Ask the expert: How do we get a toddler to sleep all night?

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Sleep training requires a lot of patience and does not yield immediate results. Photograph: Thinkstock

Sleep training requires a lot of patience and does not yield immediate results. Photograph: Thinkstock

 

Q: My grandson is 21 months old and his parents have never had a full night’s sleep. He wakes constantly and they are at their wits’ end to know how to deal with this. He has had a few changes in his life recently: living abroad, coming home, and living abroad again.

He is amazing during the day, he is a very happy, sociable, lovable child and is very good at taking his daytime nap, but when it comes to night-time he is very difficult [their words, not mine]. They have lived with me for six months so I know exactly what is happening.

Is there anything they can do for a 21-month-old? He is not yet verbal which makes it more difficult to explain to him that he must not wake up in the night.

A: Unfortunately, for many parents the path to babies and toddlers sleeping through the night can be long and requires a great deal of patience. As you rightly say, dealing with nonverbal toddlers can be a particular challenge as it is hard for them to understand the “rule” of staying in their own bed at night: when they wake in the night, all they want is the comfort of their mum or dad who they cry out for.

If this is repeated frequently every night it can of course lead to exhaustion and stress for the parents. As a grandparent, it can be hard to witness this stress – and you are witnessing it first hand, as they live with you – and you can wonder how best to help. Below are some ideas that you might want to discuss with your son or daughter.

The goal of sleep training

All children go through light periods of sleep or being awake at night. If you are lucky, they quickly settle themselves back to sleep. If you are unlucky, they call out for their parents, on whose comfort they rely to get back to sleep.

The key goal in sleep training is to help the toddler learn to self-soothe and to get themselves back to sleep at night. However, this skill is best taught not in the middle of the night when everyone is tired but instead during the daytime nap and especially during the bedtime routine.

Establishing a sleep routine

Before bedtime, the aim is to have a consistent relaxing routine that helps the child get ready for sleep. This might include a final feed, a story or some music and then a kiss and tucking in, and so on. It is important that most of the routine happens in the child’s bedroom, and most importantly the final steps must be the child falling asleep by themselves.

This means you avoid letting the child fall asleep in your arms as he will then associate you with sleep. While you might comfort him before sleep you aim to do this in his cot, perhaps stroking his head or holding his hand, but then you withdraw when he is sleepy and let him take the final step of going to sleep by himself.

You want to encourage him to have some sleep associations that he can use by himself at night, whether this is holding a teddy, learning to roll into a preferred sleep position, and so on.

If it is possible it is helpful to place him in his cot for daytime naps and to follow a similar routine: this means that these sleep associations are kept the same for naps and bedtime, and this should help in the middle of the night.

A gentle, gradual approach

Sleep training requires a lot of patience and does not yield immediate results. Some children are very dependent on their parents’ support to go to sleep, or fall asleep only when being fed. It takes patience to break these habits and to replace them with self-soothing ones.

Often the best approach is to change these habits gradually, over time: if the child needs you to hold him as he falls asleep, you can first move to holding them lying down before pulling back, and so on. Or if the child associates feeding with sleep, you stop the feeding when they are sleepy, but not finally asleep, as a first step in changing the habit.

Have a plan for night waking

Your grandson is of course likely to continue to wake at night for a period and it is important to think through a plan for how to respond to this.

His parents could opt to go through the similar bedtime routine steps above to get him back to sleep, for example rolling him into a comfortable position, giving him his teddy, whispering the same sleep words, and other methods of reinforcing the habit and his sleep associations.

Alternatively, given how tired parents are in the middle of the night, they could opt to make a temporary exception allowing him to come into their bed if this gets him back to sleep quickly and is the least disruptive for everyone. They can continue to work on establishing relaxed bedtime and naptime routines during the day, and once these are established, night- time waking can fade of its own accord.

Getting support

When they are exhausted by a child’s constant waking, parents’ self-care becomes really important. When working with couples I advise them to take turns with dealing with the night-time waking, so the burden is shared, and then to get extra support during the day.

As a grandparent there is a lot you can do to help. For example, you could get up early with your grandson when he wakes in the morning and allow his parents to sleep on and recuperate. Have a chat with them about what would work best for them.

Dr John Sharry is a family psychotherapist and co-developer of the Parents Plus programmes. He will be delivering a course on parenting teens and preteens (age 10-plus) starting on Thursday, November 5th, and a course on parenting babies and toddlers (age up to two years) on Saturday, November 14th, both in Dublin. See solutiontalk.ie