Help! What do I do if my toddler refuses to sleep?

by Guest Blogger on July 29, 2014

The mother of a 3-year-old who has trouble falling asleep at night wrote our sleep expert Dennis Rosen, MD, the following email asking for help. The answer seems fairly universal, so we want to share it with Thriving readers who may be having the same difficulties.

Dear Dr. Rosen,

Not-tiredI am hoping that you can help me.  I don’t know of a pediatrician in my area that specializes in child sleep issues.  I have a three-and-a-half-year-old, and for the past six months, getting her to go to sleep at night has been a nightmare. I’ve always had trouble getting her to sleep—she didn’t sleep through the night until she was almost two.  And even up to two-and-a-half she would wake up in the night and tell me she was bored and wanted to get up and play.

When she turned three I moved my daughter into a regular bed but she won’t stay there long enough to fall asleep. (She gets up and plays, or wanders around upstairs if she can do so without me hearing her downstairs).

I’ve tried the Super Nanny approach and kept putting her back to bed until she fell asleep. But a week of doing this for what felt like 50 or 60 times a night was too much, especially for a single mom who needs to get up at 5:30 a.m. to go to work.

I started taking everything out of her room that she may play with, taking away privileges, (I even threatened making a call to Santa to talk about her placement on the naughty list), but nothing worked. Finally, I started locking the door to her room.  At first she kicked the door and yelled but now she stays in her room and plays/talks to herself until around 9:30 or 10:30 at night. I usually have to unlock the door several times so she can go to the bathroom, (sometimes she doesn’t really have to go, she just wants my attention).

Once she is asleep she generally stays asleep.  She normally gets up between 5:30 and 6:30 a.m. in the morning.  On a rare day she will sleep until 7:00, and sometimes she up as early as 5:00 a.m.

I thought perhaps her afternoon naps were the problem, but when she doesn’t nap during the day she still goes to sleep around the same time, and still gives me a hard time about it. (She’s also pretty grumpy in the evening when she doesn’t nap.)

I now try to limit her nap to 1 or 1.5 hours in the afternoon, unless she is not well.  At night we start getting ready for bed around 7:00 p.m. (pajamas, bathroom routine, stories, and soft songs) and I try to get her into bed no later than 8:00 p.m. I tell her she can talk to her babies softly in her bed, but she isn’t allowed to get up unless she needs to go to the bathroom. It doesn’t seem to be helping.

Do you have any advice?  I would really like to get her into a better bedtime routine and any help or pointers would be appreciated.

Sincerely,

Single Mom Desperately in Need of Sleep

 Dear Mom Desperately in Need of Sleep,

It certainly sounds like you have your hands full! While it’s not possible to provide child-specific advice, there may be some general things you can try that may help both you and your daughter to sleep better.

RosenDennis-1-PreviewlargeTo start, it sounds like her schedule isn’t as regular as it could be, if even during the week her wake-up time ranges between 5 and 7 a.m. Keeping to a regular schedule, both weekdays and weekends, helps to synchronize the body’s internal (circadian) clock, making it easier to fall asleep at the same time each evening. With her wake-up time spanning a two-hour range, it is easy to see how some nights she might be ready to settle down and go to sleep at 8:30 p.m., while on other nights that only happens at 10:30 p.m.

You also mention that she naps 1.5 hours during the day. Kids that age generally need around 11 hours of sleep, so that leaves 9.5 hours left for her to get at night. (Of course, there are others who need less than that; every child is different.)

The first thing I would suggest doing would be to put her on a regular wake-up time and keep to it, seven days a week. If you chose 6 a.m., that would mean putting her down at 8:30 p.m. You’d want to make sure, too, that she isn’t getting more sleep at daycare than you are being told. While easier for the daycare staff, this can create lots of problems for parents whose kids simply aren’t sleepy enough at bedtime because they’ve slept during the day.

As for her behavior, I’m not a big fan of locked doors, which can create stress for both child and parent.  A gate at the door should do the trick just as nicely. Providing a dim reading light and books that she can look at if she’s not sleepy, as well as dolls or toys, will help to keep her from getting bored. While she may ask to come out, you need to decide if that is acceptable, and to be consistent. One possibility might be to give her a “pass” that she can use once to come out for a drink of water, or a kiss, etc.

Good luck!

Dennis Rosen, MD, is the associate medical director of The Center for Pediatric Sleep Disorders at Boston Children’s Hospital and author of Successful Sleep Strategies for Kids. If you have a sleep-related question to ask, please email it to Thrive@childrens.harvard.edu.

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Matt-1

Preschoolers are drawn to play. Summertime sprinkler fun, snow-bound sledding and endless forms of indoor, outdoor horseplay are part of a youngster’s childhood fabric.

But for Matthew Dolan, carefree play was absent from much of his early years.

As a toddler and young boy, Matthew didn’t feel well and was much smaller than his active peers. He often experienced great pain—to the point of tears—when lying down, had numerous urinary tract infections (UTIs), ear infections and bouts of strep throat.

“I was sick all the time and stayed home from school frequently,” says Matthew, now 19. “I was tiny and not as active as other kids my age. They were larger, faster and more skilled at games we played.”

Matthew’s mother, Martha, knew her son was fighting a much larger medical issue. But Matthew’s pediatrician could not pinpoint the source of the problem.

“I felt very helpless since I knew something was wrong but didn’t know what was causing his pain,” says Martha.

At 6 years old, Matthew’s medical journey took a life-saving turn. He was referred to Boston Children’s Urology Department. Full story »

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Catching up with Dominic Gundrum

by Tripp Underwood on July 23, 2014

Dominic 2When Dominic Gundrum first came to Boston Children’s Hospital late in 2012, his future was very much unknown.

He was born with a large, triangle-shaped gap running from his upper lip through the middle of his nose and forehead, known to the medical community as a Tessier midline facial cleft. His cleft was so large that fluid and tissue from his brain, normally encased in the skull, had seeped outwards, forming a golf ball-sized bubble underneath the skin of his forehead. It’s a condition called an encephalocele, and Dominic’s was so severe doctors weren’t sure how much they would be able to help him. Full story »

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Summer first aid tips for parents

by Guest Blogger on July 23, 2014

Meaghan_OKeeffe_1Meaghan O’Keeffe, RN, BSN, is a mother, writer and nurse. She worked at Boston Children’s Hospital for nearly a decade, in both the Cardiac Intensive Care Unit and the Pre-op Clinic.  She is a regular contributor to Thriving.

Summer provides ample opportunity for enjoying nature, playing outside and gazing at skies full of stars. But some of the side effects of all that outside time—scrapes, stings and other minor injuries—can take some of the fun out of summer. Here’s a quick refresher on some basic first aid every parent should know this time of year. Full story »

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Life with HLHS: Keeping up with Lucas

by Guest Blogger on July 22, 2014

Baird-boys-3By Rebekah McGowan

When we first learned that our son would be born with Hypoplastic Left Heart Syndrome, we were devastated. But once the shock had worn off we were desperate to talk to other families who had been through the experience. We asked our doctor about support groups, but he was less than impressed with what was available.

“They’re out there, but it’s mostly propaganda,” he said, scrolling through a Google search of HLHS communities. “Regardless of what you may read, these kids can’t run and they can’t do sports.”

And while he wasn’t impressed with what Google had to say about the future of kids with HLHS, he was impressed with what Boston Children’s Hospital’s Heart Center could do for children with the condition—and I’m so glad he was. Through his referral we went to Boston, and there we found the hope we needed. It was there that we learned that our son had a good chance of having an extraordinary quality of life under their care. We were also told that other than contact sports, our son could do anything he wanted to.

Over the years Lucas continued to thrive. And for each year he got stronger we participated in the NSTAR walk for Boston Children’s Hospital. It’s our way to say thank you to the hospital that saved him, and to help fund additional research, particularly in the areas of congenital heart defects that affect 1 in 100 babies born every year. Full story »

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Should I let my 14-year-old use ‘Snap Chat’?

by Michael Rich MD MPH on July 21, 2014

Michael RichMichael Rich, MD, MPH, is Boston Children’s Hospital’s media expert and director of Boston Children’s Center on Media and Child Health. Send him a media-related parenting question via cmch@childrens.harvard.edu and follow him on Twitter @CMCH_Boston.

Q: My 14-year-old daughter has been begging to get ‘Snap Chat’ on her iPod Touch. I searched for information on it and found this and I wasn’t initially impressed… http://www.hercampus.com/school/pitt/snap-chat-sexting-or-friendly-fun. I am tech savvy and know screen shots can easily be saved, but also, if she loses her device and someone else sends something, she could be held responsible. I don’t like the idea of Snap Chat and am weary of my daughter’s “everyone has it” plea. What do you think? What have you heard about it—risks etc.?

Suspicious of Snap Chat, Boston, MA

A: Dear Suspicious,

Snap Chat allows you to send and receive photos that are deleted within seconds (along with any digital trace of them, Snap Chat claims). You have done the right thing by looking into your daughter’s request and by researching the Snap Chat application yourself. Your concerns are certainly valid; images can be quickly and easily saved in other ways as well as distributed. Full story »

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Saving Grace

by Tripp Underwood on July 17, 2014

Grace 4It may seem like an insignificant thing, but a peanut butter cookie changed Grace Denney’s life forever. Just a small amount of peanut butter triggered an allergic reaction that left years of anxiety in its wake—and eventually lead Grace and her mother Richelle to Boston Children’s Hospital’s Food Allergy Program—which they credit with giving them their lives back.

A sudden onset

Growing up, Grace had always avoided peanuts. There was something about their smell that bothered the young girl so much that she went her first seven years without tasting a single nut or eating even a spoonful of peanut butter. But all that changed one day when she was at a baking event for a local youth ministry group.

Preparing goods for an upcoming bake sale, Grace was part of a team of girls making several types of treats, including a particularly delicious smelling batch of peanut butter and chocolate cookies. Thinking her tastes may have changed, Grace helped herself to one. Moments later her throat felt very dry and scratchy, making it difficult for her to breath, which scared both her and the adults supervising the event. When Richelle picked her daughter up that evening and heard what had happened, she suspected Grace might have had an allergic reaction and quickly made an appointment with an allergist. Full story »

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Soccer-Head-ball-adultsGermany’s Christoph Kramer is a World Cup Superstar. He’s also a symbol of an extremely flawed sports concussion policy. Kramer was knocked out and lost consciousness 17 minutes into the World Cup final match. Germany’s team doctor allowed him to play for another 15 minutes, finally allowing him to be removed from the game as he fell over.

“Unfortunately, this is not an isolated case,” says Michael J. O’Brien, MD, director of the sports concussion clinic at Boston Children’s Hospital. O’Brien cites Uruguay’s Álvaro Pereira. When Pereira was knocked out cold during a first-round match, the team doctor called him out. The doctor’s decision was overruled by Pereira and the coach.

“We need an agreed upon set of rules for handling players with symptoms of concussion. These rules need to be applied in all cases—whether it’s the World Cup Final or a pre-season scrimmage,” says O’Brien.

The professional athlete risks his health when he plays impaired or concussed, and also sends the wrong message to youth sports’ players and coaches. “Kids identify with professional athletes,” says O’Brien. “Aspiring soccer players try to emulate pros, even their risky behavior.”

A two-part solution

Socceer-gameO’Brien and other experts recommend a complete shift in FIFA’s concussion policy. Suggestions include:

  • providing time to assess players with suspected concussion (current player substitution rules require teams to play with one less athlete on the field while a doctor assesses the injured player, which creates a disincentive for sideline assessment)
  • authorizing an independent physician, rather than a team physician, to remove a concussed player from the game
  • implementing a standard, science-based protocol to sports concussion assessment and return to play

Parents and coaches can be part of the solution, too, says O’Brien. “We need a culture change. It’s important for parents, players and coaches to determine youth sports goals and set limits. Is the goal to stay healthy and have fun? Does possible victory merit pushing through injury and increasing risks to player’s health?”

Do you want to learn more about protecting players from head injury? Download Boston Children’s concussion prevention guide.

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