Bedtime problems and night wakings in children

Many parents understand the importance of sleep for their child’s brain development, mental health, and physical strength. Many parents also experience problematic behavior around bedtime — crying, repeatedly getting out of bed or tantrums — and night wakings among their children. The American Academy of Paediatrics estimates that 25–50% of children and 40% of teenagers experience sleep problems.

One review found that 98% of parents reported that behavioral interventions were effective at addressing bedtime behaviors and limiting night wakings among children. With this in mind, this article will focus on behavioral interventions as a means of helping children to fall and stay asleep during the night.

Why is sleep so important for children of all ages?

At a time when our brains are developing quickly, quality sleep allows us to maximize our learning and memory consolidation. It has been shown to have a direct impact on children’s mood, resilience, alertness, and cognitive performance during the daytime. In early infancy, sleep can promote physical growth too.

When children have poor sleep quality they can be grumpy, hyperactive, or distracted. This can have a negative impact on their performance at school. Poor sleep quality has also been linked to allergic rhinitis, immunity problems, and mood disorders. It can increase children’s risks of developing cardiovascular issues in the future such as obesity, diabetes, and high blood pressure. Chronic sleep loss among teenagers is considered to be a public health problem by authorities and leads to an increased risk of substance abuse, car crashes, and sports injuries.

The effectiveness of behavioral interventions

Unmodified extinction

Many studies have found unmodified extinction to be highly effective in combating bedtime problems and night wakings by helping the child to learn to self-soothe. This involves putting the child to bed and then completely ignoring any crying, tantrums, and calling out until the next morning. Parents often struggle to maintain this strategy and find it stressful to implement. Although there is no evidence that unmodified extinction causes any harm to children, the scientific evidence is conflicting with regards to its effectiveness. For example, one study found that leaving an infant to cry causes a rise in their cortisol (stress hormone) levels, which is sustained for some days afterward.

Alternatively, parents can try staying in the child’s bedroom while ignoring the child and their behavior throughout the night or they can try graduated extinction.

Graduated extinction

Graduated extinction is the parent-friendly alternative to unmodified extinction and has been found to be just as effective at addressing bedtime problems and night wakings. It involves delaying the parent’s response to their child’s crying for a few minutes and then gradually increasing this delay over time. When responding to the child, parents are encouraged to limit interactions. The aim of this strategy is to increase the ability of the child to soothe themselves and sleep independently.

Positive routines and faded bedtime

Some studies have shown that positive routines and faded bedtime can be rapid and effective strategies, but more research is required in this area. This involves delaying bedtime and then taking the child out of bed for periods of time during the night when the child isn’t falling asleep. Once the child begins to fall asleep quickly, the bedtime is gradually moved earlier. Daytime sleep should be avoided, except for age-appropriate napping. The theory is that this naturally increases the incidence of appropriate behaviors and avoids the need to reduce or correct inappropriate behaviors.

Scheduled awakenings

Studies suggest that scheduled awakenings can take longer to yield results and are unsuitable for young children with bedtime struggles. However, it is another useful option for some children. Scheduled awakenings involve waking and consoling children 15–30 minutes before a night waking typically occurs. Consoling techniques can include rocking or nursing the child back to sleep. These scheduled awakenings are gradually faded out by increasing the time span between awakenings.

Preventative parent education

This approach has not only garnered great results among children, it has also empowered parents in a meaningful way. Parent education programs have sought to treat sleep disturbances among children by preventing them from happening. The programs focus on establishing positive sleep habits from the get-go. These habits include bedtime routines, sleep schedules, a relaxing environment around bedtime, and a calm response to night wakings. It is recommended that babies are put to bed sleepy but not asleep to encourage independent sleep skills.

Overall, behavioral interventions have been found to produce reliable and durable changes to the bedtime behaviors and sleep continuity of children. Over 80% of children included in 52 studies demonstrated significant improvements that were maintained for 3–6 months. In particular, there is strong evidence for the effectiveness of unmodified extinction, graduated extinction, positive routines and faded bedtime, and preventive parental education.

Many studies have shown that behavioral interventions not only benefit children’s sleep, but some can also improve parental mood and the daily functioning of the entire family.

What else can you do to help your child get a good night’s sleep?

For children of all ages, it is important to instill good sleep hygiene. This includes a consistent, age-appropriate bedtime routine and the optimal cool, dark and relaxing bedroom environment. It also means healthy eating and physical exercise during the day. However, you should avoid exhausting children as this makes them overtired and hinders their ability to fall asleep at bedtime. Check out our Sleep Hygiene article and the list of strategies provided by the National Sleep Foundation.

Sleep disorders are also prevalent among children. If behavioral interventions and improvements to your child’s sleep hygiene are not yielding results, it may be time to consult a doctor.