Child Caring

What happened to this 20-month-old's good sleeping habits?

Hi Barbara --

My husband and I enjoyed several months this fall of beautiful sleep. Our 20-month-old son took his daily nap and slept happily through the night, fully understanding the sleep cues of the nighttime routine we've used almost his entire life. We put him down awake but drowsy, and he was fine.

All of that changed right after the New Year. For the past two weeks, it's as though he forgot how to put himself to sleep (and back to sleep). He will not lay down in his crib at night, and often cries for us. We take turns going in to comfort him, and even if we rock him so soundly that he's snoring, he wakes right up when we put him down. It's a cycle. Some nights, he doesn't sob, but he does whimper a bit, and sits in the same corner of his crib. We watch him on the monitor as he fights sleep for 45 minutes and eventually drifts off sitting up and topples over. (If he doesn't cry, we've been letting him fall asleep this way.) Half of the week, he wakes around 2-4 a.m. and won't go back to sleep.

Some notes:
We both had a week off at Christmas and our son had a lot of excitement. Despite this, he still slept just fine. The problems started when we both went back to work.(I work PT from home, so he's not in daycare.)
We have analyzed the wall in his room he's always facing, sitting up, in his crib. We've taped over all lights from the monitor, etc. to eliminate any shadows that could be scary.
Nothing has changed from his bedtime routine.
Our son grows more aware of his environment each day. So I recognize something he didn't notice for a year could suddenly be disturbing. But I'm at a loss for what it could be. If something is scaring him, I want to comfort him, but I also worry that by running back in there every night, we could be reinforcing the idea that there is something to be afraid of.

What's developmentally appropriate at this point? What do you think could be going on? Thank you,

From: Nan, Concord, MA

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Dear Nan,

While fearfulness is a decent guess, I don't think that's the culprit here. Just to be sure, I checked in with pediatrician Dennis Rosen, associate medical director of the Center for Pediatric Sleep Disorders at Boston Children's Hospital. He doubts it, too, and offers the following questions for you to consider:

* How many hours sleep are you budgeting for him per 24 hours? The typical 20-month-old needs 11 to 11 1/2 hour of sleep per 24 hours. Rosen said, "If he's taking a 2-hour nap, for instance, and you're putting him down at 8 pm, he may not be tired enough to fall asleep or, once he does sleep and awakens in the middle of the night, he can't get back to sleep because he's had enough." There are two ways to adjust for this. One is to shorten the nap time by waking him. The other is to put him to bed at a later time so he's more tired. Adjust bedtime gradually over a period of days, fifteen minutes at a time.

* Is he on a regular schedule? "The need to sleep is dictated not just by the hours the brain needs to rejuvenate and refresh itself, but also by the biological clock," Rosen said. "A consistent schedule is what enables both these drives to be active at the same time." That means the bedtime is the same every night, weeknights as well as week-end nights. Ditto for wake-up and nap times.

* What cues does he associate with sleep time? Rosen speculates that since the problem started, you're sending mixed messages about falling asleep. On the one hand, you rock him until you think he's soundly sleeping, then put him in the crib. But when it turns out he's awake, you expect him to go back to sleep on his own. "If you aren't sending a consistent message about what you want him to expect, the [typical] child will gravitate to what's more appealing to him," Rosen said. "If he knows sometimes he will be rocked and other times not, he may cry for that and expect it and be unhappy when he doesn't get it." Rosen's solution is not to rock him. "Put him in the crib awake and let him make the transition from awake to sleep on his own," he said. You can still have a bedtime routine of reading and some rocking, just not enough rocking that he falls asleep.

This will be a change for him and, yes, said Rosen, "There will be some crying and this may take a number of days." It will be more easily accomplished if you combine all the above elements, putting him to sleep at the same time each night, when you know he's good and tired.

Rosen adds that if you are worried he will think you are abandoning him, go back in at brief intervals but offer only calm, reassuring words. Even if he is standing there reaching for you, Rosen stresses: "No patting him on the back, no picking him up. That runs the risk of ruining the cues for sleep association." The idea is to send a message that says, "It's time for you to go to sleep and I'm serious."

Another strategy, popular in England, is to sit in a chair near the crib but with your back to him, so there is no eye contact and, again, no physical contact. That assumes that your presence reassures him. Gradually, you move the chair farther away until you are out the door.

Rosen is author of "Successful Sleep Strategies for Kids," A Harvard Medical School Guide.