Establishing healthy sleep habits in young children is vital for optimal functioning for them and, of course, for us as parents. It is difficult to do what we need to do and parent at our best when we are sleep deprived. Also, poor sleep in children often results in negative consequences to daytime behaviour, mood, learning, and physical development.
Recommended Sleep by Age
Young children need lots of sleep! While some children need more or less sleep than others, the table below provides a range of recommended sleep by age.
AgeNightDayTotal
0-3 months—unpredictable, varies widely –
3-6 months11-12 hrs3-4 hrs(in 3-4 naps)14-16 hrs
6-9 months11-12 hrs2-3¼ hrs (in 2-3 naps)13-15¼ hrs
9-12 months11-12 hrs2-3 hrs (in 2 naps)13-15 hrs
12-18 months 11-12 hrs1½-3 hrs (in 1-2 naps)12½-15 hrs
1.5-2 years 11 hrs1½-3 hrs (usually 1 nap)12½-14 hrs
2-3 years11 hrs1½-3 hrs (in 1 nap)12½-14 hrs
3-5 years 11-12 hrs*0-2 hrs (0-1 nap)11-13 hrs
*Children may sleep longer at night after they drop their nap
Source: modified from The Sleepeasy Solution, 2007
Establish Good Sleep Habits (Early!)
It is important for parents to start establishing healthy sleep habits early. This will help ensure that your child gets the sleep he/she needs. Also, it is easier to establish good habits early on than to correct bad habits as children get older. This is because habits (including “bad” habits) become very ingrained and more difficult to change.
Develop a sleep schedule
Developing a sleep schedule is important. In early infancy, a sleep schedule can be flexible. By 3-6 months of age, a sleep schedule should include a regular bedtime and wake time and naps at approximately the same time each day. Most young children do well with a bedtime of 7:00-8:30pm - depending on their age and, if napping, when their last nap ended.
Learning how to fall asleep independently
The most important aspect of getting children to fall asleep quickly and sleep through the night is to have them learn to fall asleep independently without parental assistance. Children need to learn this at bedtime so that when they have arousals during the night, they will know how to return to sleep on their own.
Research has shown that teaching an infant to fall asleep
independently can prevent the development of future sleep problems.
Between 6-12 weeks of age, parents can experiment with putting their baby down to sleep when they are drowsy but awake. However, babies younger than 3 months should not be left to cry for more than 5 minutes (or less, depending on the intensity of the cry). At 3 months of age (full-term and healthy), a child can learn to fall asleep on his own. The younger the skill is learned the better. It is much easier to teach a 3 month old how to fall asleep on his own, compared to a 1 or 2 year old – who has never learned the skill.
Address night wakings
If your child is waking at night, first ensure that she is falling asleep independently. If night wakings persist, ask yourself “what is she waking for?” Things that typically maintain a child waking are nighttime feeds, co-sleeping, and various types of “parental responding”. Most infants who are 6 months of age (full-term) who are gaining weight as expected don’t need to be fed during the night. Developing a plan to gradually eliminate night feeds and other things which are keeping her waking is often necessary. Like most aspects of parenting, consistency is key!
Establish a bedtime and nap routine
A well established bedtime and nap routine is important. The routine should be calming and predictable. The last part of the routine (at least) should take place in the child’s room. The lights should be low and it is important to avoid ‘dozing’ during a bedtime and nap routine as this can decrease the drive to sleep and lead to difficulty settling when it is time for the child to fall asleep. Snacks and t.v. time (if parents wish) should be done prior to the start of a bedtime routine.
Maintain an environment conducive to sleep
A child’s crib and bed area should be all about sleep and toys and mobiles should be removed. The optimal sleep environment includes a temperature on the cool side of comfortable and little to no light or noise. White noise (a constant and even sound) in a child’s room and in the hallway outside his room can help to block external and household noise, and is also believed to be soothing for young children.
Common Causes of Sleep Problems
The 2 most common causes of sleep problems are: 1) not falling asleep independently and 2) inappropriate and inconsistent responding, especially during the night. Other things that can cause or worsen sleep problems are greater cognitive awareness (becoming more alert), reaching new developmental milestones, and a poorly timed sleep schedule.
What is Sleep Training?
Sleep training includes a child learning how to fall asleep independently (self-soothing to sleep) and appropriate and consistent responding, on the part of the parents. Also important in a sleep training plan is developing an age-appropriate and well-timed sleep schedule and ensuring that the sleep environment is safe and conducive to sleep.
Safe Sleep Practices - Health Canada & Canadian Paediatric Society Guidelines The Back to Sleep Campaign advocates placing infants on their back to sleep (when first placed in the crib) until 12 months of age. The back to sleep position, until a child can roll or move to his side on his own, is associated with a reduced risk of Sudden Infant Death Syndrome (SIDS). According to the guidelines, however, children do not need to be repositioned during the night or nap, once they can roll or move to another position independently. Young children should sleep on a firm flat surface in their crib for all sleep periods. Room-sharing in the first 6 months may protect against SIDS.
Health Canada and Canadian Paediatric Society guidelines state that soft and non-breathable materials including blankets, bumper pads, stuffed animals, infant positioners, pillows, and pillow-like items should not be in a crib. These objects can prevent air circulation around a child’s face and lead to suffocation. Rather than covering a young child with a blanket, a sleep-sack or wearable sleeper-blanket is recommended for cooler months (see http://www.halosleep.com/ for wearable sleeper blankets).
The guidelines also outline that an adult bed is “not the safest place for a baby to sleep”. This is because young children can be suffocated by an adult, can fall off a bed, and can become trapped between the mattress and wall or headboard. Also, soft materials on a bed are a risk factor for overheating and suffocation. High risk groups to co-sleep with children are those who have consumed alcohol, taken sedating drugs, and those who are sleep deprived – all which can lead to decreased responsiveness. Avoid overheating your child. Being overheated is a risk factor for SIDS and can also lead to discomfort during sleep.
Medical Problems and Sleep
Parents should speak to their child’s physician if they have any concerns regarding his/her sleep. Also, before starting a sleep training plan, parents should consult their child’s physician to rule out any medical cause of their child’s sleep disturbance. Common medical problems that can disrupt a child’s sleep include gastroesophageal reflux disease, ear infections, and sleep apnoea - which is often characterized by loud snoring and pauses in breathing during sleep.
Recommended Readings
The Sleepeasy Solution: The Exhausted Parent’s Guide to Getting Your Child to Sleep – from Birth to Age 5. (Jennifer Waldburger & Jill Spivak, 2007)
Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night’s Sleep (Revised Edition). (Jodi A. Mindell, 2005)
Sleep problems in toddlers and preschoolers are very common, with bedtime difficulties and night wakings topping the list of parent concerns. Research shows that 25-30% of toddlers have bedtime problems and up to 50% still experience night wakings. These problems continue to be common (from 15-30%) in preschoolers. Often times, difficulties falling asleep and night wakings occur in the same child.
Population surveys of parents suggest that these problems may even be more prevalent. The National Sleep Foundation’s Sleep in America Poll (2004) found that 43% of toddlers and preschoolers fall asleep with a parent present at least a few times a week and 46% and 36% of toddlers and preschoolers, respectively, still wake at night and need “help and attention” to return to sleep.
Consequences of sleep deprivation are numerous and affect all main areas of functioning including social, emotional, cognitive, and behavioural. Sleep problems in children generally disrupt family life and are often the cause for significant parental distress, disruption to parents’ sleep, decreased level of effective parenting, and marital conflict. Signs of insufficient sleep in children include irritability, poor concentration, moodiness, unplanned naps, planned naps past an age when napping is appropriate, whininess, overactivity, and difficult to manage daytime behaviours (just to name a few).
Common causes of sleep problems in infancy also apply to toddlers and preschoolers. These include, but are not limited to, poor timing of sleep periods, not falling asleep independently, inappropriate and inconsistent responding during the night, co-sleeping, and an unsuitable sleep environment (e.g., too much light/noise/heat in the bedroom, toys in the crib/bed).
Parental presence at sleep-onset and following night wakings, including co-sleeping, is a common culprit in causing and maintaining sleep problems in toddler and preschool-aged children. However, with increasing age, other factors such as nighttime fears, moving a child to a bed (especially if the move is made prematurely), and limit-testing behaviours may also be relevant in causing or exacerbating sleep problems.
Many children are transitioned to a bed between 2-3 years of age. However, barring no safety concerns (e.g., a child climbing out of the crib in the dark when alone) waiting until age 3 to make the move is recommended. Children this age are usually more “mature” and better able to understand the “rules” associated with sleeping in a bed. Often times, moving a child to a bed is done with the hopes of resolving sleep problems. However, many parents report that making the move is not helpful and, often times, can make the problems worse as the child is now mobile. It is recommended that parents address sleep problems while their children are still in a crib. Use of a mesh crib tent can be helpful to maintain a child sleeping in a crib (in the face of safety concerns) until they are at a more suitable age to be sleeping in a bed. When a child is moved to a bed, parents are advised to use guard rails on their child’s bed.
Bedtime problems including bedtime resistance and bedtime stalling are common in older toddlers and preschoolers. While consistently setting limits on acceptable bedtime behaviours is often necessary, this is only effective if the timing of the bedtime is appropriate (i.e., parents put their child to bed only when tired). It is also important to ensure that too much day sleep and napping too late in the day are not contributing to bedtime problems.
Parents are often unaware that sleep problems in children can be effectively treated with behavioural strategies. Alone, or with the help of a health care professional, parents need to identify the factors which are contributing to the maintenance of the problems. Then, a detailed treatment plan that addresses such factors needs to be developed.
Treatment plans should include the development of an age-appropriate sleep schedule and an understanding of normative sleep patterns for the child’s age, the importance of bedtime/naptime routines, how a child is falling asleep and being responded to during the night, the benefits of introducing a sleep-compatible transitional (security) object, a suitable and safe sleep environment, and sleep training recommendations that are tailored to the child’s age and the presenting problems.
Often times older toddlers and preschoolers have a more favourable response to gradually reducing parental contact at bedtime and following night wakings. However, it is recommended to have a step-by-step plan in place to ensure that steady progress is being made. During this time, it is important to consistently work to eliminate parental behaviours which can maintain the problem such as co-sleeping, reinforcing unreasonable requests at bedtime and during the night including nighttime drinks/bottles, and other types of “responding” unless a child is sick. For children who are already in a bed, the use of a safety gate at their bedtime door, if necessary, is preferable to locking a door or holding it closed. A reward chart/system can be helpful to reinforce positive behaviour.
Sleep training methods are highly effective if an appropriate plan is developed (e.g., the right choice of treatment is made, all factors contributing to the problem are addressed) and if the plan is carried out properly. However, it is not uncommon for things to get worse before they get better, especially the older the child is. Parents are encouraged to evaluate the effectiveness of a treatment plan only after such a plan has been fully implemented. Before any sleep training is started, it is suggested that parents speak with their child’s physician to ensure that medical causes of sleep problems have been ruled out.
Pleasant dreams!
Dr. Nicky Cohen, C. Psych.
Practice in Clinical and Counselling Psychology
491 Lawrence Avenue West, Suite 203
Toronto, Ontario M5M 1C7
Tel/Fax: 416.783.3900 www.kidsleep.ca
How can I get my son to fall asleep without nursing?
Q. My son is eight months old, and I’m about to wean him off of the breast (need to, before I go back to work). Like probably all breast-fed babies, that’s how he’s accustomed to going to sleep. Any suggestions on how to get him to sleep once he’s weaned? Is there an easier way other than just laying him down and listening to him cry himself to sleep? I’ve heard that laying him down with a bottle works, but I’ve read that it will rot his teeth out. I’ve had the same nighttime routine for a while - a walk after dinner, then a bath and then - well, you know. I’d love to hear any suggestions. Thanks.
A. As you describe, many infants learn to associate nursing or drinking a bottle with falling asleep. While this is fine when infants are young, as they get older it interferes with them learning to fall asleep on their own. Also, sugar on teeth from milk (bottles) in bed can lead to dental caries (tooth decay or cavities) and should be avoided.
Acquiring the skill of falling asleep truly independently is key to a child sleeping through the night and is a skill that all children need to learn at some point. However children under 3 months of age should not be left to cry for more than 5 minutes and even less depending on the intensity of their cry. At your son’s age, I would definitely consider giving him the opportunity to learn how to fall asleep by himself. There are several advantages of encouraging self-soothing at this young age. In addition to improved sleep for everyone, bad habits are less ingrained and learning typically occurs quickly. If an appropriate sleep schedule and solid plan are developed, and carried out consistently, an older infant should be falling asleep on his own without much fussing or crying in less than a week.
There is much empirical support for the safety and efficacy of sleep training (also known as graduated extinction). In this approach, infants are placed in their crib (awake) to fall asleep. Parents are encouraged to check on their child, as they wish. These checks should be brief (2-3 seconds) and things that can lead to more crying should be avoided such as picking up the child or patting him. It is best to start a plan like this after speaking with your child’s physician to rule out medical causes of sleep problems (such as reflux and pain from teething and ear infections) and when you feel confident that you can be consistent. Speaking with a health care professional with training in this area to develop a treatment plan and to address your questions and concerns can also be helpful.
Introducing a transitional object can help with separation at night (and can make travelling much easier!). “Blankies” are often a good choice, because if your child rolls onto it at night, it will not disturb him. At this age, blankies should be no bigger than 8” by 8” and should be breathable (with holes). Giving him several may be helpful to ensure that he is always able to find one during the night.
My daughter has started waking at night, what can I do? Q. After initially mixing up her nights and days, my breast-fed daughter began sleeping through the night by 2 months of age. However, suddenly, at approximately 6 months of age, she began waking several times during the night (anywhere from 2 to 6 times nightly). The only thing that settles her seems to be breastfeeding, but I can’t imagine that she is hungry, especially on nights when she is waking almost every hour. Due to her continuous waking, she has been co-sleeping with us. I want to stop (or significantly reduce) the night wakings and feedings and get her into her crib.
A. It is common for previously good sleepers to develop sleep problems between 3-6 months of age. This can be due to, at first, greater cognitive awareness, and then due to reaching new developmental milestones. As you described that these problems represent a change in her sleep, I would discuss them with her physician. If she is well, a sleep training approach as outlined in Question 1 would be helpful. In addition to ensuring that she falls asleep independently (if she isn’t already), this approach would also focus on her returning to sleep on her own following night wakings.
Most paediatricians will agree that the majority of healthy full-term babies who are gaining weight as expected do not need to be fed during the night after 6 months of age. Rather, research suggests that sleeping through the night is related to both developmental readiness and behavioural factors (i.e., does the infant fall asleep independently; is the infant responded to during the night consistently and appropriately).
There is some research to suggest that infants who continue to be fed at night – when they no longer require the nutrition at night – will continue to wake during the night to eat. If there is no medical need to continue feedings after the child is 6 months of age, I often work with parents to develop a weaning schedule to eliminate the feed(s) over a period of a few days to a week. This weaning process gives infants a chance to transfer their hunger from the nighttime to the day time. Also, it is often easier on parents to eliminate the feeds more gradually than all at once.
If your goal is to have your daughter sleep in her own sleep space, in her own room, it is suggested that you do not bring her to sleep in the parental bed. Doing so, even on an intermittent basis, will likely perpetuate her waking at night and her resistance to returning to sleep on her own. Also, there is ample evidence to suggest that a bed is not the safest place for a baby to sleep. For more information on safe sleep practices for infants, see the Canadian Paediatric Society handout “Safe sleep for babies”.
What can I do about bedtime problems? Q. How do I manage sleep routines when a new baby enters the scene? Our 3 1/2 year old sometimes is difficult to put down (delay tactics and calling out to us, sometimes louder than that by flat out refusing) and I am concerned with keeping the baby asleep if it happens to be sleeping. Also, is there anything I should be saying or doing to help our son understand that the baby sleeps in our room in its cradle for now and he should continue to sleep in his big boy bed?
A. Preschoolers are notorious for making repeated requests at bedtime, fondly referred to as “curtain calls”. At this age it is even more important to set limits on bedtime behaviours such as no additional snacks after a bedtime routine has been started, no t.v. as part of a bedtime routine, and not coming out of his room. Discussing the bedtime routine as you go along (e.g., how many books you will read) and being clear about what is allowed and what is not allowed can be helpful. Some parents report that using an egg timer that is set to go off at the child’s bedtime to signal that the routine is over is helpful. Giving in to additional requests (extra books, another snack or drink etc.) can maintain the stalling behaviour.
Continuing to have a predictable, calming bedtime routine (that is done in the child’s room), adhering to a regular sleep schedule, and ensuring that a child this age falls asleep, and back to sleep, independently on a consistent basis is important. You can explain that when babies are born they need to sleep in their parents’ room. In your words you can describe that you have some “rules” and one of them is keeping the baby in your room at night. You can remind your son, that you also did this (if you did) when he was born. The use of white noise where your baby sleeps and in the hallway outside the bedrooms can be helpful to block noise.
Lastly if your son is still napping, you want to be sure that too much day sleep or napping too late in the day is not interfering with him falling asleep at night.
Dr. Nicky Cohen is a Registered Psychologist in private practice in Toronto. She received her Ph.D. in Clinical Psychology from York University and developed an interest in parenting issues related to children’s sleep disturbances after having her first child 5 years ago. She is active in the community disseminating information on healthy sleep practices and increasing awareness of the importance of making sufficient sleep a family priority. Dr. Cohen has held various research and clinical positions at the Centre for Addiction and Mental Health, the Hospital for Sick Children, and the University Health Network (Toronto General Hospital). More information about Dr. Cohen’s work can be found at: www.kidsleep.ca.
