Types of Sleep Problems
Up to 1 in 4 pre-schoolers have sleep problems
Research has shown that up to 25% of pre-school children have a persistent sleep problem. Children can have just one type of problem or can have a mixture of problems.
It can be difficult to define exactly what is a sleep problem as what may be a problem for one family will not be for another. Also because each child's rate of development is so individual to them it can be difficult to give clear guidelines on when exactly one should become concerned about sleeping patterns. However if you feel you do have a difficulty with your child's sleeping pattern it may be worth having a chat with your GP or Public Health Nurse to check out your concerns.
In trying to find the solution that works best for your child it is important that you identify their problem correctly so that you can use a suitable approach.
Below you will find a list of the most common sleep problems with a brief description of each:-
Frequent waking during the night
This is by far the most common sleep problem that parents of young children have and is often related to the child's sleep associations. This problem can create havoc in households and can lead to significant loss of sleep for both you and your child. Frequent waking can be associated with your child's sleep associations. These refer to everything your child associates with falling to sleep
In mild cases of frequent waking some simple solutions can be tried. The child between the ages of six months to one year could be fretting for their parents as at this age they go through a developmental stage called separation anxiety. Introducing a "friend" to be with them throughout the night can help, e.g. favorite toy, special blanket etc. Some children love these special objects and they can be of great comfort to them.
Another solution is to introduce a special night light (low watt light left on in your child's room overnight) or even leave the light in the landing on overnight. When your child wakes up during the night they can look around and be assured all is well before falling back to sleep.
If you are are not making progress with this and it has become a major problem, have a look at our topic on approaches to sleep problems.
Difficulty settling to sleep alone
Most children will refuse from time to time to go to bed. However some parents find that the only way they can get their child to settle to sleep is to actually stay with them until they have fallen asleep.
It can take a long time to settle a child to sleep and some parents have found that by the time they have settled their child their own bedtime has approached
If this is a problem for you, it is important to be consistent in your approach. Try to encourage your child to settle to sleep alone and institute a consistent bedtime routine. Make sure your child is settling to sleep in a situation that is comfortable and free of too many distractions.
Also daytime routines can affect your child's ability to settle to sleep, for example having a large meal before going to bed or a late nap.
Sleep associations are all the things that your child associates with falling asleep and can be very relevant to this problem. The topic on sleep associations may help you decide if these are part of your problem.
While many parents cope with this problem until their child grows out of it, there are other approaches that can help.
Feeding during the night
Feeding during the night can become a problem for some parents especially when they suspect that their child is not actually hungry but on wakening will only settle back to sleep when offered the bottle or breast.
For many parents night feeding is not a problem and they are happy to continue it for as long as their child wakes for feeding.
For those parents who feel that this has become a problem that is interfering with their child's sleep needs there are some steps they could take. If you feel that this is a problem for you it may be worth having a chat with your GP or Public Health Nurse to discuss your concerns.
Problems with feeding during the night occur with both bottle fed and breast fed babies. There is some evidence to suggest that breast fed babies tend to take longer to give up the breast at night. A good rule of thumb is that by six months you can expect your child to be sleeping for longer periods at night. They may still require feeding during the night but are going for longer periods between the feeds and are not wakening for as many feeds.
The best approach to this problem is a gradual one as when your child does wake for feeding they feel hungry and denying them food is not a good idea. You could gradually reduce the amount your baby is drinking by either gradually reducing the amount of milk or gradually diluting it with water. If you are breast feeding you could try shortening the amount of time your baby spends on the breast during these night feeds. It may also help to gradually increase the time between feeds during the night.
One of the major benefits of solving this problem is that as the child takes less nourishment during the night their daytime appetite improves.
Nightmares or sleep terrors?
Most parents will recall being woken during the night to the cries of their distressed child. But was it a nightmare or sleep terror?
The occurrence of nightmares is quite common in the pre-schooler and does not necessarily mean that your child is having emotional problems or that they are under too much stress. Many children will have the odd nightmare and will not be suffering from stress or worry.
However for some children they can indicate that your child is under stress or worried about some daytime activity. The world of the toddler is full of new experiences that can be frightening, so it might be useful to look at their day to make sure they are not under stress.
Videos and TV viewing needs to be supervised closely for this age group - because of their limited understanding they could find even some of the children's cartoons frightening.
The best way to deal with nightmares is to comfort the child who will often be distressed by them and check that they are not worried about any events during their day.
Sleep Terrors
The other type of night waking that can be confused with nightmares are called sleep terrors. These are different from nightmares and the best approach to them is different. They generally occur earlier in the night and happen as the child makes the transition from one stage of sleep to another. Children generally do not wake during these terrors and do not remember them in the morning.
These sleep terrors can last from a few minutes to half an hour. They can start with a scream and be followed by the child sitting or standing up in bed, moaning or talking gibberish and possibly moving about the room. We know that night terrors are different from nightmares because the near paralysis that occurs during dreams or nightmares does not occur during night terrors. A child who is having a night terror can move around and even though they look like they are awake they are not aware of their surroundings and can be very difficult to wake.
The best way of dealing with sleep terrors is different to nightmares because the child is in a different stage of sleep. While the child who has had a nightmare will often wake up the child who is having a sleep terror will not. After a terror your child will usually settle back into a peaceful sleep without any help. Waking a child from a sleep terror is not a good idea as this could be very distressing and confusing for the child. Also children in the midst of a night terror will reject parents attempts to hug or comfort them and trying to force your child to accept your physical presence may distress them further.
The best approach is not to comfort your child but instead make sure they are safe and allow them to settle themselves back to a more peaceful sleep. The causes of sleep terrors vary and until the age of six most of these episodes are simply a part of growing up and are not generally related to emotional or physical problems.
Is your child waking because of Nightmare or sleep terror?
To help you decide which you are dealing with look at the following table:-
Sleep Terror
Runs into your room
Runs into your room
Cries out in first half of the night
Cries out in second half of the night
Tumbles out of bed
Tumbles out of bed
Remembers nightmare in the morning, scared it will happen again
Doesn't remember upset in the morning
Difficulty settling back to sleep
Settles back to sleep once terror is over
Talks about monsters, witches etc
Doesn't want comforting, pushes you away
Actively seeks and willingly accepts comforting
Usually talks gibberish during terror
Cries out/screams
Cries out/screams
Remember that the approach to each is different so it is important to know which it is your child is experiencing.
Sleep at the wrong times
Your child may be getting enough sleep, but it's not at the times you would like. It can be difficult to manage the child whose sleeping pattern is out of step with the family. There are two extremes to this problem. The first is the child whose bedtime is very late and who can be impossible to wake in the mornings. As any parent in this situation can attest to this is not the most pleasant way to start the day! The other extreme is the child who tends to fall asleep early in the evening and starts the day in the early hours of the following morning, again not the best way to start your day.
The child whose bedtime is late e.g. 10 pm and who is sleepy in the morning is in a late sleep phase. Even when forced to go to bed earlier these children will not be sleepy and while they might stay in their room they will still not fall asleep until their later usual bedtime. They will often be difficult to wake in the morning and can be somewhat cranky if woken early! Bedtime battles are very common with this group and when they stay awake for hours after being put to bed everyone can become disheartened.
At the other end of the spectrum are those children, usually very young, who wake for the day in the early hours of the morning and of course expect Mum or Dad to get up to keep them company. These children are in an early sleep phase. They tend to go to sleep early in the evening and wake early in the morning.
Also some of these children make up for the early start to their day by taking their morning nap early and so making up their sleep requirements in this way. This however is often not an option for their tired parents! Again this problem can be very frustrating for parents as when they try to move their child's bedtime forward it can prove difficult to keep them awake past their usual bedtime.
Both of the above problems usually develop gradually and the best approach to both is a gradual reversal. It would help to keep a sleep diary to check on your child's pattern. Look at daytime naps - is the morning nap too early, or the afternoon nap too late, or are the naps too long? Do not be tempted to try cutting out the naps entirely as this could lead to worse problems with a very tired child. Rather look at changing them gradually.
In the case of the late sleep phase it's best to start by bringing the bedtime back by 10 minutes. When your child has adjusted to this, (it may take a number of nights) bring the bedtime back by another 10 minutes. Continue with this approach until your child's bedtime is at an hour that you think is reasonable.
For the child who is in the early sleep phase the same approach applies. Gradually put your child to bed later in the evening until you have reached the bedtime you want. The secret to the success of this approach is that it is done gradually to allow the child's body clock to adjust to the changes.
For a more detailed look at this approach, have a look at the topic on Gradual Steps.
Refusing to sleep alone
Most small children would happily sleep in the parental bed but for many parents this is not an option. For the parents who chose to have their older toddler sleep with them this is not a problem but many parents do not want to sleep with their child.
Three ways of dealing with this problem are:-
consistently taking the child back to bed when they appear in your room or
using Star charts to help them stay in their own room.
Allowing your child to sleep with you.
In using the first approach both parents need to agree and be consistent in their approach. When the child comes into the parental bedroom he/she is brought back to their own bed and tucked in with the minimum of fuss. This is done every time the child comes into the parent's room. It sounds easier than it actually is as initially parents can expect their child to enter their room more often and to protest at the change to their pattern. However if you can gently but firmly encourage your child to stay in their own bed this will eventually work.
The second approach of using star charts is suitable for the older child (3 years+). In this approach the child is rewarded or receives a star for spending the night in their own bed. The stars can accumulate until, say the child had received three stars, and either gets a treat or gets to do something pleasant with either or both their parents. This approach focuses on positive behavior and children can find it fun.
In the second situation where the child will only settle to sleep in their parent's bed you could try moving your child's bed or cot into your own room. Some preparation is needed before using this approach. The new arrangements are explained to the child and maybe the child becomes involved in helping to prepare their bed by getting new bed clothes etc. The child's bed can later be moved back to their own room once they have become used to settling to sleep in it.
In the third approach parents decide that it is easier for everyone if their child is allowed to sleep with them. For many families this approach works well as with all the approaches it will suit some families and not others.
It can be very frustrating when on being put to sleep in their own bed the little one appears beside your bed just as you are settling to sleep. Or being woken in the middle of the night to find that your toddler has managed to get into your bed and is now in the process of kicking and tossing with the effect that you find yourself hanging out of the bed minus your warm duvet can be somewhat disconcerting!
There are two types of situations that can cause problems.
The first is when your child comes into your bed during the night and the second is where your child will not settle to sleep in their own bed but will happily settle in the parental bed.
In the first the child will settle to sleep in their own bed but at some stage during the night will attempt to join the parents in their bed. One approach is to shut either your child's door or your own. This will not always work as children could feel shut in if their door is closed and some will just set up bed outside their parents' door. The other reason this approach may not work is that the child could become distressed at not being able to reach their parents.
Anne O' Connor B.A. M.App.Sci.
Child Clinical Psychologist
Anne is a Child Clinical Psychologist and is the founder of RollerCoaster.ie. Anne holds a B.A. in Psychology and a Masters Degree in Clinical Psychology and a further Masters Degree in Applied Behaviour Analysis.
In her clinical practice, Anne specialises in psychological services to young children with developmental delay including autism. Anne also runs a preschool behaviour clinic, which helps parents manage preschool behaviour problems such as sleep problems, feeding problems, aggression etc.