Sleep clinic 3 - two difficult toddlers

Sleep expert Mandy Gurney advises two despairing parents of young girls who are making bedtime a nightmare. Read on to find out Mandy's recommended solutions, and also to find out tips about sleep diaries and other techniques

Q. We have two children, a son aged four, and a little girl aged 19 months Our daughter, who is great all day, is an absolute nightmare at bedtime! We have tried lots of different ways to try and get her to sleep but nothing seems to be working. Since the day she was born she has always been a bad sleeper and woken through the night, but things are getting worse and worse. We have now got to the stage that, as she continues to climb out of her cot we have had no alternative but to put her into a bed as we are concerned that she will hurt herself We were hoping the move to the bed would help matters but unfortunately not. It takes us anything up to two hours to get her to sleep and she wakes constantly though the night - usually ending up in our bed (a last resort but our only way to get any sleep).

I have kept her up all day today and not given her a nap, hoping that this may help matters. I am going to try this for a couple of days and follow a strict bedtime routine of bottle, bath, story and bed. However, I am already feeling very negative about the results, as so far nothing we have tried has helped.

We have tried controlled crying and repeatedly returned her to her bed but she carries on screaming for hours and still wakes though the night when the whole nightmare starts all over again.

We really don't know what else to try and would appreciate any advice!

Mandy says

It’s always worth keeping a Sleep Diary to monitor progress – it can really help you to keep going, and help you see what progress you’ve made:

A sleep diary should contain:
The time your child wakes up in the morning
The time and length of their day-time naps
The time you start preparing for bed
The time your child went to bed
The time your child went to sleep
How many times they woke in the night
What you did
What time your child went to sleep again.

Children of 19 months still need a nap everyday, and I’m sure that’s true of your daughter. To balance out the day, she should have a sleep after lunch for around two hours.

An over-tired child is difficult to handle and will fight sleep, but naps are very important. Lack of sleep produces higher levels of the stress hormone cortisol. Napping will help to reduce cortisol levels and help your child to sleep better at night too. Naps also help children to be more alert and observant during the day.

When it comes to bedtime, it’s very important to stick to a strict bedtime routine. Choose a bedtime and be consistent. This helps to regulate the body-clock and should help your daughter to fall asleep more easily.

Your bedtime routine should be quiet and consistent. This means having a quick, warm bath, then going straight from bathroom to bedroom, getting ready for bed, dimming the lights and reading a quiet story. After that, tell your daughter that it’s time to say goodnight. If you can get bedtime working, night-time will soon get better too.

During the night, it may be best to use the Gradual Retreat Programme, which you can read about in my previous articles.

Using this technique will gradually give your daughter enough confidence to happily spend the night in her own bed and not need reassurance from you.

Your daughter is also at the age where she may be naturally experiencing a separation anxiety phase. That may not be helping with this situation.

Q. We have a two-year-old, who for some reason has decided that bedtime is not for her!

About a week ago, and for no apparent reason (her routine had not been broken), she started climbing in and out of her cot. When we went to put her back she started screaming hysterically.

Now, when we do get her to sleep, after putting her back in her bed about 30 times, she will be fine until about 3am, then she starts again, screaming and getting out of bed.

We are at our wits end, and, with two other children who are good at going to bed, we feel we need some advice on what to do. The boys are very good but I feel like they are missing out on time with me and my husband because we are constant worrying about bedtime for her.

Mandy says

My first suggestion would be to move your daughter into a bed – all this trying to climb in and out of her cot sounds dangerous.

I would also consider putting a stairgate across her door. Make sure her room is properly child-proofed, and then you have basically made her room a large cot (and stopped her from running out all the time).

You should also make sure that your daughter is having enough sleep in the day (but not too much) I would suggest a nap after lunch of about an hour and a half.

Consider the Door Shutting Technique (see below) too, as this will deter your daughter from getting up. Taking her back, even though you are being consistent, may still be perceived by her as rewarding and reassuring.

Door shutting technique

During the day, explain to your daughter what the new rules are. Make sure she understands them

• When she comes out of bed in the evening or during the night, guide her back to the bedroom (DO NOT CUDDLE HER) and tell her to get back into bed. Let her put herself into bed. Do not go into her room, but shut the door as you explained you would earlier in the day.
• Keep all interaction simple; do not get drawn into conversations.
• Shut the door for 10 seconds.
• Repeat this each time she gets up, lengthening the time that the door is closed by 10 seconds on each occasion. Keep it closed for a maximum of 1 minute.
• If she is in bed, praise her from the doorway, but if she is out of bed, repeat the door shutting technique, leaving the door shut for an increased time.

In this way you are giving a message that having the door open is under her control: if she wants it open, she can choose to stay in bed.

• This will be particularly difficult in the early hours of the morning when the drive to return to sleep is not as strong as it is earlier in the night.
• It takes a lot of conscientious effort on your part but usually works within 7 to 10 days.

Be consistent, committed and realise that it might get worse before it gets better. Keep going and within a week, you’ll see big improvements (these will be especially obvious if you’ve been keeping a sleep diary).

Good luck!

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Millpond Sleep Clinic was the first private clinic to specialise in babies' and children's sleep problems. It now has a reputation as the UK's leading children's sleep clinic

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