Remember those early sleep-deprived days with your infant? Brace yourself for toddlerhood, because you might be in for round two.
While some families are finally getting some sleep after baby turns 1, other parents find this developmental stage to be full of surprises in the sleep department. Once-predictable sleepers may start waking up during the night, fighting naps or even climbing right out of the crib at bedtime.
Other parents run into trouble when they try to break sleep habits their kids developed as infants, like needing to be rocked to sleep or have a bottle at bedtime. Whatever the case, there are many possible causes for a toddler not sleeping.
Rule out medical issues
So what’s a parent to do when faced with a toddler who suddenly isn’t sleeping well? First, rule out any possible medical conditions that could be causing the sleep trouble, advises Dr. John Dorsey, M.D., a Beaumont Health pediatrician at Beverly Hills Pediatrics.
“If they’re having real sleep problems, most of the time there will be a medical reason for it,” he says. “You have to start with a medical evaluation first.”
Reasons for a toddler not sleeping could include esophageal reflux – more commonly diagnosed in newborns but still a consideration for toddlers – or other problems like ear infections or allergies.
So before you start changing routines or trying new sleep training methods, see your toddler’s doctor for a check-up.
“They shouldn’t be afraid to talk to the pediatrician about it,” Dorsey emphasizes. “Don’t be shy about calling in. Parents a lot of times don’t come in because the parents don’t think it’s a medical problem.”
Know that every toddler is different
Just how much sleep should your toddler be getting? Believe it or not, parents shouldn’t stress too much over this number.
“It’s all over the map,” notes Dorsey, a veteran doc with 60 years of experience. “A lot depends on personality.”
Typically, a toddler will sleep between nine to 11 hours at night plus a few hours of sleep in naps.
“By the time they’re toddlers, that sleep pattern is pretty well established,” Dorsey says, pointing out that many kids in this age group will even fall asleep for their daily naps in the car or on a parent’s lap if needed. “I think most parents are settling down as to understanding about sleep issues and how they respond to it.”
Instead of comparing total sleep hours, focus on whether your child seems well-rested. Signs that a toddler isn’t getting enough sleep include irritability, hyperactivity and trouble falling asleep.
“All things being equal, you’ll have kids with sleep dynamics that vary,” he says. “Some kids will start giving up naps at 4 and other kids need a nap until they’re 6.”
Be prepared for temporary sleep disruption with changes
The toddler years are a common time for parents to try to eliminate things like pacifier use at bedtime, nursing through the night or a rocking-to-sleep routine. If you do attempt one of these changes, have a plan and be prepared for some temporary sleep setbacks.
Slowly transitioning out of the habit may prove to be more difficult than the cold turkey approach, Dorsey says. Toddlers are too young to understand, for example, that now they can only have their pacifier at naptime and not at night.
“When you want to change a habit pattern, I think it’s far better to do it abruptly and within two to three days they’ll modify [the behavior],” he says.
A possible solution
If medical causes for your toddler not sleeping have been ruled out, Dorsey recommends a variation of the “cry it out” approach for toddlers. It involves letting your toddler cry for up to 45 minutes and then going in to reassure him for 10 to 15 minutes before leaving again.
“You go in after 45 minutes, you sit with them, hold them, but you hold them only for 10 minutes. You’re holding them to assure them that you’re alive and the house is not burning,” he says. “Within two to three days they settle right down. It’s such a simple technique.”
Contrary to popular belief, Dorsey says allowing a child to cry using this method won’t cause psychological harm in normal family circumstances. “It’s absolutely not true,” he says.
The same holds true for a toddler who wakes briefly in the night but isn’t hungry or uncomfortable.
“Most of the time, when they wake up, I would have the parents wait at least 10 to 15 minutes before they even go in to see how they are,” he says, pointing out that parents should always respond immediately to an “extreme” cry versus a mild whimper.
If you don’t mind rocking your toddler to sleep but notice she wakes up once in the crib, try waiting a solid 20 minutes after your toddler falls asleep before making the transition, Dorsey recommends.
Have a toddler who’s figured out how to climb out of the crib? Put his mattress on the floor instead and go about your routine as usual until it’s time for a big kid bed. If he tries to wander the house, use a hook on the door (easily breakable in the event of an emergency) but leave a gap so he can still see out.
“A shut door is very terrifying to kids,” Dorsey says, so make sure it’s open a few inches. “The first two to three nights they will get out of bed … [then] they will learn very quickly just to fall asleep.”