When Bedtime Is a Nightmare

Most parents have experienced the bedtime blues, when putting a young child to bed is so stressful and time-consuming that it leads to utter exhaustion. Unfortunately, a grueling bedtime routine usually wears out the parents, not the child.

If you're going through the bedtime blues, you might wonder if this is normal or if something is wrong with your child. And, if something is wrong with your child, is it serious?

Children who don't go to bed peacefully are usually suffering from one of two things: a sleep problem or a sleep disorder. The former is actually a behavior problem that involves the three target behaviors of going to bed, staying in bed and going to sleep. The bottom line for sleep problems is that the child won't or doesn't know how to behave appropriately.

Sleep disorders (also known as parasomnias or dysomnias) however, are situations where a child can't achieve those target behaviors. Sleep disorders require the expertise of a professional.

Distinguishing Between Sleep Problems and Sleep Disorders

So, how can you tell whether your child has a sleep problem or a sleep disorder?

Sleep Disorders

The following are signs of sleep disorders. If your child experiences these signs, you should contact your pediatrician.

• Problems breathing, including snoring, noisy breathing, mouth breathing or choking
• Excessive movement during sleep, especially leg or whole body movement
• Excessive sweating
• Confusion and expressions of terror ( night terrors)
• Sleepwalking
• Bedwetting past age five

Sleep Problems and How You Can Solve Them

Sleep problems are behavioral, and it's important to manage your child's bedtime behaviors when they are very young.

The first step in resolving bedtime problems is to develop a pre-bedtime ritual. Such rituals are natural for parents when children are younger, but it's important to maintain them with older children, too.

For example, because most children spend the majority of their time in bed alone, it's important that loved ones give them a big sendoff at bedtime. As children get older, the sendoff might be shortened to hug and a kiss, but it still should be there. The sendoff reassures, calms and prepares the child for the night ahead.

Once you've established your pre-bedtime ritual, follow these tips to work toward successfully getting your child to go to bed and stay in bed. 

• For preschoolers, give direct instructions, such as, "It's time to get ready for bed. Please pick up your toys and books now."
• If the child ignores your instruction, put him or her to bed without picking up the toys. The next day, ask the child to do the chore at an inconvenient time, such as when cartoons are starting.
• With younger children, parents can develop a positive routine in which they issue instructions for a series of pre-bedtime tasks the child follows. The final instruction - "Let's say goodnight" - is given when the child is complying consistently.
• With infants and toddlers, ignoring bedtime crying, calling out and crying in the middle of the night is the best approach. It will be difficult to listen to your child continue to cry or call out. But after three to five nights, these bedtime behaviors should become things of the past.
• Develop an early-warning system for toddlers who tend to sneak out of their bedrooms. A bell at the top of their door or an alarm will let you know when they've "escaped."
• When toddlers get out of their beds, use the "robotic return": Treat the situation seriously and solemnly. Move stiffly and do not speak to the child as you return him or her to bed. Then, close the bedroom door so the child associates a fully closed door as the consequence for getting out of bed.
• If your child tries to open the door after you've closed it, hold the door shut and do not let go. You must win this battle to eventually win the bedtime war.
• Don't argue, discuss, yell, threaten, promise or have any other communication with your child if he or she gets out of bed after bedtime.  Children get out of bed to gain their parents' attention, and by communicating with them, parents are giving in to what the children want.

With these ideas, and possibly a conversation with your doctor, you can begin to understand your child and get him or her (and yourself) on the road to a future of restful nights.