Illustration: Jim Pavlidis
Put toddlers in charge of their bedtime. Yes, you read that correctly. And no, it's not a cruel joke for sleep-deprived parents desperate to end bedtime battles. It's actually the premise of a new book, Boss of My Sleep, by paediatric sleep specialists associate professor Sarah Blunden and Dr Kirrilly Thompson of the Appleton Institute, Central Queensland University. The book offers parents a way to teach their children to become independent sleepers without having to ignore their cries.
Research shows that about 30 per cent of toddlers and pre-school children have trouble getting to sleep and staying asleep . Some of these problems can be considered normal, but when sleep disruption persists beyond a parent's ability to cope, the end result can tip parents into depression and tear relationships apart. It can also affect children's later health and behaviour.
That's why it's vital that parents have workable sleep solutions that do no harm . “I see many exhausted parents who need help, but don't want to use the commonly promoted methods based on controlled crying, because it's simply too distressing,” Blunden says. “Ignoring a young one's cry, even if only for two minutes, is like two hours for a mother. But these parents aren't being offered anything else.”
"Controlled comforting" is where parents attend to their young child at defined, increasing time intervals, such as at two, five then 10 minutes, until the child settles. "Camping out" is where the parent sits with a child as he or she learns to fall asleep. Parents then slowly remove themselves from the child's room. These methods are not recommended for infants less than six months old.
“There's no doubt that controlled comforting, camping out, or the 'cry it out' approach work – in that the baby or child will stop crying or calling out, usually within a few nights,” Blunden says. “That might be fine for 50 to 60 per cent of children but I'm concerned about the 35 to 40 per cent of children who are stressed or anxious.”
Aware of parents' concerns about controlled comforting approaches, Dr Anna Price from the Murdoch Children's Research Institute carried out a six-year randomised controlled study involving 225 children from seven months of age.
The study showed that, compared with the control group, children who experienced controlled comforting or camping out were no more likely to have significantly poorer emotional health, sleep or behaviour problems, chronic stress, poor attachment with parents, depression or anxiety.
Changes in parenting styles could be disrupting children's sleep patterns, says Marie Clifford, manager at the Tresillian Family Care Centre in Wollstonecraft, north Sydney.
“Parents are much more flexible than they used to be, so consistent bedtime routines are often missing,” Clifford says.
“We have some parents saying they can't get their toddler to bed until midnight. With more parents in paid work, there's greater pressure to get the child to sleep through at six weeks. Some parents keep the infant or child up until 9pm to see dad when he gets home from work. By then the child is beside itself, but can be up again at the crack of dawn to get to day-care in time.
"A lot of sleep problems are caused by parents' unrealistic expectations of when their child should sleep through and trying to do too much.”
Daniel and Kim Maung of Fullarton, Adelaide, know the whole-of-house exhaustion one toddler can cause.
“When Brett was three it'd take us about an hour to get him to sleep,” says Mr Maung. “After being put to bed, he would come out of his room time and time again. After the fourth or fifth curtain call we'd be pretty frustrated, and would tell him we'd shut the door or take something off him if he didn't say in bed. Each night we ended up grumpy and exhausted and he'd end up in tears. Then he might wake up once or twice during the night and come into our room. When you have two working parents, you give in because you are so tired and need your sleep.”
Instinctively resistant to controlled crying, the Maungs were open to Blunden's rewards-based approach, which harnesses toddlers' desire for independence.
The concept, explained in detail in Boss of My Sleep, involves rewarding the child with one sticker for completing his or her bedtime routine, then another sticker for waiting in bed all night. If the child earns two stickers by morning, then there's a simple prize or lots of praise and cuddles. Parents don't need to ignore a child's call – they can respond by calling back, reminding the child they are coming back at an agreed interval, but they need to wait in bed for them. “If you ignore them, they will come out, so ignoring is pointless,” Blunden says.
Toddlers can vote with their feet if they don't want to go to bed, but Brett was sold on his stickers and sleep book, thinking it was a fun game where he could win a prize. “He didn't understand the end game was staying in bed,” Maung says. Within a few weeks Brett was going to bed and staying there all night without complaint.
“We were a bit worried about what would happen when we stopped the prizes, which we did after about two weeks,” Maung says, “but that wasn't much of an issue as he then had the confidence to be able to put himself to sleep. We told him how great it was that he was now the boss of his sleep, and he was happy with that.” He remains a good sleeper.
How much do they need?
Toddlers: 12-15 hours, including their day-time naps.
Three to five-year-olds: 11-13 hours, most of this at night.
Remember: children’s sleep needs vary. You can tell if your child is getting enough sleep by observing his or her mood and behaviour during the day.
Source: Sleep Health Foundation.
What if they don’t get enough?
Studies show that when poor sleep persists in young children, it can undermine cognitive and emotional development, making it harder for them to manage their feelings. It can also weaken the immune system, increase the chance of unhealthy weight gain, and be a precursor to anxiety and depression.
Source: Review of bedtime problems in children. Mindell et al. SLEEP, 2006.