How can I get my 6-year-old to fall asleep and stay asleep?

Our daughter has trouble settling her mind and calming down to sleep. She wakes up in the middle of the night, multiple times, due to a nightmare, bug bite or other minor inconvenience and won’t go back to sleep. We have tried rewards charts, sticker charts, taking stuffed animals away, etc. How do we sleep train her? She is the youngest of three children, otherwise healthy, physically active and a good eater. Any advice?

The transition to sleep is a very delicate time, particularly for young children. It involves separation from parents, so it is normal for worries to arise. Having a brief period of activation and vigilance (“the burst zone”) just before bedtime is also normal, and it tends to be worse for children who are anxious, worry a lot or have problems separating from their parents. It’s important to observe when your child has their burst zone because it indicates that they are about 15-20 minutes away from their optimal falling asleep time.

The bedtime routine

For some children, anxiety and fear at bedtime bring them a lot of attention, and while it might not be positive attention, it can be reinforcing to them. Special calm, loving and close solo time for children prior to bedtime is an important part of a bedtime routine. This routine should be regular and brief (15-30 minutes), and should occur just before and after the burst zone. The predictably of a bedtime routine helps calm fears and prepares kids for sleep.

If parents fall asleep with their children at the beginning of the night, in most cases the child (particularly younger children) will need to have the parent present in the middle of the night if they wake up (it’s normal to awaken multiple times during the night for brief periods). The general rule is that any cues present during the transition to sleep at the beginning of the night will need to present in the middle of the night. After establishing a routine, parents can then gradually “fade their presence” with the goal of having the child fall asleep independently at the beginning of the night.

Putting away worries

A very active mind at bedtime can be quieted by routine, but some children need more to calm worries or bad experiences. A late afternoon parent-guided worry time, and/or writing in a worry diary can help a child “download” worries and concerns and put them away before bedtime.

If worry and anxiety occur during the day and night, more assessment may be needed. Some children who have anxiety or excessive worry during the day may need help developing skills to calm their mind at night.

Changing perspectives on bedtime and the sleep period can also be helpful, particularly when there is a long standing pattern of everyone anticipating a tough and frustrating bedtime and labeling a child as a “bad sleeper.” A change in opinion and regular routines are very important.

ABOUT THE AUTHOR

Daniel Lewin Daniel S. Lewin, PhD, DABSM is a pediatric psychologist, sleep specialist, and licensed clinical psychologist. He is Board Certified in Sleep Medicine and Behavioral Sleep Medicine and is the Associate Director of the Pediatric Sleep Medicine and Director of the Pulmonary Behavioral Medicine Program at Children’s National and Assistant Professor of Pediatrics at George Washington University School of Medicine.

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