Question:
My daughter is 3 and refuses to sleep in her bed. How can I change that?
Dr. Cohen:
If she has been co-sleeping in the parental bed at all, I would start by having a parent sleep in her room (ideally in a separate sleep space such as a mattress on her floor) for the first 3-5 days. This will help her get used to sleeping in her own room for the entire night. Depending on how she is falling asleep, I would then suggest eliminating your presence at bedtime (if she is not falling asleep on her own) and following night wakings in a series of steps. For example, I would sit next to her bed and then by the door for 3-5 days each. At that point, I would aim for her falling asleep and back to sleep on her own, with brief checks if necessary.
Establishing a calming and predictable bedtime routine that ends in her room and introducing a security object such as a blankie can be helpful. Also a ‘morning signal’ such as a night-light attached to a timer can teach her when she must return to sleep on her own (the light is off) and when she can call out to start her day (the light is on). At her age, I would suspect things will initially get worse before they get better but with a lot of consistency they should improve within a few weeks.
Question:
My child gets out of bed after being tucked in each night despite a good routine?
Dr. Cohen:
Toddlers and preschoolers are notorious for doing anything and everything to delay going to bed! Make sure you have chosen a bedtime that is not too early (or too late), and ensure your child is not napping for too long or too late in the day. A calming and predictable bedtime routine which ends in your child’s room is recommended. A “signal” such as an egg timer bell can be helpful to indicate when the bedtime routine is over and it is time to go to sleep.
Once you have put her to bed, be firm and clear that she must stay in bed. Setting consistent limits around acceptable and unacceptable bedtime behaviours is important. If she keeps coming out of bed, you can either silently lead her back to bed or use a pressure safety gate until she learns the new rules (and then of course the gate can come down). A reward system can be helpful to reinforce positive behaviour.
Question:
At what age are you allowed to give your child a pillow?
Dr. Cohen:
That is a good question. I am not aware of any guidelines from Health Canada or the Canadian Paediatric Society (CPS) which outline when it is safe for a child to start using a pillow. Rather, these guidelines indicate that pillows and pillow-like items (e.g., bumper pads, stuffed animals) should not be used in a crib during infancy.
For example, CPS guidelines state:
- “Starting from birth, and for the first year of life, place your baby to sleep on her back at night time and for naps. Do not use sleep positioners or rolled up blankets to keep your baby on her back: These items can cause your baby to suffocate. When she can turn over on her own, you don’t need to return her to the back position.
- Use a firm, flat surface for sleep. Waterbeds, air mattresses, pillows, couches/sofas or soft materials are not safe sleep surfaces for babies. Babies can turn onto their side or stomach and bury their face in these soft materials, not getting enough air to breathe. Car seats and infant carriers should not replace the crib for your baby’s sleep.”
Although it is clear that pillows should not be used in a crib during infancy, there are no clear guidelines as to what age there is no longer a safety risk. Given this lack of information, I recommend that, for as long as a child is in a crib, that parents not have anything soft and non-breathable in the crib including a pillow.
For more information on safe sleep practices, see the following handouts for parents:
“Safe Sleep for Babies” (Canadian Paediatric Society)
“Safe Sleep for Your Baby” (Health Canada)
Question:
My daughter is 2 yrs old, is she too young to give up her afternoon nap?
Dr. Cohen:
Generally 2 years of age is too young to drop napping all together. Most children this young can still benefit from an early afternoon nap. Dropping the nap too early can lead to sleepiness, irritability, and poor attention and concentration. Additionally, at this age, children often have a difficult time making it easily to bedtime without a nap. I like to encourage napping, if possible until at least 3 years of age. If a child is resisting their nap or napping is making a bedtime of 8:30pm difficult to achieve, then I would consider eliminating the nap and moving bedtime earlier (e.g., to 7:00pm).
Question:
My daughter is 2 yrs old, is she too young to give up her afternoon nap?
Dr. Cohen:
Generally 2 years of age is too young to drop napping all together. Most children this young can still benefit from an early afternoon nap. Dropping the nap too early can lead to sleepiness, irritability, and poor attention and concentration. Additionally, at this age, children often have a difficult time making it easily to bedtime without a nap. I like to encourage napping, if possible until at least 3 years of age. If a child is resisting their nap or napping is making a bedtime of 8:30pm difficult to achieve, then I would consider eliminating the nap and moving bedtime earlier (e.g., to 7:00pm).
Question:
My 4yr old keeps coming into our bed in the middle of the night…any advice?
Dr. Cohen:
First, you need to make sure she knows how to fall asleep on her own at bedtime. If she doesn’t have this skill, she will get stuck during the night and need your help. If she is falling asleep on her own, but is still waking at night then it is important to look at what is maintaining her waking. Co-sleeping, nighttime feeds and other types of parental contact can keep a child waking at night.
Once you decide that you want her to sleep in her own room for the entire night, come up with a plan that you think you can stick to. This plan should include establishing a calming and predictable bedtime routine that finishes off in her bedroom, ensuring that she falls asleep on her own on a consistent basis, and gradually eliminating parental contact during the night. To get her used to sleeping in her own room for the entire night, a parent can sleep in her bedroom – ideally in a separate sleep space such as a mattress on the floor – for the first 5-7 days of sleep training. A ‘morning signal’ (such as a night-light attached to a timer) can be helpful to teach children when it is time to get up (the light is on) and when they must return to sleep on their own (the light is off). A reward system can be helpful to reinforce positive behaviour.
Things may get worse before they get better but stick with a plan and be consistent and you will see improvement!
Sincerely,
Dr. Nicky Cohen, Psychologist
Practice in Clinical and Counselling Psychology
491 Lawrence Avenue West, Suite 203
Toronto, Ontario M5M 1C7
Tel/Fax: 416.783.3900
Web: www.kidsleep.ca
The information provided by Dr. Cohen is not intended to be a substitute for professional advice. Individuals are encouraged to speak with a physician or other health care provider if they have concerns regarding their child’s sleep and before starting any treatment. All questions and responses are publicly available, therefore privacy is not provided. The information provided by Dr. Cohen is provided with the understanding that Dr. Cohen is not rendering clinical, counselling, or other professional services or advice. Such information is intended solely as a general educational aid and not for any individual problem. It is also not intended as a substitute for professional advice from a qualified healthcare provider familiar with your unique facts.
