Is your toddler screaming at bedtime? Here's a plan for you

Scientifically-based Actionable Advice
By: 
Craig Canapari, MD
Contributing writer for Baby Sleep News

Fighting Over Bedtime Happens A Lot– Even To Pediatricians

Bedtime battles are a common cause of stress for parents and kids. Sometimes your child may stay calm but use delaying tactics such as asking for another story, glass of water, or the keys to the car. (Just kidding about the last part– that comes later). In other families, the spectacle of a toddler screaming at bedtime and having a full bore tantrum is a nightly occurence.

Dr. Heidi Roman invited me to collaborate with her on a post on her excellent blog, My Two Hats. She writes about some of the difficulties that she and her husband were facing with her 29 month old son.

A couple of weeks ago this changed a bit as, all of a sudden, bedtime became a prolonged affair. Our son usually would fall asleep about 20 minutes after lying down in his crib. Now, he is often falling asleep 1.5-2 hours after the desired bedtime of 8pm. He has found various and sundry ways to delay going to sleep. He would like a drink of water. He needs his blanket fixed. He wants to rock. He has a story to tell or a song to sing. Many of these are actually very endearing, but nonetheless I worry about him not getting enough sleep and admittedly become a little frustrated. On a particularly trying night, I made the mistake of bringing him into our bed to see if he would fall asleep. Fall asleep he did, but he now refuses to go to sleep any other way. Of course.

She notes that this seems to be bedtime resistance given the lack of nocturnal awakenings and the multiple curtain calls at bedtime. I have a long summary post of sleep training techniques, but here is how I would tailor this approach in my clinic.  Here is my “prescription:”

Ten Steps to Counter for Bedtime Resistance

  1. You need to pick a convenient date to address this issue, preferably when you don’t have a big work presentation, vacation, or grandparent visit planned in the next week or so. If a vacation is imminent I usually recommend waiting until after returning from your trip. For more on this, here’s an article on when not to sleep train.
  2. Prior to starting, spend some time playing with your son in his room, especially in his crib or bed. Frequently kids in this situation really don’t like their room and bed too much when things have gone this far.  Make it fun again.
  3. Bedtime  should be brief (30 minutes), predictable, and goal directed. For example, don’t make multiple trips downstairs if the bedroom is upstairs. For more on the importance of bedtime, here’s an article on why you should be a bedtime drill sergeant.
  4. Two major reasons that parents fail are inconsistency, and failing to push through an extinction burst, which is a brief escalation in resistance after you make a change. Plan on executing the same plan every night for a week, and be aware that things tend to worsen a bit before improving. 
  5. Minimize crying by adding bedtime fading: This means moving your son’s bedtime later than is typical for a few days to increase how sleepy he is at bedtime. A good time to start is the actual time he is a falling asleep.  The keys to success include not letting your child sleep later than usual in the morning, and avoiding sneaky sleep in the late afternoon in the car or stroller. Once your child is falling asleep within 15-30 minutes you can move this earlier by 15 minutes a day to the desired bedtime. Here is more on how to do bedtime fading.
  6. Likewise, limit napping after 3 PM. This is critical. If your child is not tired at bedtime, you are going to have a hard time.
  7. I would absolutely avoid taking him into your bed as doing so drastically worsened your issues. Here’s more on the effects of co-sleeping on sleep. If you have fallen into the co-sleeping trap, here’s a guide on how to stop cosleeping.
  8. If the steps above have not been effective, you may need to consider a more traditional sleep training approach. Your son needs to relearn falling asleep on his own, in his room. You could either go to an extinction approach (at the later bedtime, expecting him to fall asleep on his own and ignoring his cries) or a more gradual process (having him fall asleep with you in the room nearby x 1-2 nights, then by the door for 1-2 nights, then outside the door for 1-2 nights). Unfortunately, given his age, you are likely to have some tears either way. Personally, we used extinction/ “cry it out” with our sons as it works the quickest.
  9. If your toddler is in a bed and runs out of his room, you need to bring him back to his room, close the door, and then open it. If he is not in bed, you close it for 2 minutes and then check and see if he is in bed. Rinse and repeat. You will only likely need to do this for a night or two.
  10. Avoid working on sleep if you are working on another major milestone such as potty training.
  11. Stay the course. Once you start the process, see it through. Otherwise any tears (yours or your son’s) will have been in vain, and you will have to do it all again later.

Remember, your child’s sleep is a dynamic process. Parents may address sleep difficulties at 7 months but then have sleeping problems come back months later, say, after a vacation, moving to a new house, starting school, or any other major changes. Don’t be discouraged. Once you have achieved good sleep once, you can do it again. Also consider that developmental milestones often trigger sleep difficulties. I always think of walking (around 10 -15 months) or potty training (3-4 years) as being significant triggers. Indeed, Heidi’s son was working on toilet training. Alice Callahan wrote another terrific post at Science of Mom on recent research showing that starting crawling was associated with sleep disruption.