children s health issues
Sleep Problems in Children
Resistance to Going to Bed
Children, particularly between the ages of 1 and 2, often resist going to bed due to Separation Anxiety and Stranger Anxiety , whereas older children may be attempting to control more aspects of their environment. Young children often cry when left alone in their crib, or they climb out and seek their parents. Another common cause of bedtime resistance is a delayed sleep start 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 start time. Moving bedtime a few minutes earlier each night is the best way to reset the internal clock, but, if needed, brief treatment with an over-the-counter sleep aid, such asmelatoninor an antihistamine, can help children reset their clock. 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 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) is often helpful. A small night-light, white noise, or both also can be comforting. Some parents may find it helpful to set limits by giving the child a "sleep pass" that can be turned in for one time out of bed. 