In response to a recent post on sleep behavior modification (teaching a child how to fall asleep on her own instead of relying on something external with which she associates falling asleep, and without which she is not able to, such as being rocked in her mother's arms, sung to by her father, or nursing), a reader raised the question of whether a child could be too old for this to be done successfully. I had responded that sleep behavior modification was certainly something that could be done in children of all ages, starting at about 4 months, though the specifics of how exactly to do this really depend upon the child's level of development and understanding. She (the reader) then wrote back:
"... I tried the sleep training and (my daughter) ended up climbing out of her crib and falling on the floor. I think I will need to wait to start the sleep training until she is transitioned to her toddler bed".
I'd like to again state that I believe there is no "correct" answer for when the best age is to modify a child's sleep behavior. Usually, the best time to do this is when the parents have come to the conclusion that their child's sleep behavior has become too disruptive, and needs to change.
With a very young child who sleeps in a crib and cannot climb (or throw) himself out, successfully teaching him how to fall asleep on his own really depends upon the parents sticking to their guns and giving the child a consistent message that, while they still love him, the rules of how he is to fall asleep have changed, and that he really has no choice in the matter. This is usually done by putting the child in bed awake, and letting him stay there until he finally falls asleep on his own, checking in on him at fixed intervals to reassure him that he has not been abandoned (and to reassure the parents that, despite all the crying, nothing terrible has befallen him), all in conjunction with implementing a regular, age appropriate schedule, and regular bedtime routines.
With a slightly older child, who is capable of escaping from her crib, or has already graduated to a toddler bed, putting a gate (sometimes two, if she is a climber) at the bedroom door is a very effective means of making sure that she gets that very same message. The gate essentially turns the entire bedroom into a defined, closed sleeping space (similar in concept to a crib), and physically prevents her from running out of her bedroom to her parent's room after being put into bed to fall asleep on her own (instead of, for example, in her mother's arms), or in the middle of the night when she wakes up and gets lonely. While one could also just as easily shut (or even lock) the bedroom door, doing so can generate a lot of unnecessary anxiety (causing the child to wonder whether her parents are still outside the bedroom, or if they've abandoned her, or if she is being punished). If this happens, the anxiety can become so strong as to prevent the child from being able to fall asleep at all, which is, of course, counterproductive to the ultimate goal of teaching her to fall asleep on her own.
When one tries to change sleep behavior patterns in an even older child (4-5 and up), enlisting his active cooperation is critical to achieving success. This can be done by implementing a reward system, with the child earning prizes for falling asleep on his own. A star chart can be used as an incentive to get him to cooperate with the process. For example, on any given night, a 6 year old who succeeded in falling asleep entirely on his own after lights out might get three stars; if he needed to call for his father to come back to the room for one more good night kiss, two stars; if he came out of the room to look for his parents but was able to go back to bed on his own, one star; and if he wound up migrating into the parent's bed, none. After obtaining a predetermined, agreed upon number of stars, the child would then receive a small, predetermined reward.
Dennis Rosen, M.D.
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