievement, so he can be successful even when he cannot do everything you hoped for. For example, offer two stickers for quietly staying in the room at bedtime, one if he calls out but doesn’t leave the room. Offer another three for the rest of the night, depending on how well he does: three if he stays in bed all night and doesn’t call you, two if he calls during the night but stays in his room, one if he comes out only once, and no stickers if he leaves his room more than once. (Later in the learning process, you might reduce the middle-of-the-night awards to only one sticker if he calls and none if he leaves his room even once.) If the problem behavior occurs mostly at bedtime, you can focus the rewards there. For example, you might give him three stickers if there are no bedtime problems, two stickers if you have to come back once, one sticker if two trips are required, and none if you must return more than twice. Another one or two stickers could be earned for good behavior later in the night.
For three-year-olds, the stickers are their own reward. Youngsters a little older may be better motivated if you let them earn a small present each week by doing well and accumulating stickers. School-age children may also like the idea of earning presents but find stickers babyish; they are often happy to negotiate a system based on points. If presents are to be earned, they should be small, costing perhaps a couple of dollars. The rewards are meant to be symbolic, not out-and-out bribery, and small presents can be given weekly. Remember that if young children have to wait too long to earn anything, they will lose interest. (Older children may be able to postpone the weekly rewards in favor of a bigger one, perhaps earned over several weeks.)
If necessary, begin by rewarding your child for meeting relatively modest goals. There is no point in offering rewards for tasks the child cannot yet do or can do only occasionally, and a child who feels he cannot earn his rewards will stop trying. Besides, success breeds success. Err on the lenient side at first in giving out stickers or points. If you’re using small presents, award them as long as your child is trying hard and having some success. Don’t be so strict that he can fail by falling one sticker short.
Set up a chart with your child and have him participate in designing it, as well as in applying stickers or recording points; he may want to decorate it and show it to others. Be creative—the possible ways to set up a sticker chart with a child are endless. Make your system fit your child. Make a big deal of the chart and of your child’s success; it should be fun for everyone. If he is working with you and trying to succeed at night, rather than fighting against your attempts to regain control, you are way ahead of the game.
If stickers alone are not enough to get your child to stop calling or stay in his room, be prepared to set limits anyway, including the use of a gate or a closed door. If he takes to the rewards at all, the limit setting will be easier. Once he is quietly staying in his room, he will begin getting stickers, earning rewards, and feeling proud of his success. If the reward approach works well, continue it as long as your child’s interest lasts. Usually problems won’t resurface after his interest fades, but if they do, be prepared to set or reset whatever limits are needed.
It is crucial that your child be sleepy and ready to fall asleep when you start this program. If his bedtime is too early, what looks like a limit-setting problem may really be related to his schedule (see Chapters 9 through 12). Remember, a child gets more alert late in the day before he gets sleepy at night. If he keeps leaving his room at night saying that he is not sleepy, chances are that he really isn’t sleepy enough to fall asleep. Even if you sit or lie down with him, he will probably be unable to fall asleep until a later hour.
When you start any program of limits or rewards, your child’s bedtime should be set no earlier than the time he has recently been falling asleep most nights; in fact, it is often helpful to begin thirty to sixty minutes later than that time, even if it means a bedtime between 10:00 P.M. and midnight. If he falls asleep at different times on different nights, start at the later end of the range—better to start with too late a bedtime than with one too early. Leave his wake-up time and nap times unchanged, unless they have been inconsistent or otherwise inappropriate—such as waking too late in the morning or napping too long or too late in the day.
Controlling his schedule in this way guarantees that he will be very sleepy at bedtime. That in turn helps keep the amount of protesting to a minimum and gets the learning process started with as little difficulty as possible. Once he gets into his sleep phase (the period that runs from when he is first ready to fall asleep at night to when he is ready to wake for the day in the morning—see Chapter 10), he gets sleepier and sleepier until it becomes difficult for him to stay awake. Use this powerful drive to your advantage. If, on the new schedule, you always have to wake him up in the morning—a sign that he needs more sleep than he is getting—you should have no trouble gradually moving his bedtime earlier again.
You may be pleasantly surprised to find that with a later bedtime all of your child’s bedtime problems disappear. And if that happens, nighttime problems are likely to resolve as well. As we’ve seen in the context of other problems, when a child wakes during the night, he tends to resume whatever he was doing when he went to sleep. If he started the night with an hour of calling and leaving his room, he will likely start up again at his first waking; but if he starts the night by going right to sleep, he is more likely to go right back to sleep after waking later in the night.
Even if problems remain despite the later bedtime, there should at least be some improvement: your child will find it much easier to stick to a reward program if he is very sleepy, and his struggles over limit setting won’t go on for so long.
Allowing your child to stay up later than usual does not mean you should allow unsupervised or inappropriate activity. The television and computer should be turned off at a reasonable hour. You may also have to be more available to your child during these extra hours for play, stories, or conversation, depending upon his age. Once the limit setting problem is solved, you can readjust his schedule as needed.
It can be difficult to use a closed gate or door to set limits for a child who shares a bedroom with a sibling, younger or older. If the sibling who does not need limit setting is old enough, he can open the gate or door as needed (for example, to use the bathroom). But if he is too young to do this himself, you can ask him to call you, when he needs to use the bathroom or is done sleeping for the night, until the other child has learned enough self-control to stay in the room without the boundary.
Siblings often sleep through any noise their brother or sister might make, whether they sleep in a separate bedroom or share the same one. But if a child protesting new limits at night is able to make enough noise to disturb his sibling, the sibling may need extra attention from you during the night until things quiet down; you may also have to let him sleep elsewhere (such as in another bedroom, on the sofa, or on your floor) for a few days to a week, until the protests stop. The noisy child will see that his behavior caused him to be left alone in the bedroom, and that may provide him with an extra motivation to settle down. It’s always better to deal with a sibling’s disturbed sleep for a few nights than to give up on a plan of limit setting for the other child (which will only teach him that screaming gets him what he wants).
Sometimes a sibling undermines the parents’ efforts at control; for example, an older sister may unlock her brother’s gate, let him into her bed, or move into his bed. It is not the role of a sibling to play parent, and you should not allow it to happen. Talk to the sibling: explain what you are doing and why, and make it clear that he or she can help her brother or sister most by not interfering. Usually this discussion is all that is needed to ensure siblings’ cooperation. If their interfering behavior persists, however, it means they, too, need limits set, and you must be prepared to stop them. It may be enough for you to move them temporarily to another room, even yours, or for a parent to stay with them in their own room, for the few nights it takes for the other child to start sleeping well.
Limit Setting Problems: Some Examples
Isabella was a five-year-old girl whose behavior had never been a big problem. Her 8:00 P.M. bedtime went fairly easily, except that she never went right to sleep. She would call for her parents every ten minutes or so, and when they returned she would ask to be covered again and to get another kiss. Her parents always complied, although when she sometimes asked them to stay with her, they usually refused. If they did not respond when she called from her bed, she would come out of her room and call again. If they still did not respond, she would go and find them. This pattern would repeat itself about five times until she finally fell asleep at 9:00 P.M. Some nights she would become upset, especially when her parents were slow to respond, and then she might not fall asleep until 9:30 or even 10:00. When she woke at night she would call for another tuck-in and another kiss. If her parents were asleep and did not hear her, she would walk quietly to their room and stand by their bed until one of them woke up and walked her back. After her parents finally gave in, she usually went right back to sleep, but it was happening three times a night and her parents were getting tired and frustrated.
Since Isabella never fell asleep before 9:00 P.M., it seemed likely that she was being put to bed too early: she didn’t wake until 7:00 A.M., and she was getting ten hours of sleep. It was hard for her to lie in bed for an hour waiting to fall asleep (see Chapters 9, 10, and 11).
The difficulty of falling asleep at 8:00 had led to the repeated calls for tuck-ins, and now the calls had become a habit to be repeated at each waking. Isabella never resisted when her parents left her room, and she would leave the room only when they didn’t answer her calls. She was clearly not frightened.
Helping Isabella and her family was easy: we moved her bedtime to 9:00 P.M. She was happy to have the later bedtime, and in exchange she said she could stop calling and leaving her room. (Note that she was getting no less sleep than before, perhaps even a bit more once the wakeful periods during the night were eliminated.) We supported the change further with a sticker chart. Isabella did very well from the first night on. When I saw her next she was gleefully waving her chart for me to see. No stronger measures were ever necessary.
Michael, a two-and-a-half-year-old boy, had an 8:30 P.M. bedtime, which he was comfortable with. Since moving from a crib to a bed four months earlier, he had developed nighttime habits that were making his mother very unhappy. He liked having a bedtime story, but he never wanted his mother to stop and leave the room. When she tried, he would run after her. So she got in the habit of sitting on his bed and making up stories until he fell asleep. If he did not fall asleep quickly, it soon became hard work. Sometimes she would stop, thinking Michael was asleep, but he would open his eyes and say “More story!”
Often, tired out after forty-five minutes, she would leave despite his protests. Michael would call from his bed for a few minutes, but then he would get up, find her, and ask her to come back and continue the stories. Sometimes she would give in; sometimes she would let him stay up until she had finished her work, and then she would take him back to bed. Sometimes, if it got late enough, she would fall asleep in Michael’s bed. If she fell asleep before he did, he would wake her and tell her to keep talking. Sometimes he would let her rub his back instead. Either way, he could close his eyes and still be sure she was in the room. When he woke at night he would call, and she would return quickly (if she had been able to leave in the first place). She would lie down with him, and usually she could get him back to sleep by rubbing his back. At this point, she would stay with him until morning.
Michael’s difficulties at night came from a combination of association and limit problems, and there were sleep schedule considerations as well: although his bedtime was 8:30 P.M., he usually did not fall asleep until 9:30, and he generally didn’t wake until late in the morning, between 7:30 and 8:00 A.M. His mother wanted to sleep in her own bed without him. She should have been able to, since Michael was not an anxious child; he separated easily during the day and was fine with babysitters. In fact, when he had a sitter he went to sleep late but alone and with no trouble.
Getting Michael to sleep well without ruining his mother’s sleep required consistent limit setting. We temporarily made his bedtime 9:30 P.M., an hour later than usual but matching the time when he usually fell asleep; his morning waking was to be a little earlier than usual, namely 7:00 A.M., so that eventually we would be able to move his bedtime earlier as well. His mother set up a gate and established a routine for Michael’s bedtimes, during which the gate was kept closed. She would read him one story and make up one short one; then she would tell him she was leaving and go, closing the gate again behind her. Michael called at first, and even came to the gate. His mother responded briefly at intervals, following the chart in Figure 4. The first night, Michael fell asleep on the floor and she moved him back to bed. By the third night the calling had stopped and he was sleeping through the night. The next week, his bedtime was moved back to 9:00 P.M., and by the week after that it was once again close to 8:30.
Kyle was a four-year-old boy whose bedtime was a horror. On a typical night, tensions started to rise after dinner; although Kyle was playing, he also kept checking nervously to see if bedtime was near. At 8:00 P.M., when he saw that his parents were about to get him into his pajamas and brush his teeth, he tried to run away. His parents, already upset, had to bring him screaming and fighting to his room. Sometimes he hit them or kicked them. Putting on his pajamas, a major task, usually required both parents. Whatever parts of his pajamas they got him into, he took off again. Often he managed to squirm away from them and run back to the living room, and they would have to chase him down and start over. He had his own bed, but they could not even get him to stay there for a story. If they tried, he would bolt again. Sometimes they sat and held him struggling in bed, but they always grew tired before he did, and eventually they would give up and let him go. Kyle would then play in the living room for another half hour, at which point his parents would try again to get him into bed, to no avail.
This exhausting process went on for hours every night. Kyle would finally fall asleep in the living room with the television on between 10:00 P.M. and midnight, usually by 11:00. His parents found that they needed to wait another half hour before they could be sure he wouldn’t wake when they moved him to his bed. Now they could go to sleep themselves, but they would usually wake around two o’clock in the morning to hear him back in the living room. The television would be on, and the room was often a mess. Putting him back to sleep was no easier than at bedtime. Kyle could be up another hour or two, and he usually fell asleep in the living room again. This time one of his parents would stay there with him. He usually slept until morning, waking between 6:00 and 9:00 A.M., depending upon how much he had been up the night before. During the day his parents could not make him take formal naps, but he did usually fall asleep on his own for an hour, sometimes early in the afternoon and sometimes late. At day care, which he attended three days a week, he took a regular nap on a mat like everyone else, without a struggle.
Kyle was clearly out of control. Although his parents had been trying hard to make bedtime work, they just did not know how. Part of the problem was that Kyle’s schedule was so varied and inconsistent that it was impossible to be sure where his sleep phase fell—that is, when he was physiologically ready to fall asleep and when he was ready to wake (see Chapter 10). The inconsistency in the times of morning waking led to inconsistent nap times, which in turn led to wide variations in the times he would fall asleep at night and in the lengths of his nighttime wakings. It was important to get Kyle settled down, but I knew it would not be easy. I also knew from my interactions with Kyle and from reports of his behavior at day care that he was a normal youngster who responded well when appropriate limits were set and enforced.
To set limits correctly at night, we needed to know when Kyle would be ready and able to sleep. We started with a schedule that allowed him too little sleep, ensuring that he would be sleepy both at bedtime and also during the periods at night when he used to be awake. Bedtime was set at 11:00 P.M., and he was to be wakened by 6:30 every morning. He was to be allowed no more than ninety minutes of nap time, none of which was to take place after 3:30 P.M., and he was not to be allowed to sleep at other times. As soon as things started to improve, we could gradually move his bedtime back to a more reasonable hour.
Within the structure of this schedule, we could begin setting limits. A double gate went up in Kyle’s doorway, and a chair and a toy box were removed from his room so he couldn’t use them to climb. His pajamas were to go on at 8:00 P.M. in a setting that had nothing to do with going to bed, and once he was in them, he would be allowed to watch a video he liked. The quicker he got into his pajamas, the more time he had for the video. Once he got the idea, he stopped resisting, and getting him ready for bed became easy. From 8:00 to 11:00 P.M. there was no longer a reason for fighting or chasing, and the parents kept themselves available to play with him or read to him during that time. He could also watch appropriate videos, but only until 9:00.
At 11:00, his parents were to take him into his room, close the gates behind them, and offer to read him a story. If he accepted, they would read him one story and then leave. If he started fighting, they would leave immediately. This time the lesson was, if he wanted the story, there could be no fighting; if there was any fighting, there would be no story. Once out of the room, his parents were to respond to his yelling by returning to the gates, without entering his room, at increasing intervals until he fell asleep, and they were to repeat this pattern of responses as often as necessary during the night. They no longer had to struggle to hold him on the mattress: now the gates took care of keeping him in his room. They could stay calm, and threats were unnecessary.
The first two nights were a challenge—Kyle was accustomed to getting his way at night. Escalation had always worked for him before, and now he had to learn that even yelling louder got him nowhere. But by the third night matters had improved considerably. By the end of the first week, he was accepting a bedtime story and was not even fighting when his parents left. In fact, it was actually becoming difficult to keep him awake until 11:00, so we gradually moved his bedtime earlier. By the end of the second week Kyle was going to sleep at 9:00 P.M. and waking at 6:30 A.M.
Because Kyle was already four years old, we were uncertain whether he would continue napping after his sleep at night improved. Therefore, we planned only to offer a nap, not to insist on one. He started to nap regularly at 1:00 P.M. on the sofa, and since that was working well, we made no effort to change it. When I next saw the family, it was clear that more than Kyle’s sleep had improved. His parents reported that he was much happier than he’d seemed before, that he wasn’t angry at them and seemed to enjoy being with them more, and that his behavior throughout the day had improved as well.
Ashley was a two-year-old who slept in bed with her parents. They liked having her there and had no desire to move her to her own room yet. However, nights were difficult, at least for her mother. As Ashley went to sleep, she liked to climb up on top of her mother and stroke her hair or face, sometimes even scratching her, while she sucked her own thumb. Once she was asleep her mother could usually ease her back onto the mattress, but over the course of the night Ashley would wake several more times, climb back up, and begin stroking again. Her mother found the behavior very unpleasant, and the loss of sleep made her tired and grouchy during the day. Nevertheless, she felt it was her job to do whatever Ashley wanted during the night. Nighttime was a time for closeness and support, she felt, not withdrawal and frustration. Sometimes Ashley’s father tried to help get Ashley back to sleep, but that never worked, at least not if her mother was still nearby; Ashley wanted her mother, her mother’s face, and her mother’s hair. However, on the occasional night when Ashley’s mother was out late, her father had little trouble getting her to sleep.
Like Michael, Ashley was suffering from a mixture of association problems and limit problems. It was fine for her to sleep with her parents, but there was no need for them to put up with her annoying habits. They could be close and supportive without letting her do everything she wanted. Besides, letting Ashley learn that she would be allowed to annoy someone else at will was teaching her a bad lesson.
So her mother told her that from now on she had to sleep next to her, not on top of her, and without stroking her face or hair. When Ashley fought this new rule, her mother got up and left the room, while her father stayed behind; if she called, her mother came back in periodically to reassure her that she was nearby, but she did not get back into bed until Ashley was asleep. If, later during the night, Ashley tried to restart the unacceptable behavior, her mother again stopped her and left again until she went back to sleep. For a few nights Ashley’s mother had to spend part of the night on the sofa while her father remained with Ashley in the bed. But on each of these nights Ashley was learning to fall asleep on the mattress instead of on a person, and without stroking or annoying anyone. A few nights were all it took. After that, Ashley’s mother had only to threaten to leave to make her stop, and a few nights after that she stopped trying to sleep on top of her altogether.