What is bedtime resistance or refusal?
This handout applies to children who are over 2 years old and sleep in a bed (rather than a crib) and refuse to go to bed or stay in the bedroom. Often, they go to sleep while watching TV with a parent or they sleep in the parents' bed. In a milder form of bedtime refusal, a child stays in his bedroom but delays bedtime with ongoing questions, unreasonable requests, protests, crying, or temper tantrums. Such children are often tired in the morning and have to be awakened when it is time to get up.
What is the cause?
If the child occasionally comes to the parents' bed because he is frightened or not feeling well, he should be supported. However, if the child postpones bedtime or tries to share your bed every night, he is taking advantage of your good nature. These are unreasonable attempts to test the limits, not fears.
How can I end bedtime refusal?
These recommendations apply to children who are manipulative at bedtime, not fearful.
Clarify what a good sleeper does.
Tell your child what you want her to do: At bedtime a good sleeper stays in her bed and doesn't scream. During the night, a good sleeper doesn't leave her bedroom or wake up her parents unless it is an emergency. A good sleeper gets a sticker and a special treat for breakfast. A bad sleeper loses a privilege for the following day (for example, all TV or access to a favorite toy).
Start the night with a pleasant bedtime ritual.
Provide a bedtime routine that is pleasant and predictable. Most before-bed rituals last about 30 minutes and may include taking a bath, brushing teeth, reading stories, talking about the day, saying prayers, and other interactions that relax your child. Try to keep the same sequence every night because familiarity is comforting for children. Try to have both parents take turns in creating this special experience. Never cancel this ritual because of misbehavior earlier in the day. Before you give your last hug and kiss and leave your child's bedroom ask, "Do you need anything else?" Then leave and don't return. It's very important that you are not with your child at the moment of falling asleep; otherwise he will need you to be present following normal awakenings in the night.
If your child is fearful, tell her you will check on her every 15 minutes (instead of her checking on you). When you come in, tell her she's doing a good job of being quiet. Leave within 15 seconds. On one of your visits, you will find her asleep.
Establish a rule that your child can't leave the bedroom at night.
Enforce the rule that once your child is placed in the bedroom, she cannot leave that room, except to go to the bathroom, until morning. Your child needs to learn to put herself to sleep for naps and at bedtime in her own bed. Do not stay in the room until she lies down or falls asleep. Establish a set bedtime and stick to it. Usually, this change won't be accomplished without some crying or screaming for a few nights.
If your child has been sleeping with you, tell her, "Starting tonight, we sleep in separate beds. You have your room and we have our room. You are too old to sleep with us anymore."
Ignore verbal requests.
Ignore ongoing questions or demands from the bedroom and do not engage in any conversation with your child. All requests should have been dealt with during your pre-bedtime ritual. Before you give your last hug and leave your child's bedroom, ask, "Do you need anything else?" Then don't return unless you think your child is sick. If your child says he needs to use the toilet, tell him to take care of it himself. If your child says his covers have fallen off, promise you will cover him up after he goes to sleep. (You will usually find him well covered.)
Close the bedroom door if your child is screaming.
Try to ignore screaming, but if it's disruptive, close the door. Tell your child, "I'm sorry I have to close your door. I'll open it again as soon as you are quiet." If she pounds on the door, you can open it after 1 or 2 minutes and suggest that she go back to bed and stop screaming. If she doesn't, close the door again. If the screaming or pounding continues, open the door approximately every 15 minutes and remind your child that if she quiets down, the door can stay open. Never spend more than 30 seconds talking to her. Although you may not like to close the door, you don't have many options. Rest assured if your child is over 2 years old and has no daytime separation fears, it is quite reasonable to do this.
Close the door if your child is leaving the bedroom.
If your child comes out of the bedroom, return him immediately to his bed. Avoid any lectures and skip the hug and kiss. Get good eye contact and remind him again that he cannot leave his bedroom during the night. Warn him that if he comes out again you will need to close the door. If he does come out again, close the door. Tell him, "I'll be happy to open your door as soon as you are in your bed and I'll leave it open as long as you stay in bed." If your child says he is in his bed, open the door. If he screams, every 15 minutes open the door just enough to ask your child if he is in his bed now.
Put up a gate or lock the bedroom door if your child is repeatedly leaving the bedroom.
If your child is very determined and continues to come out of the bedroom, consider putting a barricade in front of her door, such as a strong gate. A half-door or plywood plank may also serve this purpose. Sometimes the bedroom door will need to be closed temporarily to convince your child that staying in the their room is not negotiable. Reassure your child you will open the door as soon as she falls asleep. Also, each night, give her a fresh chance to stay in the bedroom with the bedroom door open. (Caution: If your child has bedtime fears, don't close the door.) If your child is a danger to himself or others, a full door may need to be kept closed until morning with a push-button lock, hook and eyelet screw, childproof handle cover, piece of rope, or chain lock. Although this step seems extreme, it may be critical to protect children less than 5 years old who wander through the house at night without an understanding of dangers, such as fire, hot water, knives, or going outside.
Send your child back to her room if she comes into your bed at night.
Sternly order your child back to her own bed. If she doesn't move, escort her back immediately without any show of affection or pleasant conversation. If your child tries to leave her room again, temporarily close her door. If you are a deep sleeper, consider using some signaling device that will awaken you if your child enters your bedroom (such as a chair placed against your door or a loud bell attached to your doorknob). Some parents lock their bedroom door.
Remind your child that it is not polite to interrupt other people's sleep. Tell her that if she awakens at night and can't go back to sleep, she can look at books or play quietly in her room, but she is not to bother you.
If she awakened you at night with screaming or demands, visit her briefly.
Reassure her that she is safe. If she needs blankets readjusted, help her do this. Then leave. On the following day teach her how to independently solve any complaints she makes during the night. (Remind your child that it is not polite to awaken people at night. Tell her that if she awakens at night and can't go back to sleep, she can read or play quietly in her room.)
Help siblings sleeping in the same bedroom.
If bedtime screaming wakes up a roommate, have the well-behaved sibling sleep in a separate room until the other child's behavior has improved. Tell the child who has the sleep problem that her roommate cannot return until she stays in her room quietly for three nights in a row. If you do not have a separate room available, have the sibling sleep in your room temporarily.
Awaken your child at the regular time each morning.
Even if he fought bedtime and fell asleep late, wake him up at the regular time so he will be tired earlier the next evening.
Start bedtime later if you want to minimize bedtime crying.
The later the bedtime, the more tired your child will be and the less resistance he will offer. For most children, you can pick the bedtime hour. For children who are very stubborn and cry a lot, you may want to start the bedtime at 10 PM (or whenever your child naturally falls asleep). If the bedtime is 10 PM, move the bedtime back by 15 minutes every week. In children who can't tell time, you can gradually (over 8 weeks or so) achieve an 8 PM bedtime in this way with many fewer tantrums. However, don't let your child sleep late in the morning or you won't be able to advance the bedtime.
When should I call my child's healthcare provider?
Call during office hours if:
- Your child is not sleeping well after you try this program for 2 weeks.
- Your child is very frightened.
- Your child has lots of nightmares.
- Your child also has several discipline problems during the day.
- You have other questions or concerns.
Written by Barton D. Schmitt, MD, author of “My Child Is Sick,” American Academy of Pediatrics Books.
Published by RelayHealth.
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