Night waking in babies and children are a frequent concern for parents. They can be so confusing when they are happening! Night waking is a normal biological occurrence that takes place in everyone in babies up through adulthood. As humans we wake up anywhere from 2-6 times every night. The only reason it may seem to become a problem is if you or your child is unable to fall back asleep unassisted. Biologically babies have shorter sleep cycles and they are most likely to have a waking at the end of REM sleep, the most active sleep state.
We have established that night waking is “normal” in babies, children and adults but what are the reasons that a child will have difficulty falling back to sleep?
Negative sleep associations are the most common reason that a child is unable to fall back asleep on their own. Examples of negative sleep associations are: rocking your baby to sleep, nursing to sleep, rubbing their back, holding them, singing to them etc. Anything that is present in your child’s sleep routine that is in their environment as they fall asleep, needs to be present if they wake up in the middle of the night in order to fall back asleep.
Night time fears and separation anxiety is another common reason that toddlers have a hard time falling back to sleep in the night. This is occurs often in children age 18 months-4 years old.
Nightmares are scary dreams likely to occur in REM sleep, and they typically take place after a child has been sleeping for several hours. If your child has a nightmare she/he will be able to talk with you about it and then after some time fall back to sleep.
Night terrors start around 4 years of age and can persist up until age 12; this usually occurs in non-REM sleep about two hours after a child falls asleep. Night terrors look like your child is anxious, sweating profusely, they may scream out loud, heart rate is pounding and they are inconsolable in a dream-like state. These take place more often when a child’s routine is disrupted, during illness (fever), vacations, holidays and poor sleep schedules. If this persists for an extended period of time, consult your child’s pediatrician.
Over-tiredness tends to cause night awakenings as well. If a child has poor naps or goes to bed too late, you can expect their night time sleep to be fragmented as well. When young children are overtired their sleep drive is further strengthened and wakefulness takes over their sleep drive making it harder to stay asleep.
GER (gastroesophageal reflux). Children who suffer from gastroesophageal reflux may experience frequent night awakenings in infancy and as they get older. If you think your child may suffer from GER, consult your pediatrician for treatment options. My daughter experienced this when she was an infant and with the proper medication, started to feel much better in a very short period of time.
Snoring or loud nose breathing can cause frequent night waking as well. Sleep disordered breathing can cause serious health problems. If you believe your child suffers from sleep disordered breathing, consult your physician.
Now that we have covered the “why” for night awakenings, let’s review some things you can do as a parent to help decrease the likelihood of night waking.
Ensure your child is getting enough sleep. Prevent over-tiredness in your child by making sure they go to bed at a reasonable bed time (6pm-8pm the latest) and take their naps consistently at the ideal sleep times (8:30/9am, 12-1pm). If your child does not nap anymore, then make sure they are going to bed earlier to make up for the lack of nap.
Set an appropriate bed time. Often I think parents put their children to bed too early when they aren’t tired enough to fall asleep. Make sure the bed time is really appropriate for your child by watching their behavior more than the clock. You want bedtime to be stress-free and peaceful for everyone. If your kid is fighting you constantly then look at their schedule. Maybe bed time is too early or too late?
Create a solid and consistent soothing routine. Children thrive on consistency and routine. Make sure you follow the exact same sequence each night before bedtime to decrease any anxiety in the process for your child and instead make it a peaceful process. The soothing routine can be anywhere from 15 minutes up to 30 minutes (longer with a bath) and it may look like this: 3 books with a light snack, brush teeth, go to the bathroom, sing songs, go to bed.
Eliminate any negative sleep associations. It’s never too early to eliminate negative sleep associations such as rocking, nursing, bottle, holding etc. Try to make the bed time process as simple as possible for you and for your child. The goal should be this: Give a hug and a kiss, say “good night I love you, sleep well” and walk out of the room. If you need to do more than that to get your child to fall asleep on their own, then you may need to start sleep training!
Talk to your child. If your child is having excessive night waking, talk to her/him in the light of day often about what is going on at night or in their day. Maybe there is added stress or anxiety about something taking place in the home or at school. Maybe there is underlying anxiety the child can’t articulate yet, but talk to them and explore the possibilities.
Talk to your child’s pediatrician if you have tried all of the above in addition to sleep training and things have not gotten better within a few weeks.
Night awakenings can be very stressful for parents as well as for children. Try and rest assured that they are very common during the first few years of life. In most cases with some specific intervention, they decrease over the course of a few weeks. If you feel like you are reaching the point where you have tried everything and are still not seeing progress, do not be ashamed to talk to your doctor, a child sleep consultant or a child psychologist that specializes in sleep disorders if your child is older.