How to Win the Bedtime Battle: How-To Guide for Caregivers
This article was reviewed by our Baystate Health team to ensure medical accuracy.
Richard Zheng, DO
It’s the rare—and lucky—parent or caregiver that hasn’t faced a bedtime battle or two with their child. Whether they’re four or fourteen, fights over bedtime can be a frustrating power struggle for all involved and especially already sleep-deprived parents.
Pediatric sleep specialist Dr. Richard Zheng of Baystate Sleep Medicine says, “Sleep struggles, or insomnia, in children can take many forms—from resistance to going to sleep, difficulty staying asleep, or to trouble falling back to sleep once awakened, to being too dependent upon their parents to fall asleep. The good news is that it is possible to overcome these struggles with insomnia in children. But the bad news is that it isn’t always easy.”
Why Sleep Matters for Children of All Ages
Sleep is critically important to the physical and emotional health of children of all ages (and not just because it gives parents a few hours of calm and quiet!).
Dr. Zheng notes that the brain needs rest to form memories. “For children who are learning new skills and gaining an understanding of the world around them at an incredibly rapid rate, sleep is essential to keeping their development on track. Being well rested also makes it easier for them to regulate their emotions and mood, which is, again, critical to their emotional growth and development.”
He adds that being well rested can also help the body fight off illness and infection – especially important for little ones exposed to illnesses at school, daycare or other community activities.
How Much Sleep Does My Child Need?
How much sleep children need varies by age. While there is a bit of wiggle room for each child, the American Academy of Sleep Medicine recommends the following:
| Stage | Age | Total Sleep |
|---|---|---|
| infants | 0-3 months | 14–17 hours |
| infants | 4–12 months | 12–16 hours |
| toddlers | 1–2 years | 11–14 hours |
| preschool | 3–5 years | 10–13 hours |
| school-age | 6-12 years | 9–12 hours |
| teens | 13-18 years | 8–10 hours |
What Causes Sleep Issues in Kids?
As for why your child may not be getting the recommended amount of sleep, Dr. Zheng recommends looking at the non-behavioral factors that impact your child’s sleep. “In some cases,” he says, “they may be easier to address than behavioral ones.”
He notes where a child is developmentally, both socially and emotionally, can impact their sleep. “For example, if you have an anxious child, they may have trouble falling asleep on their own or going back to sleep if they wake up. In addition, cultural differences can impact a child’s ability to fall asleep independently. In some cultures, sharing a bed with parents is quite common but it comes with its own set of challenges that may make it difficult for a child to fall and stay asleep as well as the amount of sleep both the child and the parents get.”
He adds that sleep schedules, “Especially those that get interrupted by, say sports and activities, or, if a child splits their time between two households with different sleep schedules, can make it difficult for children to consistently fall and stay asleep.”
However, the main factor affecting a child’s ability to fall asleep is the sleep environment.
“Sleep environment refers to the home—how many kids are in the home, how many kids are in the same room or even in the same bed. All these things constitute the sleep environment, and all have a big impact on a child’s ability to fall asleep or to fall asleep on their own.”
For young children, behavioral sleep insomnia comes in two types: sleep onset association and limit setting.
Sleep Onset Association Insomnia
“Sleep onset association insomnia,” Dr. Zheng explains, “involves a child being dependent upon someone, some thing, or some action to fall asleep. They may only want mom to put them to bed and, if mom’s out for the evening, they may not fall asleep until she returns. They may ‘need’ a specific blanket, toy, or pacifier. Or, in the most challenging of instances, they may require an activity, like nursing or being walked and rocked, to fall asleep. While that doesn’t sound so bad, the challenge arises when they wake in the middle of the night and need that same action to fall back to sleep.”
Dr. Zheng encourages parents struggling with sleep onset insomnia in their child to try one of three strategies to break the association and teach their child to self-soothe and fall asleep on their own.
Break the Sleep Association
Often dubbed the “cry it out” method, extinction involves simply cutting off the association. “There’s nothing delicate about it,” says Dr. Zheng. “You stick to your set bedtime, and you leave the child alone in the room until morning. There’s no checking in or giving pats on the back with this approach.” He adds, “This can be a very successful strategy for some. However, it can also be very challenging—especially for parents—to follow through with it. It’s also challenging if there are other children in the home, or you live in an apartment building, as the sleep of others may be interrupted by the cries of an unhappy toddler.”
Also referred to as the Ferber Method, Gradual Extinction involves a parent leaving child to fall asleep on their own but returning to check in on their child at specific timed intervals (see chart below). Dr. Zheng says, “Each night you lengthen the amount of time between intervals so the child can learn to fall asleep on their own and, equally important, fall back to sleep should they wake up during the night. It’s important to keep the check-ins as just that, a check-in. You simply want to make sure they’re safe. You don’t want to try to calm them or help them fall back to sleep. The check-in should be no more than two minutes, if that.”
Sometimes called the “Fading Parent” method, this approach is often used in cases where the child is accustomed to falling asleep with a parent in their bed or sitting on their bed, maybe patting their back or stroking their hair. To break that association, this method involves taking the child through their bedtime routine and putting them to bed when drowsy.
The first night, the parent stays by the child’s side until they fall asleep. But each successive night, the parent moves a bit further away from the child but still in their line of sight. “Consistency,” says Dr. Zheng, “is key here. You keep extending the distance until the parent is able to leave the room and let the child fall asleep without their presence.” He adds, “It may take up to two weeks, but it can be very effective.”
Limit-Setting Sleep Disorder
Very common in 2–6-year-olds, this type of insomnia is the classic If You Give a Mouse a Cookie situation but with children.
Dr. Zheng says, “Children will often claim they ‘need’ something to fall asleep—a glass of water, followed by certain stuffed animal, followed by a snack, followed by another hug, and on and on, until they’ve managed to delay bedtime for minutes or even hours. If a parent is not enforcing limits, it can be exhausting for all.”
To bring an end to the seemingly endless stream of wants and needs, Dr. Zheng recommends first establishing a consistent bedtime routine.
“A good bedtime routine should last for an hour or less and include 3-5 consistent activities,” he says. “The energy level of the activities should decrease as you move closer to bedtime as should the child’s proximity to the bed. Ideally, the last activity will have them in bed, maybe listening to a story.”
He notes that creating and displaying a bedtime routine chart in the child’s room can work to limit the child asking for things not in the routine. “And if they do,” he says, “You can simply point to the chart and say ‘Sorry. That’s not part of the routine’ and get right back to it.”
Another effective strategy for this type of insomnia is what’s known as the Pass System.
The way it works is that you create passes on paper or cardboard. Your child receives one to three laminated passes to use each night which allow them to get out of bed for pre-approved activities like getting a drink of water or getting one last hug. When the passes are gone, so is the option to keep getting out of bed. Over time you want to cut back on the number of passes allowed each night until the child starts falling asleep without add-on activities.
“This is a good approach as you can involve your child in making the passes and it gives them some control over the bedtime routine,” says Dr. Zheng
Is Melatonin Safe for Children?
One of the most common questions Dr. Zheng gets from sleep-deprived parents is “can I use melatonin to get my child to fall asleep?”
He says, “Many people think melatonin is a magic pill that will end the bedtime battles. Unfortunately, that’s not the case.”
“Melatonin is naturally produced in the brain at the end of the day and essentially serves as a signal to the rest of your body that you should be getting ready for sleep. But it doesn’t put you to sleep. Taking more of it only makes the signal stronger but doesn’t induce sleep.”
He also notes that, as a supplement, melatonin is not regulated by the Food and Drug Administration. “There are a LOT of variances from brand to brand and even pill to pill from the same manufacturer,” notes Dr. Zheng. “Further, melatonin may not be the only ingredient in the supplement. Some contain cannabis, serotonin, and even THC.”
He encourages patients considering melatonin for their children to first speak to their child’s doctor about the decision and emphasizes that even if it appears to work, melatonin does not address the root cause of a child’s sleep issue. “It’s essentially a bandage on the problem and not really an answer to the issue at hand.”
“If you’re struggling with sleep issues with your child, it’s best to address the sleep environment and, if needed, try some of the noted strategies. With patience and consistency, you can bring an end to the bedtime power struggle and develop a peaceful routine that works for everyone.”
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