Stimulating Healthy Sleeping from Birth Onward
Let’s start at the beginning. Promoting healthy sleeping habits in toddlers starts in infancy- at birth to be exact. Infants spend most of their time sleeping. These periods are interrupted by short intervals of calm alertness when the infant’s hunger has been satisfied and he or she is not in discomfort caused by dirty diapers, illness or other causes. These periods of calm and satiation begin to set a tone for the infant’s experience of the world as a safe, gratifying place.
I strongly suggest that from day one, your infant sleeps in his or her crib, NOT in your bed. I can hear you exclaiming, “What harm can that possibly do to my child?”
In the first few months of life, there is no harm done. But, by taking your infant into your bed consistently, you are interfering with the development of the ability to fall asleep easily, without significant parental involvement. When you hear what’s in store for you during the toddler years, you’ll be glad that you started by having your infant sleep in the crib.
I could tell you one story after another of parents coming to my office asking for help. “How do I get (4-year-old) Janet out of our bed?” asked Mother. “It better happen soon!”, said Father. “We haven’t had sex in over a month.”
When an infant is returned to the crib, clean and fed, sleep comes easily. Over the course of the first year, the intervals of wakefulness and sleep both lengthen. When the infant sleeps in the crib and not the parents’ bed, most infants are sleeping through the night by six months of age.
The Toddler Years
The toddler years are usually defined as ages one to three. These years are characterized by explosive physical and psychological development. In order to understand the causes of sleeping problems during the toddler years, we need to spend a moment understanding why the “terrible twos” occur. The “terrible twos” aren’t so bad when you understand their developmental purpose. Using the new-found ability to walk, the toddler charges into life (and furniture) and anything else in his or her way. Unfortunately, balance is shaky and one of the greatest risks to toddlers is injury from falls or running into furniture. The “terrible twos”, also called the developmental disturbances of the toddler, are characterized by destructiveness, messiness, motor restlessness, clinging, inability to separate, whining, and chaotic emotional states such as temper tantrums.
For all of its severity and pathological appearance, such behavior is short-lived. It remains in force while there are no outlets other than physical movement for the child’s energies. And the troublesome behaviors disappear or diminish in intensity as soon as new pathways for expression appear - particularly the acquisition of an expanded vocabulary. Language helps because it is a form of trial action and diminishes the need to express every thought and emotion through movements.
Thus, for a brief interval, there is a natural imbalance between the powerful, rapidly maturing body - exploding with new potential - and the limited ability of the mind to contain and channel newly emergent feelings and functions. Once that untamed energy is harnessed by the appearance of complex language and action is sometimes replaced by words, the imbalance gradually diminishes. This will not be the last time we will encounter such unevenness. Ahead lies adolescence. Then the body of the child vanishes overnight, trapping the innocent mind of the child in the awkward, hairy Frankenstein body of adolescence. This imbalance takes longer to redress; the mind doesn’t catch up for several years. (Some parents say almost forever.)
Toddler Sleeping Problems
Sleep disturbances occur during this phase of development for the same reasons that developmental disturbances do. They are extremely common during these years. In fact, although the reasons why they occur differ, sleep disturbances are common throughout early childhood and into the elementary school years. (Adolescents love to sleep, particularly after staying up all hours of the night, doing whatever they do when their parents are sleeping.)
The first type of sleep disturbance is related to the toddler’s intense involvement with his or her mother. Issues of separation and individuation are central themes in the toddler’s development. Separation involves the process of toddling away from mother during play and exploring the increasingly fascinating world. However, if the toddler wanders too far away from his or her lifeline, the world can be a scary place. If Mom is out of sight for too long, the toddler anxiously rushes back to the safety of her presence.
Falling asleep is a time of regression, a time of leaving the world of consciousness and the tenuous control of thoughts and feelings that is the norm at this age. Falling asleep is a time of leaving the best security blanket in the world, Mom. I don’t mean to exclude dads. In fact, fathers, day care providers, grandparents and other adults who plays a significant role in the toddler’s daily existence also provide security. To learn more about the separation-individuation process please refer to my ebook Guiding Your Toddler’s Development:Eating, Sleeping, Toilet Training and More (http://bit.ly/toddlerdevelopment).
So instead of falling asleep, the toddler cries, whines, climbs out of the crib or bed and shows up in the living room, interfering with much needed parental free time. Sometimes, several repetitions of the bedtime ritual are needed before the toddler finally falls asleep. Exhausted Mom and Dad often follow suit soon thereafter. How do you respond to such behavior? Hopefully, with kindness, patience and gentle firmness. A warm tone of voice is important. So is the patience to talk quietly and calm the toddler down - sometimes offering the inevitable drink of water - before walking the toddler back to bed - his or her bed, not yours. Sometimes sitting on a chair alongside the child’s bed will do the trick. Getting into bed with the toddler defeats the purpose since it suggests that the toddler cannot learn to sleep on his or her own. Consistency is critical. If parents set the clear limits suggested here, as the toddler progresses through the second and third year of life, this form of sleep disturbance gradually disappears. None too soon for exhausted parents.
The second type of sleep disturbance is related to the toddler’s great joy in practicing newly emergent skills such as walking, climbing, taking things apart and exploring every nook and cranny in the house. Continuous motor activity is the order of the day. I have a vivid memory of a young mother, always one or two steps behind, trying to protect her two-year-old son from toddling into the corners of the coffee table and climbing up, or falling down stairs. If left to their own devices - not a good idea - toddlers will stay in perpetual motion until they literally fall down from exhaustion.
A defined bedtime ritual is the best way to insure a transition from determined exploration of the immediate world and peaceful slumber. About an hour before bedtime, tell the toddler that it will soon be time to get ready for bed. The words are usually ignored or greeted with “No, I want to play!” or, even worse, tears or a temper tantrum. A bath is a good way to start the countdown to sleep. It is calming, confined to one space, and provides an opportunity for quieter play. A limit often needs to be set here, too. Who wants to stop playing in the bathtub? After wrestling the toddler into pajamas, a light snack might be in order, followed by a book or two on the living room couch.
Then comes, the moment of truth, not unlike when the matador finally defeats the bull. Hopefully, the ritual has produced a sense of calm and readiness to sleep. If not, delaying behaviors like getting out of bed, asking for a drink of water and calls for Mommy or Daddy will occur. As with all forms of toddler behavior, they are met with firm, but quiet kindness. “Sarah, I know you don’t want to go to sleep. But it’s time. Tomorrow you’ll wake up bright and early and be ready to play again. So close your eyes and go to sleep. I’ll check on you before I go to bed.”
The third type of sleep disturbance of the toddler is related to toilet training and an internal struggle of wishes to wet and soil verses desire to be dry and clean. This internal conflict arises as the toddler begins to comply with the parents’ wishes that he or she use the potty. But he or she still enjoys the freedom to pass urine and have BMs whenever and wherever they wish. Falling asleep means giving up conscious control of mind and body. Thus, the ability to consciously and purposefully control bowel and bladder is diminished. Therefore, the toddler experiences falling asleep as a threat to the wish to be dry during sleep. How to toilet train a toddler and what to do when the child wets the bed or soils is clearly outlined in Guiding Your Toddler’s Development:Eating, Sleeping, Toilet Training and More (http://bit.ly/toddlerdevelopment).
A Successful Bedtime Transition
Daddy: “Mary, it’s about time to get ready for bed. You can play for a little while longer while I get your bath ready. Then after your bath and brushing your teeth, we’ll have a little snack. Then I’ll read you one of your favorite books. And then it’s off to bed.”
Mary: (age two and a half, stomping her feet) “No, I want to play more!”
Daddy: “I know you do. But it’s bedtime, and you’ll have plenty of time to play tomorrow.”
Mary: (getting agitated) “No! Play more now!”
Daddy: “OK, keep playing now. I’ll run your bath.”
Mary continues playing as Dad gets the bath ready.
Daddy: “Ok, the bath’s ready. Let’s go.”
Mary: (beginning to cry) “No, no, no! Play more!”
Daddy: (calmly) “I’ll help you put your toys away. Then off to your bath we go.”
Mary: (refusing to help) “No, no, no!”
Daddy: (taking Mary by the hand, calmly but firmly) “Let’s go.”
Mary struggles, and Daddy picks her up, gives her a kiss and takes her off to the bathroom. A mild struggle ensues as Daddy wrestles Mary out of her clothes and into the bathtub. The tears stop soon after as she begins to play with her water toys.
Daddy: “Now, isn’t this fun? Let’s get you washed while you’re playing.”
Daddy: “OK, Mary, time to get out.” Another mild struggle ensues as Mary resists but responds to Daddy’s smiling face and reassuring voice as he playfully wraps her in a towel and helps her into her PJs.
Mary enjoys her snack and begins to get sleepy while Daddy is reading her a book. Because he wants her to fall asleep in bed rather than on the couch, Daddy suggests they finish the book when Mary is in bed.
Daddy: (after reading a few pages after Mary has been tucked in) “Good night, Princess. I’ll see you in the morning.”
Daddy leaves, and Mary falls asleep. The transition from vigorous play to sleep has occurred gradually, but not without a struggle to be sure.
The Same Bedtime Transition
But a Different Outcome
Daddy: “Mary, it’s about time to get ready for bed. Pick up your toys. It’s time for your bath.”
Mary: (age two and a half, stomping her feet) “No! I want to play more!”
Daddy: “It’s time to go to bed. You’ve played enough today. Stop now and pick up your toys.”
Mary: (getting agitated) “No! Play more now!”
Daddy: (obviously annoyed) “I said NOW!” Dad had been through a tough day. He didn’t have much patience left.
Mary: (starting to cry) “No, no, no! Play more!”
Daddy: “Don’t say ‘No’ to me. One more word and you’ll get a spanking!”
Mary: (starting to have a tantrum) “No, no, no!”
Daddy: (picking Mary up and swatting her bottom) “I said now!” He carries her off to the bathroom screaming.
A major struggle ensues as Daddy wrestles Mary out of her clothes and into the bathroom. Tears roll down her face. “Mean Daddy! Water is cold!” After Daddy washes Mary while she continues to struggle, she gets soap in her eyes and cries even louder. Daddy takes Mary out of the tub, wrestles her into her pajamas while complaining, “You are not a good girl! No snack for you tonight.” Daddy puts Mary into bed. She is still screaming. He doesn’t kiss her. And he tells her to go to sleep, “Or else!”
A Comparison of the Two Transitions
Daddy in the first example may sound a bit idealized. But he clearly understands toddler development and is consistently loving and firm. He allows Mary time to get used to the idea and tolerates her normal negativism. “No” is the favorite word of the toddler, and playing is much more fun than going to bed. Although Daddy is sensitive to Mary’s resistance, he does not let her alter his plan for getting her to bed. He is obviously in control of his feelings in the face of her resistance and uses a kind voice as well as encouragement to diminish her resistance. He clearly understands that he is the adult and the one in charge. And she is a very young child with no ability to know what is best for her.
I empathize with the daddy in the second example. After a rough day at work, it’s difficult to come home to a rambunctious toddler who is in perpetual motion and constantly saying “no!” A clear knowledge of toddler development would have helped father understand that Mary negativism was a normal phenomena at her age and not premeditated, willful disobedience. As he became impatient, misunderstood Mary’s behavior and raised his voice to demand obedience, Mary descended into a tantrum and lost all ability to cooperate with her father. The result was an exhausted father who undoubtedly felt bad about how he had acted and a distraught toddler who went to sleep in tears.
I fully understand that no parent - even the most understanding and patient one - gets through these years without occasionally raising his or her voice or occasionally swatting the child’s behind. Raising a toddler is a tough job. At no point during childhood, possibly other than adolescence, does an understanding of child development have greater positive effect on both child and parent.
The 2 A.M. Dilemma
Jeff complained to me that his 22-month-old son Andrew woke up about 2 am nightly, crying and demanding his sippy cup. Mom would nudge (maybe push) Jeff and say that she was tired from working hard the day before, so would he please get out of bed to get Andrew’s sippy cup. Dad usually stumbled around to find the cup and fill it with milk before giving it to his son and sleepwalking back to bed. Dad was not a happy camper, particularly when he had trouble getting back to sleep while his son and wife slept like angels.
On a couple of occasions when Mom was away overnight and Andrew awakened crying, Jeff said to himself, “No way!” and stayed in bed without responding to Andrew’s cries. To his surprise, Jeff discovered that Andrew cried briefly and soon went back to sleep. When Jeff reported this to his wife, she was not pleased. Andrew still needed his sippy cup, she declared. After all, he was only 22 months old.
Well, from a child development standpoint, Andrew didn’t need his sippy cup in the middle of the night. His response of quickly falling back to sleep when Dad “neglected” to give him the cup was clear evidence that Andrew was ready to sleep through the night without nourishment. In actuality, it wasn’t even the nourishment that Andrew was seeking. It was a remnant of the close infantile bond between mother and child- so necessary during the first year of life, but no longer needed as Andrew approached the age of two. Once a mother, always a mother. Mom dearly loved her son and was hesitant to give up that wonderful sense of fusion with her first-born.
When Jeff saw that I supported his efforts to get Andrew to give up the sippy cup during sleeping hours, Jeff volunteered the following story. Mom was a professional who occasionally worked on weekends. Two months prior , Jeff spent the weekend taking care of his son while Mom was away working. At that time, Andrew was still using a pacifier. When Andrew asked for it, Jeff made an honest effort to find it, but couldn’t. There wasn’t another one in the house, so Andrew went without. Soon he seemed to forget about the pacifier. Since Jeff thought that Andrew was too old for a pacifier (and I agreed), when his wife returned, Jeff told her that the pacifier was gone for good and Andrew didn’t seem to care. Mom grumbled but went along with her husband’s decision. And so Andrew was weaned from his pacifier.
To get back to the main point of my example, toddlers have sleeping problems centered around waking up in the middle of the night when they have not been weaned (from bottle or breast at about a year of age) and when parents do not gradually wean the child from the no longer necessary need for nourishment during the night. When the use of the bottle or sippy cup is prolonged into the second year of life, the result is interrupted sleep for parents and delayed development for the toddler.
“Mommy, I Go Pee-Pee?”
Sarah was 28-months old. Toilet training, begun at age two, had been going quite well. Sarah was dry most of the time during the day and used the toilet consistently for BMs. However, when Sarah would wet during the day, she became very upset. Mom and Dad were reassuring and four months into the process, Sarah’s toilet training was progressing quite normally. However, she became anxious as bedtime approached and asked to use the potty several times before going to bed.
If she did wet the bed during the night, Sarah would wake up crying and continue sobbing until Mom or Dad comforted her and changed her sheets and pajamas. Then, reassured and dry, Sarah would go back to sleep. As the months went by, Sarah gained more and more control of her bowels and bladder. The incidents of wetting at night and disruption of the sleep of all concerned gradually diminished and stopped entirely by the time Sarah was three-years-old.
Not all children have such a strong reaction to wetting the bed. In fact, some sleep right through it. Dealing with bedwetting is a subject for another time. This example is meant to illustrate a common toddler sleep problem that is related to an age-appropriate developmental task, namely toilet training.
Parental Dos and Don’ts
Do not take infants into your bed. It sets a bad precedent that will be hard to break later.
Do wean your infant at a year of age.
Do not leave infants and toddlers for more than a day or two. Longer absences encourage regression and sleep disturbances.
Do wean the infant/toddler from the pacifier, if one is used at all, during the second year of life.
Do begin toilet training at approximately age two.
Do change a toddler’s wet bed and pajamas during the night if he or she is distressed and awake.
Do understand the terrible twos. Understanding increases patience and allows the parent to proceed with the toddler’s best interest in mind.
Do have a bedtime ritual that gradually helps the toddler make the transition from activity to restful sleep.
When participating in the bedtime ritual, do be firm and consistent.
Although tempted, do not raise your voice or use spanking.
Do have your toddler fall asleep in his or her bed, not on the living room couch.
Do not lie down on the toddler’s bed to help him or her fall asleep. If you are attempting to establish a routine after allowing your toddler to sleep in your bed, for a week or two, sit on a chair near the bed. Then gradually discontinue this practice.
Do take the 2 a.m. intruder back to his or her bed every time.
So there you have it. I’ve offered some explanation of why toddlers have sleep disturbances, information on the terrible twos that are the cause of those disturbances, and some practical Do’s and Don’ts. I’m sure that I haven’t addressed the myriad of circumstances troubling you about your toddler. But hopefully, the information presented here will help you decide how to proceed with the best interests of your toddler’s development in mind. If the sleep disturbances of your toddler still worsen over time, do consult with an experienced child psychiatrist or child psychologist. They can help you understand your child’s needs and guide your parenting in the child’s best interests.