The eternal drama - falling asleep, sleeping through the night

Many parents have the same problem: despite the daily routine and usual wind-down practices, small children won't sleep and often wake up at night screaming! Why?

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Sleep is very important for your child as it is essential for the happiness and stability of your child. When a child is deprived of sleep, he could become a nightmare for your whole family.

Whether a child sleeps alone, with siblings or with parents it does not affect the quality of a child's sleep. All these habits could generally function well. The important thing is for a child to have a regular sleeping or waking routine that guarantees healthy and restorative sleep during the day and night. It is important that you recognize a sleeping disorder of your child and react promptly.

Many parents are uncertain when it comes to sleeping practice of their child. Maybe you ask yourself how long a child should sleep during the day and at night. Did you know that a six-months baby could sleep 9 hours without waking up? One sleeps longer and the other sleeps shorter but most children are actually capable of sleeping through the night.

With the following guideline you will recognize your child's sleeping problem and help you find a solution.

Details of sleeping problems

• Parents spend too much time 'helping' your child to sleep.
• A child wakes up often at night.
• The mood and attitude of a child is affected by bad sleep.
• Parents cannot sleep through or get less sleep because of a child's sleeping problem
• Bad sleep cause poor parents-and-child relationship.

When you recognize the sleeping problem try to solve it promptly. You might be able to get tips from other parents or doctors. In some cases it is important to consult a medical-sleeping expert.

Appropriate wind-down ritual

Bedtime means that you have to separate from your child and this cause emotional issues for both sides. On the other hand, it could be a special and valuable time. Spend at least 10 to 30 minutes wind-down time with your child before tucking him into bed. But you should keep activity low-key to avoid overstimulating your child. Also you should not tell or read unpleasent stories. The children should know that it is a special and happy time to end the day. If you give in to all his pleas, getting more drinks or reading more stories, your child would think that he does not have to stick to the sleeping ritual. Without regular bedtime ritual there will be stress and fights.

Sleeping problem caused by false association

'I am totally exhausted. I have to rock my child to sleep, whether it is during the day or night. When she wakes up at night, I have to hold her in my arms and rock so that she falls asleep.'

If this is familiar to you, it could be that you child is accustomed to rocking or nursing, breastfeeding and/or to be in your arms when falling asleep, establishing a link between the two. This makes him more likely to cry when he wakes up later and cannot settle himself back down into sleep.

The cause of these problems: we all wake up for a short time during the night specially during the REM sleep (REM = Rapid Eye Movement). Adults usually do not realise this and falls asleep again.

When parents notice that their child is awake, they feel obligated to feed, rock, pick up or to lie next to their child in order to settle him back down. Children quickly get used to such sleeping method and cannot fall asleep by himself without help. They become dependent on the help of their parents to fall asleep instead of learing to sleep alone with things that are always reachable such as a favourite blanket or stuffed animals.

'My child can only sleep in the car. As soon as he falls asleep, I take him out for 1 to 2 hours drive because the moment I bring him inside the house he wakes up.'

In this case their child associate the wrong thing with sleep. If your child cannot sleep in his own bed but in a car, in a rocking cradle or in a push chair, the child has established a link between movement and sleep.

Sleeping alone without help

When your child is used to fall asleep with parents' help e.g. rocking or holding in arms, he does not know how to fall back asleep on his own. Therefore he starts to groan or whimper when he awakes up. When you rush to pick up your chld as soon as he starts crying the your child will be more dependent. As a result he never learns to fall back asleep by himself. Often it is a mix of several feelings, making it a complicated time. On one hand, it is the parents' obligation to comfort their child but on the other hand it is important that the child learn to sleep by himself. Parents should know that children could learn and want to sleep on their own.

Of course you should not ignore your crying baby. You should make sure that the baby is fine and is not hungry, sick or needs to have his nappy changed. With the following technique your child can learn to sleep without much effort and without worries or feeling of guilt that you leave your child alone.

In order to solve sleeping problems of your baby you have to teach him to associate sleep with something that does not involve you. It is the best to apply the learning process during the night. Although some parents prefer to start the learning process when your child is taking a nap in the afternoon.

During the learning process you should expect your child to cry in the beginning. You have to realise that you are not neglecting your child when you do not rush to him immediately. With good combination of encouragement and comfort your child learn to sleep by himself. If you give your child a sucking to soothe him to sleep, it should not be used after 5 or 6 months old because it simply falls out of his mouth from this age. A favourite blanket or special dolly are the best because your child will always find it in the bed when he wakes up at night.

The learning process

The following method help children in the age between 6 months and 3-year-old to learn to sleep by himself. The child should be tucked into bed after a quiet wind-down practice. Wish your child a good night and leave the room. Leave the night light on if your child pleas. Should your child cry longer than two minutes go back to his room. But do not turn the lights on and take him out of the bed. Do not give him more milk or read him more stories or lie next to him even your child asks for it. Pat him or speak softly to comfort him. Go out of the room quickly. Do not stay in the room longer than 1 to 2 minutes.

If your child calls you again or cries, wait a few more mintues before you go back to his room. The minutes that you have to count while your child cries can be heartbreaking and painful. This learning process feel like a test of patience for parents than for your child. But for the sake of your child to learn to sleep on his own you would have to go through with it.

Time schedule to go back to your child's room when your child has sleeping problems:

+ the waiting time remains the same for round 5, 6, etc.

 Desensitising - method for older children

Older children have difficulty sleeping alone because they are afraid to be alone in bed. In case your child has this problem and you would like to be with your child to help him sleep on his own, you should try the Desensiting treatment. You have to be consequent and apply this method everytime your child goes to bed.

Explain to your child that you are sitting on a chair close to his bed and waiting until he falls asleep. Every night enlarge the distance between the bed and the chair towards the door. Night after night go closer to the door and at the end place the chair outside the room. For children, who cannot leave the bed, the door can be left open. For children, who can leave the bed, the door must be closed.

It may take 1 to 3 weeks until it finally succeeds. Positive reassurance and award such as a small prize can speed up the learning process. Praising your child can also be very effective.

Sleeping problem with compulsion to eat and drink

'My child is always hungry at night. He wants to be fed all night. I am very exhausted'

These complaints suggest excessive breastfeeding or giving bottles all night. This problem usually occur for babies and toddlers. The babies need to be fed many times during the night and for children from 6 or 7 months old need to be fed one time at night.

Children who gets hungry at night and wakes up a couple of times, need to be fed in order to fall back asleep. When a child is used to being fed at night he will become hungry even he does not need any nutrition. It is the parents' responsibility to teach their child to eat at a reasonable time.   

Children from the age of 5 to 6 months drinking more than 230ml of fluid do not necessary need it. This also applies for children that need to be breastfed one or two times at night for 2 to 3 minutes. Whether your child takes more fluid than necessary can be tested using a sucking. If the sucking is competely wet when your child wakes up, it is possible that your child has a sleeping problem of compulsion to eat and drink.  

Gradually reduce the amount you breastfeed your child instead of stopping at once. For babies that are breastfed every 1 ½ hours than should be breastfed every 2 hours on the first night. On the second night every 2 ½ hours and so on until it is no longer necessary. This process takes approx. 1 to 2 weeks. In case your child is fed with a bottle, you can reduce the amount by feeding 30 ml less every night.   

Problem maintaining boundaries

Setting boundaries and consequences for your child starts around the age of 2. If your child resist to go to bed or does not let you leave his sight than he has problems accepting the rules.

Parents must be aware that it is their responsibility to determine the appropriate time for your child to go to bed and to keep up with it. Even though your child may still be active and awake. Children can be very creative with their wishes: they want to be huged again, a piece of tissue, a glass of water, the light to be turned on or off or they need to tell you 'something really important'! Some times it is hard to tell whether they are serious or playing games. With consequent approach you can signal your child that you noticed his tricks and you are not willing to accept. Boundaries must be clear and reasonable.

For older children it may occur that they wake up and leave the room instead of calling their parents. In such case you can lock the door or block the door with a piece of furniture that it does not open so that they stay in the room. You can explain that you are willing to open the door again if they do not leave the room.  

The door should be closed all night. You should try not to enter the room to comfort your child but talk to him from outside the door. Every few seconds in the beginning and than every 1 to 3 minutes.  

This method only works for small children. The goal is not to scare your child but to show him that he has to stay in bed.

it is important that the parents understand the meaning or boundaries and maintaining it. The method with the locked door can be effective for children who cannot stay in bed. On the other hand, you can encourage your child to stay in bed by giving him rewards if your child wish to have something. In order to maintain boundaries your babysitters and other family members should also keek the same rules.

Encouraging healthy sleep habits

With the following rules you can encourage your child to accept healthy sleep habits.

• Set up a sleeping/waking up routine and make sure that it is kept.
• Make sure that your child is relaxed before going to bed.
• Kümmern Sie sich vor dem Zubettgehen persönlich um Ihr Kind und benutzen Sie Fernsehen und Videofilme nicht als Ersatz für Ihre persönliche Fürsorge.
• You should take care and focus on your child before tucking him into bed. Do not use television or video as a subsititute.  
• Check to make sure that television, video and computer games are suitable for your child.
• Make sure that your child does not fall aleep while giving him a bottle, breastfeeding or holding him in your arms.
• Do not give your child a drink with caffeine (ex. cola).

You may rest assure that most sleeping problems do not cause neither physical nor mental damages on your child.

If you cannot solve your child's sleeping problem with the suggested methods than please consult your doctor. Healthy sleep habits happy family!

When you child sleeps well, he seldom wakes up at night and usually has good mood during the day.

Source: Prof. Dr. Thomas Penzel, Klinikum der Philipps-Universität Marburg, Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM)

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