Moomah the Magazine
Three (or more) In The Bed

Three (or more) In The Bed

In the middle of the night, you roll over in your bed on your nightly quest for a restful sleep, and there among the pillows and perhaps your partner, are footy pajamas connected to a little person who has hijacked the slumbering mothership.  Sleep may well be the most oft-talked about frontier of parenting.  Family, friends, and colleagues all share their warnings, recount their horror stories, and pass on advice in the collective oral history of children stealing sleep from their parents.  However, you may not have known the true potential for disruption until experienced firsthand—and most likely in the wee hours-- when you are left to ponder: Who knew that the  early years of falling asleep anytime, anywhere, and sleeping long, long hours would be so desperately missed during parenthood?

Now back to the extra body in your bed…

You’re exhausted, and have read, heard, or been given to read materials with lots of information and advice.  Some of it may even be useful.  Know this: if your child is having sleep problems, you are not alone.  Most children do, and many children have a really hard time going to sleep.  You may even feel or be made to feel like you’re getting it all wrong!  That’s likely the exhaustion (or your mother-in-law) talking.  What follows is an attempt to add to the list of options you may consider when deciding what is best for you and your child.

This article is NOT about the pros and cons of co-sleeping and the family bed.  There’s plenty of information out there, and even more opinions.  Unless we’re talking about infants for whom co-sleeping can be potentially dangerous under some conditions, parents can choose the sleeping scenario that is best for their family.  Oh, and unless we are talking about emerging adolescent 13 year olds, co-sleeping may not be ideal either…as the director of our center likes to remind us, no parent should be in the bed when a child has his first wet dream. 

Also, this article will NOT answer the question: To Ferberize or not to Ferberize?  Again, sleep training that involves “crying it out” is a personal family decision.  There is solid evidence that these behavioral “extinction” protocols can work when applied consistently and do not psychologically damage a child’s long-term well-being.  But they are not for every family.  Any intervention can and should be modified to the specific concern of the child and family, and that IS precisely what this article is about.

Like any human phenomenon, the ability to fall and stay asleep is likely a complex mix of genes, biology and the environment.  Well that simplifies matters!  If your child falls under the category “easy sleeper” (the proverbial “good sleeper”) or was quick to sleep train, tell no one.  Chronically sleep-deprived parents cannot handle this information with the sincere congratulations they would otherwise muster.  Then, proceed to light a candle, sing halleluiah, and enjoy your restful nights.  If, however, your little-angel-by-day, has more difficulty self-soothing, falling asleep and staying asleep, here are some points to consider:

1. How old is your child? 

Are we talking about a 9 week old? a 9 month old? or a 9 year old?  Your child’s age AND developmental level will determine his or her sleep needs and how best to establish positive sleeping habits.  Newborns should have their needs met immediately.  Sleep deprivation will be largely unavoidable given their feeding schedule.  I have yet to meet the unicorn woman who was capable of “sleeping when they sleep.”  Within weeks, babies begin to show regularity in their sleeping and feeding cycles. 

Most experts agree that by the time an infant is 6 months old he or she may generally ready for the big time.  Big time = greater sleep regularity and sleeping for an extended period of time that may qualify as sleeping “through the night.”  Some kids will transition easily, while others may not.  Anywhere from 1/3 to ½ of 6-12 month old babies continue to wake up in the middle of the night to the point that parents find disruptive.  Though sleep training may start during this period, some kids may need more “exercise” than others.  Developing positive and consistent sleep habits as early as possible is key.

• Conceptualize “going to sleep” as a complex skill that your child needs learn.  The best way to learn complex skills is to break them into smaller skills appropriate for their level.

• Think about what pre-sleep routines you’d like to instill on your child over time.  Reading or story time together?  Snuggle time? Brushing teeth (once they have them)?

2. Are we talking state or trait? 

A child’s ability to sooth and be soothed may be a part of his or her temperament.  They may have difficulty self-soothing or unwinding, the “falling” part of falling asleep.  Until their little fingers can grasp a glass of red wine to unwind, no wait, that’s for parents…redo… These children may need more help and more time to develop this skill.  How do we teach a child any skill?

• Modeling is often the first (and often powerful) way we teach behavior.  Like the bunny ears of shoe lace tying, parents can show kids their own positive self-soothing and relaxation habits.  Toddlers can be taught deep breathing.  Pre-schoolers can be encouraged to quietly look at books.

• For younger kids, consider one of the modified behavioral sleep training protocols such as controlled comforting or “camping out” to allow kids to practice self-soothing in a more systematic way.  Controlled comforting involves parents staying in the room to comfort and settle a child for a limited amount of time (e.g., one minute), leaving the room after that time, and returning in incrementally increasing time intervals (e.g., two minutes, four minutes, and so on) to repeat the steps until the child falls asleep. 

As the name implies, “camping out” involves staying in the child’s room but gradually decreasing interaction and slowly moving away from the child’s bed (e.g., in a chair next to the bed, then a foot away from the bed, etc.).  For older kids, you can also set up a consistent “check” method that allows them alone time to practice 1) being alone, 2) using strategies associate their beds with restfulness, and 3) STAYING in their rooms.  If they are doing what they’re supposed to when you “check” on them every 10 minutes or so, you can provide brief verbal (e.g., “Good job relaxing in your bed”) or nonverbal (e.g., smile, thumbs up) praise.

• Nothing beats a well-stocked bedside table, well stocked with soothers and comforts: a favored snuggly panda, a sachet of lavender, a small glass of water, a favorite photo.

• Is this a “state” issue, and something more transient or temporary for the child?  Is your child sick?  Is he or she anxious about a test?  Is your child experiencing a developmental change that may be disrupting normal sleep patterns?

• Children’s brains go through enormous growth changes.  Sleep disruptions will happen and may be connected to these periods of developmental transition.

• Set up a time for your child to talk about his or her anxiety well BEFORE bedtime. Try to understand and help him or her to understand the specific worry.  Validate and normalize anxiety (e.g., “That CAN be scary but you are safe.”).  It is normal for kids to be anxious about monsters, safety, and school and friend issues.  Provide comfort and just enough (not too much) reassurance around safety concerns and help them to problem solve a plan around their other worries.

3. What are the causes and consequences of the behavior? 

As a cognitive behavioral psychologist, I spend a lot of time trying to figure out kids’ behaviors and patterns of behaviors.  Behavioral principles tell us that if a behavior continues to happen there must be something reinforcing it.  Behaviors have an antecedent and a consequence, something that came before the behavior happened and something that comes after the behavior happens.  When a child keeps appearing in your bed—and this is not your choice!—then it’s time to start sleuthing:

• First step: observe and take notes.  Keep a log.  Gather data.  What happens when you put your child in his or her toddler bed? Or before your child walks into your room?  What happens when he or she winds up in the bed?  For verbal children, what are they expressing in those moments?  What are your child’s beliefs about his or her own ability to fall and stay asleep?  Your own thoughts and beliefs?   Do you and your partner agree on a sleep plan?  What may reinforcing the behavior?

• If your child developed “behavioral insomnia,” wherein he or she cannot sleep unless certain conditions are met (e.g., only being held by you,  being near you), know that children are a study in contrasts!  They thrive with structure and routine AND they are also highly adaptable.  What are the antecedents and triggers of their parental bed-seeking behaviors?  Come up with a plan to gradually reintroduce your child to his or her own bed. 

• Positive reinforcement works.  For pre-schoolers and older kids, develop a behavior plan and sticker chart as you shape their goals and target specific behaviors gradually.

• Decide on a sleep plan and practice it.  As with any “training,” it will likely be difficult at times and will surely test your strength and endurance!  Try to be as consistent as possible.  Include in your plan some coaching for yourself and encouraging self-statements: “I can do this,” or “I trust my instincts,” or “I love my baby but I want my bed back.”    

In the enduring wisdom of The Godfather…”You give’em one message…we go to the mattresses.”  Good luck!

-- Dr. Sandra S. Pimentel
The Columbia University Clinic for Anxiety and Related Disorders

Posted in: Parenting   

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