By Julie M. Schuster, MD
We are all familiar with the energy of a toddler, especially at bedtime. “Please, just one more story!?” One might think it must be easier to convince North Korea to shut down its nuclear program than get your child to go to bed. Here are some tips to help establish good sleep hygiene for your little one.
Establishing effective sleep habits starts in infancy. While it will certainly vary by age, it is never to early to start a bedtime routine. It may consist of singing a song in a quiet room during infancy. Nighttime feedings should be different from daytime ones – lights out, no noise, no playtime. While newborns must eat every few hours during the night, these feedings should start to decrease as your infant gets older. By four months, your baby does not physiologically need to eat during the night. It is mostly a routine to awaken for a bottle and you can try to comfort your baby when she awakens without a feeding. Your infant should always sleep alone. This is also something that must be established early. From 0 – 6 months, your infant is at risk for Sudden Infant Death Syndrome (SIDS) if they sleep in your bed. After that, there is the risk of the baby falling out of the bed and getting injured. It is much easier to have your baby sleep alone from the beginning rather than trying to move them to their own bed later.
Many parents ask when they can move their child from a crib to a toddler bed. Once your baby is old enough to sit up and later pull up to standing, you must lower the crib mattress so they do not climb out. Once your toddler has acquired skills that they could use to effectively climb out of a crib with a lowered mattress, it is time to move them to a toddler bed. Having a routine established where your child knows this is their bed where they are to stay all night is mandatory by this age. Otherwise, your toddler can now get out of bed, walk to the door, open the door, and either roam freely about the house with numerous dangers awaiting them, or incessantly bother you until you allow them to get into your bed. This often happens if good sleep habits are not already in place.
Toddlerhood is a time to hopefully continue the good routines you have already established. Your bedtime routine has now evolved, and will likely consist of activities such as brushing teeth, going to the bathroom, putting on pajamas, reading a book, then a hug and lights out! Having this routine lets your child’s brain and body know that bedtime is coming and helps them to prepare. It is also important to have a consistent bedtime (other than special occasions). Children thrive with routine and go to sleep more readily if bedtime comes at the same time each night. One strategy some parents have used is to make a chart of bedtime tasks and check them off as each one is completed. You can draw a picture next to each step of your child happily completing each task. Make bedtime activities desirable by letting your child have a cute toothbrush, picking the toothpaste, and commenting on how beautiful his clean teeth are or how nice he looks in his new pajamas.
Some children try to negotiate their bedtime each night (“I’m not ready”, “One more game”). When they sense the time for bed is nearing, they may dig in their heels. Perhaps they are fearful of going to bed. Be calm and reassure them that you or someone they trust will be nearby. Avoid active physical play before bed, as well as sugar and caffeine late in the day and evening. These can all make it difficult for a young child to go to sleep. If your child has problems with bed-wetting, avoid liquids after dinner and make sure they urinate before bedtime.
If your child throws a tantrum during the bedtime routine, do not beg or plead with them to complete their tasks and go to bed. Always remember that you are the adult and you are in charge. Tantrums should be ignored. You can tell your child that you are leaving the room. When they are finished with their fit, you will return. Don’t feel obligated to negotiate with your child over expected activities such as bedtime. Minimize distractions, such as siblings who are not going to bed at the same time. Do not allow your children to routinely fall asleep with you or your spouse while in front of the TV. Studies have shown that TV interferes with children’s sleep and should not be allowed in their bedrooms. Set a limit to either the number of books you read or the time you will spend reading prior to bedtime and stick with it.
Ensure your child is getting appropriate daytime naps as too much or too little time spent napping can interfere with nighttime sleep. According to the American Academy of Pediatrics, a newborn should sleep 15+ hours per day. From 4 months to 3 years old, a child should sleep about 13 hours at night plus a 1+ hour nap. From ages 3 to 5 years, they should sleep 12 hours at night and as needed naps. Some children no longer require naps at this age. From 5 years and onward, children should sleep 10-11 hours per night with no daytime naps.
Bedtime can be fun and keeping your child well-rested is important for her growth and development. It’s also helpful for a busy mom or dad to have time in the evening to spend with each other or finishing other activities for the day!
Image from: www.babyshrink.com
Dr. Schuster is a pediatrician with Oldham County Pediatrics www.oldhamcountypeds.com. Their office locations are in LaGrange and behind the Summit shopping center. Dr. Schuster is married to Bryce, who is a general surgeon.