My last posting discussed ways of getting a child to stop migrating to her parents' bed at night. I had suggested engaging the child's cooperation and active participation in the efforts, through positive reinforcements, in parallel to making sure that other issues that may have been impacting the child's ability to sleep through the night were addressed as well. In response to this, a reader wrote:
I think it's important to consider the family dynamics as well. Obviously, the mother is out of the picture, because of a lethal accident, or because of a hostile divorce, but anyway, this little girl has lost her mother in a traumatic way and probably feels very alone in the world.
Her father is playing family with a new wife and presumably tries to divide his attention between his daughter, the child of his new wife, and his wife. This volatile balance is threatened by the arrival of a new baby, the only child in the house that will be living with its father AND mother, and the seal on the new bond of the couple. This will definitely further reduce the time and love the six-year old will receive.
I don't really think that stickers and food rewards will address this existential anxiety or relieve the girl's nightmares and fears of abandonment... All too often, sleep issues are just symptoms of much deeper-rooted problems, and it's important to address them.
I think that that is a point very well taken, and appreciate the opportunity to expand upon it. Anxiety and other underlying emotional issues can and do have a profound effect on sleep. A child who wakes up one night to find a raccoon in his bed may well refuse to sleep alone in his bedroom until enough time has passed and/or enough positive experiences have dulled the trauma and allowed it to recede. A child who has become separated from a parent, whether through death, illness, divorce, or deployment, may become anxious about losing the second parent; and the arrival of a new sibling can generate anxiety about the child's place in the new family order and concerns about whether she continues to be loved as much as before, in both cases leading to the child demanding more proximity with the parent(s). If these underlying issues are not revealed and addressed, there is very little chance that a sticker chart will bring about the desired change in the child's behavior. There really is very little chance that the child who is terrified at the prospect of waking up next to a grinning raccoon will stay in his bed just so that he can go out for pizza on the weekend with his father.
This is why, when trying to help people overcome their problems, be they related to sleep, or lung disease, or any other issue which affects their physical or mental well being, it is very important to listen to the person, patiently, and to try to understand what they are saying and describing. Asking the right questions is also important, but many times the responses aren't so tidy, necessitating divergence from the "script". Rigidly adhering to a formulaic, one-size-fits-all approach to solving problem "X" will not succeed, in the vast majority of cases.
Dennis Rosen, M.D.
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