pediatrics
Sleep Problems in Children
Resistance to Going to Bed
Children, particularly between the ages of 1 and 2, often resist going to bed because of Separation anxiety , whereas older children may be attempting to control more aspects of their environment. Young children often cry when left alone in bed, or they climb out and seek their parents. Another common cause of bedtime resistance is delayed sleep onset time. These situations arise when children are allowed to stay up later and sleep later than usual for enough nights to reset their internal clock to a later sleep onset time. Moving bedtime to a few minutes earlier each night is the recommended intervention for resetting the internal clock, but, if needed, brief treatment with an over-the-counter sleep aid, such as an antihistamine or Resistance to going to bed is not helped if parents stay in the room at length to provide comfort or let children get out of bed. In fact, these responses reinforce night waking, in which children attempt to reproduce the conditions under which they fell asleep. To avoid these problems, a parent may have to sit quietly in the hallway in sight of the child and make sure the child stays in bed. The child then establishes a sleep-onset routine of falling asleep alone and learns that getting out of bed is discouraged. The child also learns that the parents are available but will not provide more stories or play. Eventually, the child settles down and goes to sleep. Providing the child with an attachment object (like a teddy bear) often is helpful. A small night-light, white noise, or both also can be comforting. Some parents set limits by giving the child a "sleep pass" that the child can turn in for one time out of bed. If the child is accustomed to falling asleep while in physical contact with a parent, the first step in establishing a different bedtime routine is to gradually lessen the contact from full body to a hand touching the child to a parent sitting next to the child's bed. Once the child is regularly falling asleep with a parent next to the bed, the parent can leave the room for increasing durations. 