Lots of children struggle with falling asleep and staying asleep. Oftentimes, the cause isn’t a medical issue, but more of something the child has learned over time.”

Children may get used to having certain things – like rocking, music, TV, phones or having water nearby– and then become unwilling or unable to fall asleep without that thing. They may also have a hard time staying asleep when that thing they are used to is not present all night- like a parent, or bottle. This is called a sleep association.

Sleep associations are common in children and may change as the child grows and develops. However, if a sleep-onset association continues and starts to disrupt their sleep, they may have a diagnosis called “behavioral insomnia of childhood disorder, particularly the sleep-onset association type.”

Common Symptoms

  • Bedtime Opposition
  • Difficulty Falling Asleep
  • Waking Up Frequently

Bedtime Opposition: What Is It and What Can I Do?

Bedtime opposition is what it sounds like – kids that don’t want to go to bed! That’s most kids, right? You can help reduce bedtime opposition by:

  • Having a consistent bedtime routine (ask older children to help plan out their bedtime routines)
  • Getting kids to bed around the same time every night
  • Eliminating screen time or reducing exposure to bright blue lighting for 60-120 minutes before bedtime

For more ideas, read about reducing bedtime battles.

Difficulty Falling Asleep: What Is It and What Can I Do?

First, make sure you’re practicing good sleep habits. There may be some that you’ve started but can use some more practice on.

For toddlers and pre-school children, having a visual nighttime routine chart with motivating rewards may help.

For toddlers and pre-school children that have difficulty staying in bed, consider the sleep fairy!

  • At the end of their bedtime routine, tell your child that the sleep fairy is watching them at night to make sure they stay in bed without you after lights out.
  • If they stay in bed, they will have a note and/or small reward in the morning.
  • Try to make it easy for your child to earn their reward at first, and then as they are successful reward them in the morning for staying in bed the whole night.

Waking Up Frequently: What Is It and What Can I Do?

Did you know that the way our sleep cycles work, all of us wake up for short moments of time multiple times a night? These wake-up times may be so short that we don’t notice them. The problem is that some children cannot put themselves back to sleep independently.

This usually happens when the child is used to falling asleep at bedtime with something or someone (light, caregiver, bottle, rocking) that’s not there in the middle of the night to put them back to sleep. So, when they wake up, like all children do, they cannot fall back to sleep alone and call out for their caregiver to give them what they need.

Similarly, changing locations after they fall asleep can also cause a child’s alarm system to go off when they wake up in a different place in the middle of the night.

The solution is usually to have your child learn how to fall asleep alone and in the same location they will be sleeping in all night. For younger ones, you can still hold and rock until they get sleepy but lay them down before they fall asleep (drowsy but awake).

Be mindful that what a child needs to fall asleep is what they will need when they wake up at night. You'll want to come up with ideas of safe, preferred objects, such as a pacifier or sound machine, that they can create an association with. Select something that isn't disruptive to sleep. That way, they won't need you to be in the room in order to fall back asleep.

You may need to find your local behavioral sleep medicine specialist to help assist fading you or your child’s preferred objects (if disruptive) from their bedtime routine.

  • Use the bedtime strategies above in the middle of the night if they still keep waking.

What About Nightmares?

  • Try image rehearsal therapy.
    • Change the ending of the story. Draw or write out the bad dream and give it a happy or brave ending instead. Try to have your child imagine it in as much detail as possible.
    • Avoid scary media.
    • Make sure your child gets enough sleep.
  • For other nighttime fears like fear of the dark or monsters under the bed, take advantage of your child’s imagination and magical thinking and try Monster Spray.
    • Mix up some water, glitter, a little soap in a spray bottle and have your child spray it three times before bed every night. Be sure you tell them the spray will keep the monsters away.
  • For youth with developmental disabilities or trauma-related nightmares, cognitive behavioral therapy for insomnia or nightmares may be beneficial and include:
    • Scheduled worry time during the day can prevent worry at bedtime
    • Relaxation strategies

Children can develop serious sleep concerns, but they can be treated! Helping children develop healthy sleep habits will benefit them for many years to come.