At 7:30 p.m. you hand-hold your preschooler to bed, give a kiss, turn down the light, and crack the door just enough to alleviate his aloneness. But how long before he's at your knees begging he cannot sleep or wants a drink of water for what seems like the ten thousandth night in a row? You blow him another kiss and wish him a good night's sleep -- for his sake, you say to yourself, but in reality also for your own.
Most every parent has experienced the claustrophobic dread that takes over the room while trying to convince a child to lie down, close his eyes, and stay still long enough to fall asleep. We console and cajole, we beg and plead, but he is not at all compelled hearing about the importance of good sleep for his health and happiness tomorrow.
Evidence tells us that the impact of disrupted sleep can be extensive and follow a child through life. It can have deleterious effects on cognitive development, mood, and the ability to pay attention and behave. Studies show it may even impact parental health and well-being, as an infant or toddler who cannot sleep through the night is a potential cause of maternal depression.
There's no doubt about it: Bedtime epitomizes all the demands and challenges inherent to parenting. We (hopefully) remain calm on the outside, churn on the inside and muster all of our resources only to discover, when nightfall calls, that once again we cannot control everything after all.
And yet, evidence also tells us that getting our little ones -- even infants -- to fall asleep by themselves and rest through the night is more than wishful thinking. We can actually influence the odds our children sleep well. It spite of concerns sometimes raised, sleep training itself has been shown to be not only safe for children's emotional development but effective. It requires only two parental disciplines: Establishing a set routine and implementing it consistently
Researchers reporting in the journal Pediatric Sleep came to this conclusion after reviewing 52 studies involving various sleep-time approaches on more than 2,500 children from infancy to age 5. They found that virtually all pediatrician-sanctioned approaches should work, even after just a few days. The one consistent finding was... consistency! As long as parents stick with a plan, no matter how challenging, most children develop healthy sleep habits.
To Sleep, Perchance to Sleep
Establishing consistent routines makes parenting easier. Any habit established in early childhood is likely to persist into adolescence and beyond. It is far easier to teach your toddler how to calm down and fall asleep than to convince a media-addled, sleep-deprived teen to turn it all off and get under the covers.
Establishing habits in children as early as possible is a parenting benchmark and a cornerstone of adult self-care. When children push nighttime boundaries, parents become chronically over-tired. That makes them less likely to maintain the necessary routines in the first place, which sets up a vicious cycle. He cries and pleads and we're too tired to wait for it to stop. But "just tonight" does not mean much to a child, and joining you in bed or acting like a "jack-in-the-box" for two hours takes on a life its own.
Here are some guidelines for establishing a bedtime routine. As you will see, it all comes down to new habits and consistency.
• You decide when bedtime starts. We all fall asleep easiest when our internal clock (our circadian rhythm) readies us for sleep. For a child put to bed too early, falling asleep is a challenge. Too late, though, and children pass their 'sleep window' and become restless again. An appropriate bedtime aims for head on the pillow (not starting bedtime itself) as the body slows. A consistent bedtime in and of itself has been correlated with cognitive performance.
• Start an hour before 'lights out.' Determine when you think your child should be asleep and start bedtime around an hour earlier. If that timing is unclear, monitor it by observing for when your child starts to slow down a little. Whatever you decide, set a reminder alarm if you tend to lose track of the time yourself.
• Establish an environment of calm. Children need guidance on ways to ratchet down from the day's activities. The idea of "sleep hygiene" means a habitual plan that quiets children, including activities such as showering or bathing, quiet games and reading. In spite of a common misperception screen time actually wakes the brain; studies suggest a need for electronics free time before falling sleep so keep it out of the routine. Avoid horsing around or other activities that rev-up the body. Offering a choice between reading and sleeping is one great way to encourage a lifetime habit. Bedtime is 8 p.m., but you can read until 8:30 p.m. It's one of the healthiest nighttime choices children can make.
• Encourage sustainable "sleep associations." Children seek reassurance when falling asleep and several times each night while cycling through light sleep. They consciously or unconsciously check for a comfort object or a parent. If it is you they have learned to seek, they may wake when you are not there, so avoid making yourself a sleep association. Instead, create a space in which your child feels safe and comfortable, and encourage a sleep association with stuffed animals, soft toys, pictures, or whatever else soothes.
• Ease yourself out. If you have become part of what your child needs to fall asleep, gradually reduce your presence. To move a child out of your bed or to get yourself out of their bedroom, pick a start date. Anticipate several weeks of disruption whenever you change the rules. Fade out your physical presence, perhaps sitting near their bed, then moving towards the door gradually over several weeks. Or fade the time between checking in on your child, returning after five minutes, then 10 after a couple of nights, and adding on from there.
• If a child wakes and gets out of bed, place him back in his bed without discussion. Avoid letting bedtime become a source of attention. If your child needs something, provide it with minimal conversation. If he needs nothing except to avoid going to sleep, direct him dispassionately but firmly to lie down again.
• Monitor for anxiety. If fearfulness or anxiety undermines sleep, discuss with your pediatrician or another health care professional ways for managing these challenging emotions.
• Consider tying the bedtime routine to a reward program. Offer stickers or points towards a long-term goal for each night successfully following your guidelines.
Follow Mark Bertin, M.D. on Twitter: www.twitter.com/markbertinmd