The mother of a 3-year-old who has trouble falling asleep at night wrote me the following email asking for help:

Dear Dr. Rosen,

I am hoping that you can help me.  I don't know of a pediatrician in my area that specializes in child sleep issues.  I have a 3 1/2 year old.  For the past 6 months, getting her to go to sleep at night has been a nightmare.  I have always had trouble getting her to sleep when she was little, she didn't sleep through the night until she was 1 1/2.  And even up to 2 1/2 she would often wake up in the night and tell me she was bored and wanted to get up and play.

When she turned 3 I moved my daughter into a regular bed.  Since then she won't stay in bed long enough to fall asleep (she gets up and plays, wanders around upstairs if she can without me hearing her downstairs).  I tried the Super Nanny approach and kept putting her back to bed until she fell asleep.  

But a week of doing this what felt like 50 or 60 times a night was too much for a single mom who needs to get up at 5:30 am to go to work.  I started taking everything out of the room for her to play with, taking away privileges, calling Santa to put her on the naughty list) but none of this worked so I started locking the door to her room.  At first she kicked the doors and yelled at the top of her lungs but now she stays in her room and plays/talks to herself until around 9:30 or 10:30 at night. I usually have to unlock the door for her several times to go to the bathroom (sometimes she doesn't really have to go, she just wants my attention).  Once she is asleep she generally stays asleep.  She normally gets up between 5:30 - 6:30 am in the morning.  On a rare day she will sleep until 7:00.  Sometimes she gets up at 5:00 am.

I thought perhaps her afternoon naps were the problem, but when she doesn't nap during the day she still goes to sleep around the same time and gives me a hard time.  She is also pretty grumpy in the evening when she doesn't nap.    

I now try to limit her nap to 1 - 1 1/2 hours in the afternoon unless she is not well.  At night we start getting ready for bed around 7:00 pm (pajamas, bathroom routine, stories, and soft songs) and I try to get her into bed no later than 8:00 pm.  I tell her she can talk to her babies softly in her bed, but she isn't allowed to get up unless she needs to go to the bathroom.  It doesn't seem to be helping.

Do you have any advice?  I would really like to get her into a better bedtime routine.  Any help, including your thoughts on whether or not she should see someone about her sleep pattern, would be appreciated. 

Sincerely,

Desperate Single Mom in Need of Sleep

Dear Desperate,

It certainly sounds like you have your hands full! While it’s not possible to provide child-specific advice, there may be some things that you can try to do which may help both you, and your daughter, to sleep better.

It sounds like her schedule isn’t as regular as it could be, even during the week, when her wake-up time ranges between 5-7. Keeping to a regular schedule, both weekdays and weekends, helps to synchronize the body’s internal (circadian) clock with the external clock, making it easier to fall asleep at the same time each evening. With her wake-up time spanning a two-hour range, it is easy to see how some nights she might be ready to settle down and go to sleep at 8:30, while on other nights that only happens at 10:30.

You also mention that she naps 1.5 hours during the day. Kids that age generally need around 11 hours of sleep; that leaves 9.5 at night. Of course, there are others who need less than that; every child is different.

The first thing I would suggest doing would be to put her on a regular wake-up time and keep to it 7 days a week. If you chose 6 AM, that would mean putting her down at 8:30. You’d want to make sure, too, that she isn’t getting more sleep at daycare than you are being told she is; while easier for the daycare staff, this can create lots of problems for parents whose kids simply aren’t sleepy enough at bedtime because they’ve slept during the day.

As for the behavioral piece, I’m not a big fan of locked doors, which can create stress for both child and parent.  A gate at the door should do the trick just as nicely. Providing a dim reading light and books that she can look at if she’s not sleepy, as well as dolls/toys, will help to keep her from getting bored. While she may ask come out, you need to decide if that is acceptable, and to be consistent. One possibility might be to give her a “pass” that she can use once to come out for a drink of water, or a kiss, etc.

Good luck!

________________

Dennis Rosen, M.D.

Help your child get a great night's sleep with: 

Successful Sleep Strategies for Kids (a Harvard Medical School Guide)

About the Author

Dennis Rosen, M.D.

Dennis Rosen, M.D., is a pediatric pulmonologist and sleep specialist who practices at Boston Children's Hospital.

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