Sleep concerns and your toddler
It can be difficult to know whether your toddler is experiencing a sleep or settling concern. If your toddler’s sleeping patterns are not affecting you or your family and you have strategies that work, then they may not have a sleep concern.
The following definition of ‘severe night waking’ provides a guide – however, you know your child the best, and if something is a concern for you, seek help and advice from your Maternal and Child Health nurse, doctor or the Maternal and Child Health Line on 13 22 29.
Severe night waking is when your child does one or more of the following things five or more times a week, for one or two weeks:
- Consistently wakes more than three times a night
- Consistently takes more than 30 minutes to settle
- Stays awake for 20 minutes after waking
- Goes into the parents’ or caregivers’ bed
- Has difficulties with sleep and settling that is causing parents/caregivers significant distress.
Strategies to help your toddler sleep and settle
Parents are encouraged to be responsive to the needs of their toddlers. Responsive settling is recognising that your toddler needs help and responding appropriately.
You can do this by knowing your toddlers’ cues, tired signs (Factsheet 9: Preventing sleep concerns) and the intensity of their cry. It is important that your toddler knows you are emotionally and physically available if they become distressed.
Developing positive sleep environments and routines can also support your toddler at bedtime to self-settle.
Every family is different, and you need to use a strategy that you feel comfortable with and suits your toddler and family.
Parental presence
Parental presence aims to use your presence as a way to help your toddler self-settle.
Research shows this strategy is effective, but it may take longer than other strategies to reduce sleep concerns.
It is also more work for parents, as you need to stay in your toddler’s room for seven to 10 days whenever your toddler is awake, so they know you are there.
However, you do not interact with your toddler, the aim is to break the link between your toddler’s sleep behaviour and your attention.
- Decide on an appropriate bedtime.
- Start a positive bedtime routine, such as a warm bath and reading a book.
- Place your toddler in their bed or cot, preferably while still awake or drowsy.
- Gently pat the toddler and say good night.
- Lie down on a bed or mattress in the toddler’s room with a night light on and pretend to sleep where the toddler can see you.
- If the toddler wakes during the night and is distressed, make slight noises or movement, such as coughing or turning over, so your toddler knows you are there.
- If your toddler becomes very distressed, soothe them with gentle words and by touching them – but try not to pick them up.
- After one to two minutes, lie down and pretend to sleep.
- Continue doing this every time the toddler wakes and is distressed. Repeat the process for day sleeps and naps.
- Continue with the strategy for seven nights.
- After three nights in a row of minimal sleep disturbance, you can return to your own room.
- If your toddler’s sleep becomes disrupted again, you can re-introduce the strategy.
If there is no improvement after two to three weeks, consult with your Maternal and Child Health nurse or doctor.
Camping out
Camping out is similar to the parental presence strategy. It may be useful if you don’t want to sleep in your toddler’s room but find it hard to leave your toddler to cry even for a few minutes.
This strategy may take one to three weeks until your toddler can go to sleep by themselves.
You will be more successful if you plan ahead and take time to progress through each camping out step:
- Decide on an appropriate bedtime.
- Start a positive bedtime routine, such as a warm bath and reading.
- Place your toddler in their bed, while they are still awake or drowsy, and say good night.
Try each of the following steps in order. Each step may take two to three nights until your child is used to falling asleep like this and then you can progress to the next step:
- Lie or sit next to your toddler and gently pat or stroke them until they go to sleep, then leave the room.
- Place a chair beside the cot and sit without touching. Allow your toddler to go to sleep before you leave the room.
- Sit at gradually increasing distances from the bed or cot. Allow your toddler to go to sleep before you leave the room.
- Eventually, place the chair outside the bedroom door.
If your toddler wakes, repeat the step you were using at bedtime to help them learn to self-settle.
Bedtime fading
Bedtime fading can be used for older toddlers from 2–3 years. It is based on physiological theory of establishing sleep by limiting your toddlers time in bed. With this approach your toddler does not go to bed until they feel naturally tired or drowsy, resulting in less night-time waking.
- Record the time your toddler goes to bed every night for a week.
- Identify the latest time and set this as bedtime.
- Gradually push back the bedtime by 15 minutes every two days.
- You can also move the bedtime earlier (if needed) using this approach, once your toddler gets used to falling asleep easily and quickly when put to bed. You can move the bedtime forward by 15 minutes every two days.
- Continue until your toddler falls asleep quickly and has minimal night-time wakings, reaching a preferred bedtime.
Controlled comforting
The controlled comforting method (also known as controlled crying and checking method) has been around for many years. To be effective you need to ensure that you do this approach correctly and effectively. This approach may not be right for your family. More information on controlled comforting is available at Raising Children’s website.
Cot to bed transition
Once your toddler is observed attempting to climb out of their cot, it is time to transition them to a bed. This is usually between 2 and 3½ years of age but can be as early as 18 months.
Make sure your toddler’s furniture and sleep environment is safe, this is especially important if they happen to get out of bed at night while you are asleep. Reduce their risk of injury by keeping dangerous items like cords from blinds and power points out of reach and limiting access to areas where your toddler could fall, such as stairs and windows.
Information on how to safely transition your toddler is available on Red Nose website, moving from cot to bed.
Strategies to assist with transition from cot to bed
- Involve your toddler in the process of getting the new bed. Tell them about it and get them to help set up the bed.
- Provide positive encouragement to make the transition exciting and fun, such as praising them for being grown up and making the move.
- Maintain a positive bedtime routine.
- Let the toddler take a blanket from the cot, which might help them feel more secure and comfortable.
Strategies to deal with calling out Moving from a cot to a bed can bring about new difficulties at bedtime, and toddlers may go through a stage of calling out.
If a positive and consistent bedtime routine is not stopping your toddler from calling out, and this is becoming a concern, you can try the following options. It is important to be consistent.
Option 1: Returning your toddler to bed
- Use your toddler’s name when you speak to them, and ask them to stay in their bed. Only speak to your toddler once.
- Return your toddler immediately, gently and calmly, to bed. Do not talk, make eye contact or reprimand your toddler in any way. Do this as many times as it takes until your toddler stays in bed.
- It might take many returns before your toddler stays in bed. You will need to be very patient. This might not be the best option if it makes you angry or upset.
Option 2: Restricting your toddler to the bedroom
- Use your toddler’s name when you speak to them, ask them to stay in their bed and not to leave the room. Only speak to your toddler once.
- If your toddler comes out of bed again, tell them that they have not stayed in bed and you will now be closing the door. Tell them that the door will be re-opened when they stay in bed. Return your toddler to bed and close the door. It is best to stay near the door to ensure your toddler does not get distressed by the door being closed.
- Another alternative is installing a child gate to prevent them coming out of the bedroom or a night-light if you think your toddler is afraid of the dark.
- Ignore any further calling out.
If there is no improvement after two to three weeks of using these approaches, talk to your Maternal and Child Health nurse, doctor or call the Maternal and Child Health Line on 13 22 29.
Credit to https://www.betterhealth.vic.gov.au/
