Ask An Expert
10 Strategies to Help Kids Sleep Through the Night
Dr. Larry Mitnaul, a board-certified child and adolescent psychiatrist (and father of five!), breaks down the science of sleep and shares ten of his hard-earned tips for getting kids to slumber through the night - from infants to preschoolers.
- Zhenzhong Liu
- Written By
- Dr. Larry Mitnaul
Hush little baby don’t say a word…
If your child’s sleep (or lack thereof) has got you stressed (and similarly short on sleep), you might wonder if buying a horse-and-cart or a billy goat would improve your situation, as the lullaby suggests. Why, after all, do we say “sleep like a baby” as though it means something serene?
Sleep is a time to rest and reset after a day full of big emotions (yes, for kids too)! Yet, it can predictably be frustrating and beyond all control for parents of young children. Before considering the frustrations and some potential solutions, consider the science of sleep for young children - from the womb to the toddler years. What is a healthy sleep pattern for these youngest humans?
The Science of Sleep
Let’s begin at the beginning. Have you ever asked yourself how your baby was sleeping before birth? Around 28 weeks (7 months) gestation, our children have already begun to experience distinct patterns of sleep and wakefulness. By 32 weeks gestation, REM (rapid eye movement) sleep appears. REM sleep is the stage characterized by dreaming. Then, around the 34-week gestation mark, the more “quiet” sleep emerges in the NREM (non-rapid eye movement) stage, which is generally associated with growth and repair. In total, a baby approaching full-term sleeps up to 90 percent of the time, just as a newborn does; but that doesn’t mean that sleep is continuous.
Newborn and Toddler Sleep
So What is Normal for Newborns?
Sleep varies significantly in early development, and you may be surprised at how quickly things can change within those early months. 0 to 2-month-olds commonly have short sleep/wake cycles. For bottle-fed babies, that can mean two to five-hour periods of sleep over a day. Breast-fed babies often have shorter cycles of one to three hours. It is normal that these children will have one or two hours of wakefulness in between those sleeping periods.
Also, before two months, there is no circadian rhythm (associated with light and dark) to a newborn’s sleep — unlike we adults who care for them, they don’t yet recognize night and day. You can play a role in your child’s developing a circadian rhythm. Most of us naturally will keep light to a minimum while caring for a newborn during nighttime hours. Rest assured (pun intended); this is a short phase.
From the earliest days of infancy, several culprits can impede a baby’s ability to sleep soundly. The usual suspects are related to diaper changes, environmental factors - noise, light, temperature - and even the parents’ emotional state.
What Is Normal for Infants?
In infants, two to twelve months old, sleep shifts gradually from these brief episodes to more consolidated periods of varying lengths. In other words, we begin to see a more significant distinction between nighttime sleep and those shorter, daytime naps. Daytime nap times can vary, but on average is three to four hours in total time, and nighttime sleep typically amounts to nine to ten hours. Most parents notice that by 12 weeks, their newborn is better adjusted and has developed a sleeping pattern, even if it doesn’t mean quite yet sleeping through the night in one stretch.
Sleep Strategies for Newborns and Infants
Expert advice for parents of newborns varies greatly since, as we’ve established, there are no discernable patterns of sleep. The overarching guidance is to ensure that their needs are met. No one is advocating neglect, and a newborn cannot “cry it out” as that is their primary means of communication. Consistency will be a crucial ingredient to your success at this stage. Consistency looks different from infancy to toddlerhood, but it’s essential as they age. First, ensure your baby’s needs are met-they should be fed and dry. Then, put your baby down drowsy but not yet fully asleep so that they will get used to drifting off on their own. Perhaps keep your warm hand on your baby and remove it slowly. When it seems your baby cries anytime he or she wakes anywhere other than your arms, consider all your options.
When you hear your baby cry, stay consistent in how you respond. Maybe you rock your baby for a few more minutes, then nurse or bottle-feed under the glow of a nightlight, and then back to the crib…Gradually, the stretches between wakings will increase in duration, and little Abner will come to expect a cuddle and lights out again.
Toddler and Preschooler Sleep
What Is Normal for Toddlers?
During the toddler phase (twelve months to three years), typical nighttime sleep is mainly unchanged (9 ½ to 10 ½ hours), but the length of time spent napping decreases to around two to three hours - and it occurs in one or two stretches at this intermediate napping phase.
As the number of naps gradually decreases (from four a day to one) as the child ages, we see how attachment issues and separation anxieties play a role in sleep. Additionally, those photo-worthy motor milestones such as rolling over, pulling up, and standing begin to influence a child’s sleep. As a result, the child will be more physically exhausted and more excitable and capable.
As parents, it may feel like we need to “up our game" because at this stage, they’ve developed the ability to walk (i.e., walking into your bedroom at night!). However, some of the common challenges in this stage are the transitions from a crib to a kids bed, bedtime refusal, and sleep-related concerns (such as night terrors or bad dreams, rocking, etc.).
What Is Normal for Preschoolers?
In the preschool period (3-5-year-olds), the length of sleep at night typically lengthens (11-12 hours). As a result, naptime dwindles to once daily or none at all. One theory of bedtime battles during this age range is the onset of a circadian surge in alertness in the evening, sometimes referred to as the “forbidden zone.” This enhanced alertness can lead to increased bedtime refusal.
NOTE: If a child has had early-life difficulties (like significant medical issues or trauma), some of these typical sleep patterns described above can be significantly delayed; they may require additional support from your child’s pediatrician or a specialist.
Sleep Strategies for Toddlers and Preschoolers
The expert advice for determining bedtime tends in two directions in this age range: where crying intervals are consciously permitted and one that gradually moves bedtime to better “sync” with a child’s natural state of drowsiness. The biggest hangup for parents on choosing which expert advice to take is this question: “Do either of these methods lead to emotional or physiological issues for my child later in life?” The scientific research suggests that both these approaches can reduce child and parental stress. In infant studies, measuring cortisol, the stress hormone, has generally demonstrated lower cortisol levels in both approaches. In clinical studies, it is noted that the mother’s stress level also tends to decrease with either method. Most importantly, the child-parent attachment does not appear to be hurt by either approach.
As a father of five, I could write a book on the various nighttime difficulties I’ve seen in my kids. But, instead, now that we’ve acknowledged that healthy sleep from birth to preschool doesn’t mean drifting off at bedtime and waking to the sun, let’s consider some practical tips and strategies for coping with unexpected wakefulness and nurturing healthy sleep:
Sleep Strategies for All Kids
Don’t let that all too familiar question: “How’s he sleeping?” alter your stress level. While few parents complain that their newborn sleeps too much, many new parents express concern that they are failing if their infant does not seem to be sleeping soundly - and it’s often in comparison to how other parents relate their nighttime bliss. Recognizing that periods of wakefulness are normal for newborns will help you avoid fighting a developmentally normal sleep pattern. Keep in mind that each child, family, and home are different; and that the transition into recognizable sleep patterns is long and varied.
Tune into the 5 Senses
Physical touch is essential to self-soothing and emotional regulation in the early years. Your heartbeat is the calming pulse, your touch the warm blanket surrounding your little one in infancy. Noise is also a significant factor: Its addition or subtraction can mean success in the sleep arena. This part can be easier said than done – especially when you have more than one child. In our house, having the soft sound of running water (pre-recorded and hopefully not from our sink) or nature sounds can mask the noises of a busy home, especially when older siblings are up later or no longer nap. We’ve mentioned the light of the sun and nighttime, but another trick that can help is to start dimming the lights in your home as bedtime nears. The artificial lights in our homes confuse the natural inclination (of children and adults) to relax with the sun’s waning rays. I cannot fail to mention the other major culprit of light mismanagement: our screens. At least one hour before bedtime, eliminate all screen time to give your child’s brain its best chance at calming and entering rest. Even with our most advanced e-reading technology, I’d recommend keeping those screens out of the bedroom.
I’ll let your pediatrician advise you on sleep-posture for newborns, but the older and more active your toddler gets, attention turns to their environment. Consider keeping your child in a crib as long as they tolerate it (i.e., not risk injury by climbing out). This provides peace of mind for you, and it avoids stressing a toddler who’s not yet ready to move out of the safety of his crib. Once you begin to transition to a toddler bed, consider simplifying what is in the bedroom. Store toys and essential care items elsewhere to avoid distractions and safety risks. (Our oldest proved that he could escape his crib and paint the room in Desitin at the end of one day’s nap!) Finally, stay aware of any potential risks of strangulation or suffocation (such as loose bedding, soft objects, etc.).
One of the tenants of positive parenting is attunement with our children and lovingly meeting their needs. Think about how you can enrich that connection with your child during their waking hours to avoid the guilt creeping in at night. When I hear parents voice that sense of guilt, I suspect it has led to reinforcing patterns they don’t intend - like having their older child sleep in their bed or repeatedly responding to late-night requests when kids want to stall bedtime.
Bedtime by the Clock
Consider making adjustments to bedtime for the toddler if refusal is an issue. Consider the phase of development your child is in and see how the hours devoted to sleep stack up for you. Pushing bedtime back or forward by half-hour each day, or even quarter-hour increments can help “sync” your child’s sleep with the whole family’s routine. And while a consistent bedtime is important, none of us truly follows a perfect schedule. So, set your goal and adjust as necessary.
The Bedtime Routine
I think of ritual as the glue to establish a predictable rhythm within the family. Bedtime rituals are a part of that. Establishing this rhythm of life can be problematic initially but yields rewards later. These rituals are as individual as each family is but may prove even more important than watching the clock. Perhaps after brushing teeth, you snuggle and read a story or two, imagine what you’ll dream about, pray and give goodnight kisses before you exit your child’s room. Having a pleasant ritual helps your child look forward to doing it again the next day. Imagine that – a routine that is so joyful that your son or daughter can’t wait to begin! For those with multiple kids, staggering this routine may also be a “special time” for individuals, undivided attention for those 15 minutes before bed. This routine also avoids surprises and soothes children’s sense of security in that they “always” know what comes next. And, you can anticipate the grown-up time that comes once the littles are all tucked in.
While mentioned briefly in the newborn section, consistency in the later developmental stages is also part of that loving, family ritual that will assist you in “setting positive expectations.” This is often the most challenging part to practice – especially if your immediate attempts at starting the above strategies do not translate into obvious, immediate success. While infant crying is expected, some older kids will have tears during the bedtime routine. As you know from experience, few tears result in lifetime scars. The most important parts are ensuring their needs are met (personal connection during the day, hunger/satiety, bathroom needs, safety, and establishing your ritual). If those are met, the tears and frustration at bedtime may be a part of their transition to sleeping independently.
Let me define discipline. It is not corporal punishment or breaking anyone’s will. Discipline is helping your child do what’s best for him, even or especially when he doesn’t know what that is. How often have I heard parents tell me, “but they won’t (go to bed, stay in bed, go to sleep),” etc.? Do they literally never sleep, or have we fallen into the trap of letting the child determine their own bedtime? As with many situations, unless we refuse to relent, our children learn to push just enough to sway us - testing limits is a natural phase of toddler development. So, know this, it WILL be hard at first, especially if you are already in that trap. But summon your fortitude and resilience. You might end up sleeping on the floor outside your child’s room for a week to make sure he stayed in his room (even if not in bed) until he was sound asleep. Eventually, he’ll catch on and know that when you say go-to-bed, you mean it, and there will not be a get-up-and-play-again-until-you’re-really-tired period. Do your best to keep your cool; keep your voice soft and soothing but be firm in training your child to remain in bed.
Evidence points to a child’s sleep difficulties impacting parents’ well-being and parental stress affecting our children’s ability to sleep. It sounds like a vicious cycle. So, if you notice that you are struggling emotionally or that your partner is significantly struggling emotionally, find help. YOU are worth the investment and time to address these concerns by finding good support or even considering therapy.
Hand in hand with self-care is parents working as a team. As you and your partner make a plan that considers your child’s needs, determine how you’ll take turns, so no one gets burned out. Dads can be a huge help just hopping up (and I know that’s harder than it sounds) to get that crying baby for a diaper change and handing him to Mom for nursing. Maybe that nighttime ritual means Mom does the dishes (listening to her podcast) while Dad reads the bedtime stories. If you’re a single parent, ask for help from a grandparent or caring friend if you feel you’re at your wit’s end. Even if all your baby’s grandparents give you is a shoulder to cry on, it’ll buoy you up for another day (or night) knowing someone knows what you’re going through - and there’s living proof that you both survived!
You’ve Got This
Sleep changes significantly throughout development. Knowing what to expect can reduce your frustration significantly. Give these tools a try to help your family sleep in heavenly peace. Otherwise, consider the strategy my wife and I employed with our first child: Read EVERY child sleep book you can get your hands on during each precious waking hour — and by the time you’ve completed the last book, your child will have figured out how to sleep on their own! Be encouraged. You can do this!