Solve Your Child's Sleep Problems
The Sleepless Child
Most children occasionally feel frightened at night, and fears can lead to sleep problems: frightened children do not like to be alone.
In this chapter, I will outline a number of considerations useful in assessing the severity of your child’s nighttime fears, and I will describe methods you can use to deal with them. Although professional help may be necessary for a very anxious child, you should be able to manage most anxiety-related sleep problems yourself by using such techniques as emotional support, desensitization, rewards, schedule adjustments, negotiation, unlearning of automatic behavior, and limit setting.
The Anxious Child
As your child grows, she will face many new challenges. She must learn to tolerate being apart from you during the day—alone in a room, with a sitter, or at day care, nursery school, or kindergarten—and (at some point) each night when she goes to sleep. She must learn to control her behavior, her bowels, and her bladder; to hold feelings of anger, jealousy, and aggression in check; and to master the give-and-take of interacting with her family and friends. She will learn, wonder, and perhaps worry about death, God, heaven, and hell. She will find pleasure in genital stimulation but may worry about masturbation. She will question her ability to perform on a par with her peers and wonder whether she can live up to your expectations of her.
Each stage of your child’s development brings with it particular vulnerabilities to certain anxieties. For example, when she begins nursery school, her concerns about separation may increase for a while. She may be reluctant to leave your side during the daytime, and she may not want you to leave her at bedtime. If you get sick, she may feel guilty, imagining that her angry words or thoughts caused your illness and made you less available to her than usual.
Toilet training presents other concerns. Your child may worry about her ability to control herself. She may even be tempted to soil. Yet at the same time, she wants to please you, and she may fear incurring your displeasure. For many toddlers these worries are heightened at night: how can they avoid soiling or wetting while they are asleep?
For a five- or six-year-old, a scary movie can be particularly frightening. She may be very upset by scenes of kidnapping or those in which a child shows aggression toward a parent. Movies can be very real to a child. All children have aggressive fantasies, and most feel a bit guilty about them, but seeing these thoughts acted out on the screen can become a source of great anxiety.
Although the ages from six to twelve are considered to be a period of relative psychological calm, children between the toddler years and adolescence face pressures in a number of areas: in school, on the sports field, at music class, in religious programs, at home, and even from their own thoughts. They struggle to make friendships and to find new role models apart from their parents; they are called upon to be increasingly independent and to become more sensitive to problems in the home; and they start to carve out their own identity. At these ages, previously unrecognized learning and psychological problems can become clearly evident.
Most children in this age range sleep alone. A child who is too frightened to do so may be embarrassed to have her friends find out. She may be unable to participate in events with her peers that require being away from home overnight, and she may find her self-confidence shaken and her self-image worsened.
Adolescents, too, wrestle with major worries as they undergo the rapid physical and emotional changes of puberty. They start to worry about the future—college, jobs, money. Teenagers’ sexual feelings are very intense. Moral issues become more relevant, and adolescents face constant dilemmas as they struggle with new and important decisions. They must weigh personal desires against peer pressures and family standards in such areas as academic performance, sexual habits, and drug and alcohol use. They may experiment with new value systems and abandon old ones. They may believe their parents no longer trust or support them, and they may reject their parents’ help entirely.
Most adolescents with fears intense enough to affect their nightly sleep choose to suffer alone rather than ask their parents for help. Such youngsters are in need of help, but they may be more likely to get this help through counseling than from the behavioral techniques described in this chapter.
Anxiety is a common and important cause of bedtime struggles and nighttime wakings. During the day it is relatively easy to keep worries under control. Most children have too much to do, and too many distractions, to sit and brood. But even a child who feels fairly confident in the daytime can feel insecure at night. Waiting for sleep to come, she may begin to worry. As she lies in bed in a dark, quiet room, there is little to distract her thinking, and her thoughts and imagination can run free. If she wakes during the night in a dark, quiet house with everyone else asleep, her anxiety can grow even worse. It’s small wonder that even a child who has no difficulty going off to school may resist going to her room to sleep at night.
Because the ability to control one’s thoughts and feelings diminishes as one gets sleepy, children often regress at night, and they begin to feel, and act, more childish. In this state, a five-year-old may need the same level of reassurance that a three-year-old needs during the day. It will not help to scold her or tell her she is being a baby. Better to try to understand why she is feeling insecure. At such times she may need you to be more involved in her care than you might be during the day.
Although certain anxieties are normal, or at least reflect internal struggles that are part of normal development, others are caused by external events. Any significant social stress over which the child has little control—illness; parental fighting, separation, or divorce; alcoholism or other substance abuse; death—can lead to a great deal of worry, guilt, anxiety, and fear at any age. At night, when a child must give up what little control she has over her world along with the ability to stay aware of what is going on outside her door, fantasies stimulated by these strong feelings are especially likely to emerge, and they can be quite frightening. Bedtime difficulties and fears are to be expected.
Tyler was a four-year-old boy who had never had many problems with sleep until, four months before I saw him, a loud thunderstorm frightened him in the middle of the night. From then on, Tyler was unable to sleep by himself. Each night one of his parents had to lie down with him from his 8:00 P.M. bedtime until he fell asleep an hour later. They kept reassuring him when he asked if there would be more thunder. If his parents needed to leave the room even briefly before he fell asleep, he would keep calling after them, and if he couldn’t hear them, he would come out to see if they had gone downstairs and to get them to return. He insisted that two bright lights be left on in his room all night. Once he was asleep his parents could leave the room, but he always woke around midnight and began screaming. Usually one of his parents went in and lay down with him again. He would clutch them tightly until he returned to sleep. Often they would stay with him until morning to forestall any further screaming later in the night. If his parents did not respond to his screams quickly, he would run into their room. They would let him into their bed, where he would sleep fine until morning.
During the daytime Tyler’s fears seemed to disappear, although he stopped playing in his room alone; in fact, he spent little time there at all. He had no trouble at nursery school and on play dates. Although he was a little apprehensive about being left with a sitter, it was not a big problem (although the sitter had to stay with him until he fell asleep or else he would stay up until his parents returned).
Tyler told me that he was too frightened at night to sleep alone, but when I asked what frightened him, he had no answers except thunder. I did not doubt that he found thunder frightening, but since I did not find him to be an unusually anxious child, I also felt that his nighttime behavior was based as much on habit as on fright, and his main anxieties now were actually secondary ones that had grown out of the initial fear. What started as a single scary night had become a series of nightly fears. Would his parents leave his room before he was asleep, or would he wake to find them gone? Could he get them to return quickly, or would he have to leave his bed and venture out to find them? Would he wake to find the lights turned off and the room dark? Would his parents become angry sharing his small bed or giving over part of their bed to him?
I also saw Rachel, a seven-year-old girl who was generally cooperative and well behaved. She was doing well in school. She had many friends and appeared busy and happy during the day. She seemed to get along well with her parents and her older brother, and there were no signs of any major problems in the family. During the day she did not appear at all fearful.
But her behavior changed completely every night at bedtime. She begged to stay up. She was desperate to sleep in her parents’ room and would do anything, even sleeping on the floor in a sleeping bag or accepting punishment, to be allowed to do so. If her parents tried to carry her to her own room she would hang on to their legs, sobbing. The struggle became so intense that her parents finally gave in and let her sleep on their floor most nights. Although that helped, Rachel still refused to go up to her bedroom ahead of her parents. Eventually she became reluctant to be on the second floor alone even during the day. She also disliked being left with a sitter at night; when that was necessary, she always stayed awake until her parents returned.
As I spoke with Rachel and her family, it became clear that, despite her relatively untroubled daytime life, she did suffer from tremendous anxieties that became overwhelming at bedtime. In the quiet darkness of the night, while she lay in bed, disturbing fantasies which she could not control began to fill her mind. If she was alone, she would call or come out of the room in search of her parents. At Rachel’s level of fearfulness, a firm response from her parents would only have intensified the problem. If they had tried to put her in her room and close the door, she would not have settled down or felt reassured: she would have become hysterical. Fortunately, they understood that Rachel needed sympathy and attention.
Rachel was helped by some of the methods described below—but only up to a point. She initially remained anxious and unable to sleep alone. Ultimately, Rachel’s anxiety was brought under control through psychotherapy. As her general anxiety lessened, it became easy to help her and her family reestablish normal routines at night.
Rachel required counseling as part of her treatment, but (as in Tyler’s case, as you will see) psychotherapy is usually unnecessary; most nighttime anxieties can be handled more easily. There are many things you can do by yourself to help, and these approaches alone are effective in most cases. If you are in doubt, discuss the matter with your pediatrician or consult a therapist to help you decide on a course of action.
Evaluating Your Child’s Fears
Not all complaints of being “scared” at night mean the same thing. Some children complain of fears when they are really not anxious at all; others are truly terrified. Some children are only scared of insects; others seem to be frightened by everything. Some are only frightened at bedtime; others are just as scared throughout the day. For this reason, not all complaints of being scared at night should be handled the same way. In deciding what kind of support your child needs, you may find it helpful to consider the following questions.
Is Your Child Really Frightened?
1. When she says she’s scared, does she look and act frightened? When children wake their parents at night, they commonly explain themselves by saying “I’m scared” or “I had a bad dream.” But it is easy for children to say they are scared whether they are or not. Those words can be uttered by rote and without much real meaning. If your child reports her “fear” in a matter-of-fact manner, and if she is calm and does not appear frightened, then in all likelihood she is not truly scared. Appearances are more reliable than words in this context. The complaint may be just one of many your child has tried; she may have abandoned requests for extra drinks or tuck-ins and started complaining about “monsters” in her room because that complaint is the one that got the best results. As a parent, you do not want to respond to this “pseudo-anxiety”: your response will only encourage it. On the other hand, you do want to respond if the anxiety is sincere.
2. Is she really having bad dreams? All children have nightmares now and then, but if your child says she has a bad dream every night, remember that nightmares generally occur only occasionally and are not usually the cause of frequent nighttime disturbances. Most children who complain of bad dreams nightly are unable to describe much about the dreams, usually because there haven’t been any. After a truly scary dream a child will look and act frightened, and she will have a real dream story to report (in contrast to a vague reference to “monsters” or “bees” or “robbers”). As always, judge your child’s anxiety more by paying attention to how she appears and acts than by the particular words she uses.
(If she seems extremely frightened but cannot be comforted at all, make sure she is actually awake. What many families believe to be frequent nightmares are actually sleep terrors, confusional arousals, or other similar partial wakings; see Chapter 13.)
When your child does wake truly frightened from a scary dream, she should not have to stay alone; yet you certainly want to avoid having to sit with her every night. You should help her orient herself and realize that she is not in any real danger. It may also help to discuss the dream with her matter-of-factly. You can do that briefly at the time, but longer talks are better done the next day (discussions in the middle of the night can easily become a bad habit). There are a number of good books for children about dreams and nightmares that may also be of use. Other aspects of dreams and nightmares are discussed in Chapter 14.
3. Is she testing limits? Distinguishing a child who is anxious at night from one who is only testing limits is important—the appropriate responses are quite different—but making this distinction is not always easy. An anxious child and one testing limits are both likely to resist going to sleep, make extra requests at bedtime, call out repeatedly, and keep coming out of their rooms. Both may complain of fear (remember, a child testing limits will use whatever excuse seems to work). It is easiest to tell the difference in extreme cases: the anxious child appears very frightened, whereas the limit tester may even be laughing. Furthermore, the firmer you get with the anxious child, the more terrified she becomes; a limit-testing child might become angry (not frightened), or her behavior may simply improve.
Sometimes limit-testing problems and anxiety occur together, since poor limit setting can cause a child to become fearful. Children need proper, predictable, consistent limits, and their absence can lead to increasing anxiety. If on some nights parents happily give in to extra requests while on other nights they respond with anger and threats, the child will not know what to expect. She might want to make one more request, but she will be understandably nervous about your response. Here is a case where setting nighttime limits appropriately for an anxious child will help matters, whereas when the anxiety has a different cause, firm limits are likely to make it worse. If you are not sure that poor setting of limits is the key problem, err on the side of assuming that there is another cause to the anxiety. You can always set limits later.
4. Is she just not sleepy? If your child’s problem is anxiety, then sleep should come fairly quickly on nights when you sleep together (if it is clear to her that you will be together all night). If it takes her just as long to fall asleep with you there, then she may be going to bed too early. As explained in Chapter 9, we all go through a period of extreme wakefulness in the hour or two before the time we usually fall asleep. Most children forced to go to bed too early act like children with limit-setting problems: they keep calling their parents and coming out of the bedroom with various excuses. Some very well-behaved children (perhaps too well-behaved for their own good) stay put, but without the option of reading or watching television, they may lie in bed, fantasize, and eventually end up scaring themselves. Under such circumstances, these children do get a bit anxious even though they are not inherently anxious children. If the bedtime hour is adjusted, the anxiety disappears.
How Severe Is Your Child’s Anxiety?
1. How intense are her fears at night? To help a child with anxiety-related sleep problems, you need to determine just how pronounced her anxieties are at night. Again, observe your child’s behavior—don’t just listen to her words. It is usually obvious when a child is really terrified at night. She will grow frightened, even panicked, as bedtime approaches. She will cling to you, cry, and beg not to be alone. She may accept any punishment as long as she won’t have to stay by herself. On waking at night she screams from under the covers, afraid to leave her bed, or she races to your room. If, instead, she stops to gather up her blanket and teddy bear before calmly walking to your room and then patiently stands by your bed waiting for you to wake, she may be a little nervous, but it is unlikely that her fears are major. A fearful child may move into your room at night, but if the fears are very intense, she will not go back to sleep on your floor without waking you first. A child’s fears cannot be very intense if she is able to go to sleep easily by herself on nights when you leave her with a sitter. Similarly, the more fearful a child is, the less likely she will be to want (or be able) to sleep at a friend’s house. Even during a sleepover at her own house, a very fearful child may risk embarrassment, leaving her friends in her room to join her parents in theirs.
2. Is her anxiety present all day or just at night? Anxiety that is present all day long is more worrisome than anxiety that only appears at night. You should be reassured if you find that your child has no difficulties during the day at home or in daytime programs, and that she is social, enjoys being with others, and is not easily panicked. If this is the case, nighttime fears are likely to be isolated and easy to deal with. But if she seems anxious throughout the day, about many things and in various settings and activities, then it is less likely that the nighttime anxiety can be solved simply and by itself; instead, more general psychological help may be indicated.
3. Does she have trouble separating in the daytime? Separation anxiety is common in young children but can occur at almost any age. It can start as early as about eight or nine months. Often a period of increased anxiety lasts several months and then gradually eases. A child having separation difficulties probably cannot be left easily with a sitter, and she may still be up and awake when you get home; she appears panicky and cries each day when she is brought to day care or preschool, and the panic does not disappear quickly when you leave; she resists going to school; and she refuses sleepovers with friends, or calls to ask to come home. She may refuse to leave your side when you are out of the house with her, and she may be reluctant to join in activities or play with others even if you are close by. At home, she may become upset if you leave the room, even for just a few minutes. If she has such difficulties with separation, expecting her to sleep in a room by herself may be unfair and unrealistic. In contrast, even if she is very “clingy” at home, you should be reassured if you find that she does fine with sitters or at day care (at least once you’ve left), plays well with others, and is not afraid to try new activities. If she handles separation well during the day, and particularly if she will go to sleep without a problem when left with a sitter, you can be confident that she will be able to handle separation at night.
4. Is the anxiety of long standing or is it a recent development? A frightening video, something heard at school, or a bad dream can cause short-term anxiety. Transient fears such as these afflict all children and do not imply a need for professional counseling. With support and understanding from parents at night as well as during the day, such anxieties generally resolve themselves within a few days or weeks. A child with occasional fears will find the extra compassion offered by parents during those fearful periods very helpful; just knowing that such help will be available when it is needed can reduce the severity of these fears and shorten their duration.
Long-standing fears, lasting several months or longer, are a cause for more concern. These fears can intrude into a child’s day and affect her choice of activities. If severe, they increase the likelihood that the child will have difficulty coping with normal daytime activities. Such fears are not likely to disappear with support alone. Bear in mind that a scary movie, seen once, generally won’t produce major, lasting fears, but it can unmask anxieties that are already present. Therefore, even when long-standing anxieties seem traceable to a scary event, the real cause may be quite different from the initial trigger.
What Is Your Child Afraid Of?
1. Is there an identifiable external cause to her fear? Although single events like a scary movie may expose existing anxieties, they can also trigger short-term worries and—if exposure is repetitive or ongoing—long-term fears. There may be a specific reason for your child’s fear: last night’s television show, an illness in the family, or a parent’s absence due to a business trip. She may be afraid of a bully at school, an unsympathetic teacher, or an upcoming exam. Or the source of the fear could be trouble at home (perhaps parental fighting, drinking, or depression). Depending on the nature of this cause, you may be able to provide enough help with understanding and support, or you may need to seek professional counseling.
2. Does she seem to be frightened by many things, or is she just afraid of a few specific ones? Some children are not frightened as a rule but do have significant fears of particular things, such as insects, spiders, snakes, or fire. If, as with Tyler, the object of fear happens to be thunder, your child may have sleep problems only on stormy nights. On those nights, you need to make yourself especially available to her: if you refuse to comfort her at those times, she may become frightened every night, worrying that there will be a scary storm and she will have to get through it alone. To address fears of insects, spiders, snakes, or fire, you can, for example, reassure your child by telling her about the precautions you’ve taken to avoid them (or, for snakes, that there are none where you live), or gradually desensitize her through education (using books) and exposure (at zoos and museums). But, most important, you must assure her of your ability to protect her should there be any problem.
If, instead, your child is afraid about many things, day and night, she may have a more generalized form of anxiety. Unless these fears are minor and occur only occasionally, trying to deal with them with the behavioral techniques described below is unlikely to resolve them. Here, too, professional counseling will likely be needed.
3. Is she afraid of “monsters” and “robbers”? If your child develops feelings of anxiety that she does not understand, she is likely to use her imagination to come up with an explanation. She must find something she can believe to be a cause of her fears, something external and threatening over which she has no control: hence monsters and robbers. Such anxieties are especially common in young children. Often they relate to issues of control associated with toilet training, hostility toward a new sibling, or the need to keep aggressive impulses in check at day care or preschool.
Remember, although the monsters or robbers are not real, your child’s fear is genuine. It comes from real feelings, urges, and worries. She does not understand that it is these feelings that are making her anxious. To resolve such fears, your child does not need protection from monsters: she needs a better understanding of her own feelings. She needs to know that nothing bad will happen if she soils, has a temper tantrum, or gets angry at her brother or sister. At such times she can best be reassured by knowing that you are in control of yourself and—to the extent that she needs it—of her, and that you can and will protect her. If you can persuade her of these things, she will be better able to relax. Since these monsters represent your child’s feelings, not things in the room, your calm, firm, and loving assurance will do more to banish the goblins than will searches under the bed. Spending half an hour every night shining flashlights behind the furniture does little to reassure your child, and it might even reinforce her fears: why would you be looking so hard if monsters couldn’t be there? The monsters are in your child’s mind, and it is there you should focus your efforts. She certainly needs reassurance; whether she needs more than that depends upon just how frightened she is.
4. Is she afraid of the dark? Few children like to sleep in total darkness, and there is no reason why they should. It is helpful if the bedroom is dimly lit by a night-light or by streetlights from outside, so that when your child wakes up at night, especially after a dream, she can see where she is, reorient herself within the room, reestablish a sense of reality, and put the dream in its proper perspective.
If a child is afraid only of the dark, a night-light (two to seven watts) usually suffices. But a nervous child may request additional lights: first a table lamp, then an overhead light. The room often ends up quite brightly lit: a total of 60 to 200 watts is common. Many parents turn the lights off after their child falls asleep, but when she wakes in the dark she gets scared and turns the lights back on, or a parent has to come in to do it for her. Other parents leave the lights on all night. But at night, even 60 watts is very bright (as we all know, our eyes adapt to the dark at night and become more sensitive to light; most school-age children are able to understand this too, if we explain it to them). Waking in that much light is a strong arousal stimulus not conducive to a rapid return to sleep.
Occasionally a child actually prefers darkness to the shadows created by a night-light. That is fine if it is really her preference and if, in fact, she does sleep well without any light. But for some children, the fear of “shadows” is the same as the fear of monsters—that is, the fear does not originate in the shadows, but the child, having an anxiety she does not understand, tries to rationalize it by blaming it on something else. If the shadows are gone, she will find something else to be afraid of.
5. Is she afraid of having her door closed? Just as most children want some light in the room, so most want their doors at least ajar at night. This is particularly true of frightened children, although those whose fears take the form of robbers may actually feel safer with the door closed. In general, the open door allows a child to maintain a sense of connection (to what’s outside), awareness (of where her parents are), and reality (where she is). Hearing her parents moving about or watching television nearby is reassuring because it reminds her that they are there. Once the door is closed and she can’t hear what is really happening outside, she might use her imagination to decide, the same imagination that conjures up monsters. Don’t worry that the usual noises of family activity will disrupt her sleep. If she is only scared at night when her door is closed, the remedy is easy.
6. Is there a self-reinforcing pattern to the fear? Most often, when an isolated event such as a scary movie causes a child to become frightened at night, the fear lasts no more than a few weeks. Sometimes, however, the nightly memory of being frightened, and perhaps of her parents’ inappropriate responses to the fear, leads to increasing anxiety that spirals out of control until the child reaches a state of near panic. Each night the child remembers the fear of the night before, not the original trigger.
Suppose a child wakes one night from a truly frightening dream, wakes her parents, and finds that they respond to being wakened with anger, threats, and punishments. She is now as frightened of their response as she was by the dream. The next night she is afraid to go to bed, because she knows that if she has another frightening dream she will not be able to get help, and she also knows she may become so scared that she will have to wake her parents, which will only make them angrier. The fear of making them angry adds to her anxiety. If the next night goes badly, her anxieties may escalate until the nighttime becomes a battle for her parents and a time of terror for her. What started as a single bad dream has become weeks or months of major disruption. At that point, the parents and even the child may have forgotten the original dream and have no idea what she is actually frightened about. No one is getting enough sleep, the parents are angry, and the child is suffering terribly.
When I see a family at this juncture, I always consider the possibility that, even though everything seems out of control and the child is terribly frightened, the underlying problem may be less serious than it appears. With proper interventions, the spiraling process can be reversed and the escalated fears gradually brought back under control. It is of utmost importance that the child experience falling asleep quickly and without fear, so the only bedtime memory the next night is a good one, and the spiral can become one of increasing confidence. Then, and only then, is it possible to decide whether a significant predisposing psychological problem exists.
How to Cope with Nighttime Fears
If Your Child Isn’t Really Frightened
Like most parents, you can probably tell if your child is really frightened. If you decide she does not look or act genuinely frightened, you must be firm. Stick with the bedtime routine and say good night. Do not return repeatedly. More guidelines for setting firm limits and getting your child to cooperate can be found in Chapter 5.
Be as sure as you can when you make this judgment. If a child is genuinely frightened at night, being firm in this way will not help. It may well make matters worse.
For Very Mild Fears
If your child begins to have difficulty going to sleep because she is worried or a bit fearful at bedtime, talk it over with her during the day. At night, be empathetic, reassuring, and supportive. As long as her worries are relatively mild, you probably should not make any substantial changes in her bed and nighttime routines. You might sit with her in her room a little longer than usual, but keep her on her normal schedule as much as possible (except, perhaps, for setting her bedtime later than usual for a while, as discussed below). Simply reassure her firmly and calmly that she is safe and that you will take care of her; then put her to bed with her usual story or quiet talk. Your child will be more reassured in the long run if you show her that you can take care of her than if you give in to her fears.
For More Substantial Fears
If your child is anxious at night, having more than just some mild worries, goal number one is to do whatever you have to do to take away the anxiety. Other issues can be resolved later. Therefore, all the suggestions below follow the same basic formula: Start by doing whatever is necessary to help your child feel safe and able to sleep well during the night—but try not to do more than necessary. As things calm down, gradually reduce this extra support and boost your youngster’s confidence at a rate she can tolerate.
For a child whose anxiety is mild, even very small steps can help. Keep in mind that the fear might be the outcome of a spiral that you need to reverse. The better each night is, the easier the next night will be. Try to keep to more or less the same schedule and routines as before, especially if the fears developed recently. Be sure to find time for your child during the day and evening. The bedtime routine should be pleasurable and unrushed: understanding and reassurance are important. Try to determine how much support your child needs to feel safe and secure, and offer it freely, at least initially. She must know that she can get help without angering or upsetting you. That knowledge alone makes the night less scary.
Every child is different, but for most children at least some of the techniques described below will be helpful. The techniques listed first may be enough to help a child with mild fears; those listed later may be needed for children with more severe anxieties.
Techniques to Help a Child Feel Less
Frightened and Fall Asleep Quickly
1. Arrange for enjoyable time in her bedroom. If your child sleeps (or is supposed to sleep) in her own room or with siblings, but she doesn’t spend much time there during the day, her associations with her bedroom may be only unpleasant ones. Spend time with her in her room during the day doing something enjoyable such as reading a story or playing a game. These visits should have nothing to do with bed or sleep. When bedtime comes, the final routines should take place in her room, they should be unhurried, and they should include things she looks forward to, such as a story. If getting into pajamas or brushing teeth has become unpleasant, it should be done ahead of time.
2. Move her bedtime later. A (temporarily) later-than-usual bedtime can be very helpful for several reasons. The sleepier your child is and the faster she falls asleep, the less scary that night will seem, and the easier the next night will be. Make the new bedtime late enough that your child’s mind is no longer active and she is having trouble staying awake. Take note of the time when she has actually been falling asleep, and start no earlier than that. The best idea is to set bedtime thirty to sixty minutes later than that time, for a while, to help assure that she falls asleep as quickly as possible. Remember: better at first to put her to bed a little too late than too early.
It is critical that you get your child falling asleep quickly at bedtime. That will help not only with bedtime fears but also when she wakes during the night. When we wake at night, we all tend to pick up our thoughts where we left off before we last fell asleep. If you spend a long time worrying about something before falling asleep, you are likely to start worrying about it again as soon as you wake during the night, as if the intervening sleep hadn’t even happened. Children are the same: if they fall asleep too quickly to worry or be scared at bedtime, then they are more likely to ignore their wakings during the night and fall back asleep without becoming frightened all over again.
3. Use stickers or other prizes as positive reinforcement. Rewards alone will never resolve significant anxiety, but they can help if a minor fear has spiraled out of control or if the complaint of fear has become more habitual than real. Nothing is better at helping a child feel less afraid than success at being unafraid—that is, the reversal of the spiral.
The reward system can work as described in the chapter on limit setting. However, instead of backing up the rewards with limits, here you must leave your child the option of getting whatever she needs from you to feel unafraid. Where to start depends upon your child’s current nighttime behaviors, needs, and abilities. If she has problems only during the middle of the night, you can offer one sticker for going to bed without problems—she’d be certain to earn that one—and two if she has no problems during the night. Or you can offer three stickers for not waking anyone, two for just getting tucked back in, one if you have to walk her back to bed, and none if she needs more help than that. Again, success leads to more success. But your child must know that if she is very frightened, she can still count on you being there. If she believes that if she is too frightened to earn a sticker she will be left to cry alone at night, she will abandon the reward system altogether.
For school-age children, the attraction of stickers may be gone, but you can negotiate a similar system for points, with small, tangible rewards at the end of the week if things have gone well. Try to avoid large prizes—your child may work toward one, then quit trying once it is achieved—and never take back any prize your child has already earned. Don’t set the reward too far in the future, or your child may lose motivation and interest. And don’t be rigid about the number of stickers or points needed for a reward. If your child has been trying hard and making progress, reward her even if she’s short a point or two. Make a big deal of success.
4. Teach your child to practice dealing with wakings and mild anxieties—alone. Some children automatically call out that they are frightened even before they actually are, sometimes even before they are fully awake. They may even start getting out of bed before they are alert enough to know why they are doing it. Getting children to interrupt this automatic behavior can help, especially if it is supported with a reward system. I ask children to pause when they wake up and consider how they actually feel, instead of immediately calling for help. If they are not frightened, they should not call. Even if they are frightened or become a little nervous, I ask them to try to wait a bit longer. If they become very frightened, they can request whatever help we have agreed they might need and can have. The more nights without calling (whether they wake but control their calling, or don’t wake at all) the more rewards they earn, and the more successful and competent they feel.
5. Talk to your child; ask her what she needs. Offer to help in ways such as those described below. I am always impressed by children’s insight in assessing their own needs. If your child tells you that it is important for you to check on her but that you do not need to stay upstairs between checks, that is probably correct. Even if the initial requests are a bit more demanding than you wanted, start there. If you can get her falling asleep quickly and sleeping well, you are making progress. Support levels and rewards can be renegotiated every week. A child who needed to be checked every five minutes at first might now just want you to make sure she falls asleep before you go to bed. A child who started out earning stickers just for staying in bed may now be able to earn them by not calling out or waking anyone.
6. Set appropriate limits. As described above, setting certain limits on an anxious child, such as requiring her to stay in her room alone, can have unwanted consequences: she may become more anxious, starting a spiral in the wrong direction. The only situation when this is not so is when the cause of the anxiety was the absence of appropriate and consistent limits in the first place. On the other hand, less drastic limits can still be set for an anxious child. For example, if you agree to sit with your child because she is scared, you can nevertheless refuse to read endless stories, to keep getting more drinks, or to let her twist your hair. If she is scared, she needs you, not drinks and stories. As long as you are available, you can refuse most other requests and demands.
7. Leave lights on and doors open. Night-lights can be very helpful, but bright lights (either used at bedtime or left on all night) should be turned down gradually at a pace the child can tolerate. The overhead light can be turned off in favor of the lamp; a 60-watt bulb can be replaced by a 30-watt bulb, then a 15-watt bulb, and then the 7-watt bulb used in most night-lights. If necessary, a dimmer control for the lamp or overhead light can easily be installed. If your child complains about the shadows, you can change the room’s lighting pattern, but once you find a reasonable one, stick to it. Turning the lights on and off or moving them around the room every night will do little to allay your child’s fear. Finally, leaving the child’s door open is almost mandatory, unless she specifically requests that it be closed.
8. Agree to check on your child periodically. Children often call out repeatedly to keep tabs on their parents and to keep them from wandering too far away (in the child’s judgment). Agreeing to check on your child until she falls asleep may fill this need. (Checking only means looking in on her to be sure she is all right and to let her see that you are near; it does not mean getting into extra nighttime conversations or interactions.)
Explain that she does not have to call you and that you will keep checking on her until she is asleep. Make the initial intervals short, perhaps five minutes or even one minute if necessary, so that she can see you before she gets too worried. Most children are reassured hearing you puttering around nearby as they fall asleep so they know you haven’t gone very far. A later-than-usual bedtime will help assure that she falls asleep before you have had to look in on her many times. Once she becomes comfortable with this routine, you may be able to lengthen the intervals to ten or fifteen minutes. But trust is the key: she must know that you will do what you say. Don’t wait longer than you agreed to just because she is quiet.
If she regularly wakes up during the night, you may have to agree to check on her then, too, but treat that as a short-term aid only: checking in the middle of the night is difficult since you must keep it up until she is back asleep. Fortunately, once children find they can count on being checked during the night if they need it, their wakings at night often become very brief or disappear altogether.
Checking on a child once or twice at bedtime is not particularly difficult, but if it takes thirty minutes or more before she falls asleep, the checking process becomes burdensome. In this case, it may be that she is going to bed too early—this is especially likely if she is never frightened later during the night. (Children who are very frightened generally need to be checked by their parents, or to be with them, during the night as well as at bedtime.) On the other hand, if you need to check your child repeatedly both at bedtime and during the night, if the need does not diminish over a week or so of checking, if a later bedtime does not help, and if each time you check her she seems truly frightened, then this approach may not be enough to help her with her anxiety. You may need to stay with her all night (see below), or her anxiety may be too severe to manage with behavioral techniques alone. But if she usually does not seem at all frightened even if she continues to call for checking, and especially if only brief periods of checking are necessary before she goes back to sleep, it may be that the ritual has become a simple habit that you can change using techniques of negotiation, rewards, and limit setting as described above and in Chapters 4 and 5.
9. Agree to stay upstairs until she is asleep. Children often do not want to be the only one upstairs (or downstairs) while they are going to sleep. If that is the case, then agreeing to stay on the same level of the house as her bedroom until she is asleep, or until she says it is okay to go to another floor, may be all that is necessary. Keep your promise. If she does not have to keep checking to be sure you are still nearby, then she can relax and go to sleep.
10. Agree to stay up later than she does. Some children—especially those whose parents go to bed early—worry that they will be the last one left awake, and that in the middle of the night they will be the only one up. Racing to fall asleep before the parents do, they are certain to stay awake. Checking is helpful in this situation. You may not even have to check on your child at intervals, as long as you promise to be sure she is asleep before you go to sleep yourself. Also promise her that if she wakes in the middle of the night and needs your help, you will get up and stay up until she falls back asleep. This is a burden if you have to do it frequently, but if you are willing to do it and make it clear to her that you are, the need usually disappears quickly.
11. Sit in her room. If checking even at short intervals is not enough to keep your child calm, you may have to stay in the room. That probably means sleeping there (see below), but it may be enough to sit with her until she falls asleep. Sitting with her is fine if you don’t have to stay long—another reason to start with a late bedtime—but it is very difficult to do repeatedly during the night. Your child may also fight sleep if she knows that you will leave as soon as she has fallen asleep. But if sitting with your child awhile is all that is necessary, it may get her sleep back on track. Then, as her anxiety eases, you can work your way back out of her room. By a process of gradual desensitization, you can progressively move your chair farther from the bed, then out into the hall; or you can work on leaving for brief but increasing intervals (see below); or you can start a reward system. Do whatever works best.
12. Sleep in her room. For the child whose anxiety is severe, the suggestions above may not suffice. A child whose separation anxiety is such that she cannot allow you out of her sight even briefly during the day should not be expected to stay in a dark room alone for ten hours; nor should an older child with serious anxiety, regardless of its cause. If your child is sufficiently frightened, the only way to make her feel safe at night may be to be there yourself. Remember, your first goal—at first, your only goal—is to take away the fear and make the nighttime pleasant again.
The fastest way to get things under better control is to offer to sleep in her room: preferably you will sleep in a separate bed or on a mattress on the floor, but if absolutely necessary, you may sleep in her bed at first and move to the floor as a second step. You could achieve the same effect by letting her sleep in your bed or in your room, but, assuming the long-range goal is to get her back to her own room, you will only be adding a step to the process, because to help her move back to her room you will probably still have to sleep in there with her initially.
Letting her move every night from her own room to a sleeping bag on your floor is also a poor technique. It forces her to get up and switch rooms in the middle of the night, which will hamper good sleep; it fosters an automatic habit of room switching; and it forces her to sleep on the floor. Unless you take steps to change the sleeping bag routine, it may go on indefinitely (I have worked with families who have been stuck in this pattern for years), and your child may come to believe that she will never be able to sleep alone the way her friends do.
Start the night by lying down in your child’s room while she goes to sleep. Don’t leave before she falls asleep unless she says you can; wait until she is deeply asleep before going out and finishing your evening activities. Then, return to her room when you retire for the night. (If you hear her start to wake before that, you should return immediately.) The goal is for her to know and trust that you are there when she falls asleep and will still be there whenever she wakes. If you try to sneak back to your own room whenever she is asleep, you will undermine her trust and she will start trying to stay awake or reawakening frequently to check on you.
Most children’s nighttime fears dissipate if a parent sleeps in their room with them. Your child should start sleeping well. And so should you (although in less than ideal circumstances). The idea here is to let things calm down, reverse the spiral, get back to normality, and reassess the situation.
If your child’s nighttime fears are only one part of a generalized problem with anxiety, then she will likely remain very anxious during the day even after things are going reasonably well at night. In this case, you may have to continue sleeping in her room until that anxiety is addressed directly. Consider seeking professional counseling, particularly if the anxiety is pronounced and long-standing.
If the day and night are going well, you may be able to start applying some of the approaches listed above as you would for a child with only mild anxiety. Once your child has gone a week or two without being very fearful at night, she may be able to release you at bedtime, as long as you stay upstairs and promise to come back if she is frightened.
Your child may now be sleeping well, no longer bothering to check that you are there during the night. In this case, if she can learn to fall asleep at bedtime without you in the room, the problem will be resolved. Your child may agree to this step, perhaps helped along with a reward system and some negotiation as described above. If she is not ready, you can gradually help to prepare her. Before she goes to sleep, you can leave her room briefly “to get something.” How long you stay away depends upon your child’s ability to tolerate your absence; it could be ten seconds or ten minutes. If she does not fall asleep immediately upon your return, you might go out again. Gradually, perhaps over a week or two, make the trips out longer and the trips back shorter until you’re really just checking on her. Now your child is starting to get used to being in her room alone again—this is very important, because it means that simply finding herself in the room alone is no longer a cause for alarm. And she will start to fall asleep while you are out of the room—also very important, because if she wakes to find herself in the room alone, she will not find anything changed from the way it was when she went to sleep. Once she is comfortable falling asleep alone, you can plan on staying out of the room the rest of the night. If she starts waking again at night, use your judgment as to whether she is simply repeating old habits or is actually frightened. In the first case, set appropriate limits or respond briefly at increasing intervals as described in Chapters 4 and 5; in the latter, make yourself more available again.
Do Not Use Siblings (or Pets) to Do Your Job as Parents
Many siblings share rooms at night, and of course that is fine. But if a child is frightened at night, it is your job to deal with that fear, not her brother’s or sister’s. You should not make one child let her frightened sister climb into bed with her during the night, or force another child to go to sleep with his frightened brother, or move either of them into a frightened sibling’s room or let the sibling move in with them. Nor should one child have to rely on another to feel safe at night. If two siblings have been asking to sleep in the same room, that may work out fine, but don’t let one youngster’s anxiety be the reason.
Buying a cat or dog (or using one you already own) to stay in your frightened child’s room at night may or may not be fair to the pet, but either way it will usually not help your child. The bedroom door will have to be closed, to keep the pet from leaving the room, which might cause your child more anxiety. Even if a cat is there, your child may have trouble finding her; your child’s sleep may be further disturbed by a dog trying to leave or by a cat patrolling the room throughout the night. In any case, the presence of a pet is not enough to allay significant anxieties in most children, and even when it is, the child only becomes dependent on the animal, and the cause of the underlying fears goes untreated.
How We Helped Tyler
Tyler benefited from a number of the techniques described in this chapter. I suggested to his parents that they spend time with him in his room each day for a game or a story. They were not to leave him there alone. Since Tyler rarely fell asleep before nine o’clock, his bedtime routine would not even start until that time. After a story, they would say good night around 9:30. Tyler would be very sleepy then: the late bedtime, along with an unchanged 7:00 A.M. wake-up time, guaranteed it. Tyler liked the later bedtime, and he thought he could stay in his room alone as long as his parents stayed upstairs and looked in on him frequently until he was asleep. Since they were to check him regularly even if he was quiet, he would not have to call. Tyler also agreed to let us turn off one of his lights at night, and over the next two weeks, his parents were to gradually replace the bulb in the remaining lamp with dimmer ones. These goals were further supported with a reward system that I negotiated with Tyler: he would be awarded stickers when there were no problems at bedtime, and more stickers when he handled the nighttime by himself or with only a minimal intervention. The stickers could then be converted into small presents.
If Tyler woke up at night, he was to try to go back to sleep without calling or waking anyone. If he felt he needed help, he could call, and one of his parents would check in on him; if need be, they would check on him regularly until he was asleep again, as they did at bedtime. He was never to sleep in their bed, but if he was very scared on a given night, one of his parents would sleep that night in his room (on a separate mattress on the floor, so he could continue to practice sleeping in his bed alone)—but on those nights he would earn no stickers. Finally, any night there was thunder, a parent would sleep in his room and he would still get his stickers.
Most of the areas of concern were now covered. Tyler would be sleeping in his own bed every night. The long wait to fall asleep would be gone, making it easier to go back to sleep later in the night. He would start each night by falling asleep in his room alone, so that if he woke later in the room alone, nothing would be different. He would not have to keep track of his parents’ whereabouts at his bedtime because they would always be nearby and checking on him, and he could always get more help later in the night if he needed it. Also, the bright lights would be gone. And he did not have to worry about the possibility of thunder because, if there were any, one of his parents would come right in. Furthermore, when he did well he got stickers and prizes.
In fact, things went very well. Tyler did call out a few times at bedtime the first night, but not often after that. He learned that his parents were close by and checking, as they had promised, and he started falling asleep too quickly to worry about checking anyway. He did need his parents to look in on him a few times during the night for a few nights, but once he saw that this help was always available, he stopped asking for that as well. All this time he was sleeping in his own bed alone all night, and each night was easier than the night before, as I had told him it would be. He was very proud of his stickers and the toy cars he got as rewards. Eventually the family was able to move his bedtime back to 8:30 P.M., and the lamp was replaced with a night-light. Soon he started wandering up to his room for toys during the day, and not long after that the fearful nights were only a memory.
All the techniques mentioned above should be considered guidelines. Try to design an approach that suits your child’s needs, your own abilities, and your particular living circumstances. Often trial and error will show you what works or what changes have to be made. Sometimes you will be able to move ahead faster than you expected; sometimes you’ll have to go more slowly. But in the beginning, always give your frightened child the benefit of the doubt. Assume that her fear is real and remember that you must provide support before you begin making demands. If you aren’t making progress, or if the progress stops, you may need professional help to decide how serious your child’s anxiety is, whether your behavioral program should continue, and whether counseling is indicated.