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Helping Children Fall Asleep: Sleep Onset Problems in Children

If you’re the tired parent of a young child, you may wonder if your child’s sleep problems are normal. Could your child have insomnia? Can toddlers have sleep disorders? These concerns are perfectly legitimate, because many infants, toddlers and preschoolers have difficulty falling and staying asleep.

What’s normal when it comes to sleep for young children? According to research, children between nine months and two years wake twice nightly on average, though some infants begin sleeping through the night—defined as sleeping for at least five hours at a stretch—as early as two to three months of age.

But as many as a third of toddlers and preschoolers wake often enough to cause concern for parents—up to nine times per night, according to research.

Children with sleep difficulties may have a Sleep Onset Association Disorder (SOAD). Sleep Onset Association Disorder develops when a child learns to associate falling asleep with a specific environment or person. Some examples include falling asleep while being nursed, rocked, or held, or falling asleep in a car seat or parent’s bed. When the conditions or person the child associates with sleep aren’t present, the child won’t be able to fall asleep, or fall back to sleep after awakening at night.

Sleep onset disorders are highly common in babies and toddlers; researchers estimate that up to half of infants and 15 – 20 percent of toddlers have SOAD.

Well-meaning caregivers can unintentionally set the stage for SOAD in young children. When children aren’t allowed to practice falling asleep independently, the can become dependent on a certain person or environmental condition to cue sleep.  

Treating Sleep Onset Association Disorders in Children

Sleep physicians recommend several treatment approaches for SOAD in children. The first, extinction, is also known as “crying it out.” The child is put to bed awake, and parents avoid checking on the child during the night. Without prolonged interaction or soothing from caregivers, the child learns to associate his or her own bed with falling asleep.

Another technique involves gradually reducing parental interventions during the night to support independent sleep. Parents put the child to bed in his or her own bed, and remain close while the child falls asleep for the first few days. Gradually, the parent reduces the amount of time spent in the bedroom at bedtime, sometimes sitting farther and farther from the child’s bed each night, until the child is able to fall asleep on his or her own.

Sleep experts also advise parents to maintain healthy sleep habits, or sleep hygiene, for their children, because sleep deprivation increases the likelihood of sleep problems in children, including SOAD.

Sleep hygiene for children

  • Establish a bedtime routine to ensure the child knows it’s time to relax and prepare for sleep. Experts recommend that a child’s bedtime routine should take 30 minutes or less.
  • Put the child to bed at the same time seven days a week.
  • Maintain age-appropriate daytime naps, so the child isn’t overly tired or wakeful at bedtime.
  • Put the infant or child to bed in the same bed every night.
  • Do not allow the child to sleep in the parent’s bed.
  • Periodically check on the child through the night as needed, but don’t linger in a child’s bedroom.
  • Carry out nighttime parenting in the child’s bedroom, not the parent’s bedroom.
  • Avoid giving children caffeinated products, including sodas, dark chocolate, and coffee ice cream.
  • Big meals and vigorous exercise should be avoided within a few hours of bedtime.
  • Maintain a consistent wake-up time each morning.
  • A child’s sleep environment should be kept cool (around 68 degrees Fahrenheit), dark, and quiet.

When it comes to sleep onset problems in children, there’s good news: With appropriate sleep strategies and proper sleep hygiene, children can erase problematic sleep associations and learn to sleep more soundly. And that’s good news for young children as well as their tired parents.

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