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Patient Instructions/Care Plan Information
If you have any other questions about common sleep issues or how to address them, please let me know. Attached is a detailed care plan that includes more information about common sleep problems as well as some suggestions on how to address them. Good luck and thanks for choosing K for Parents!
What do I do if my child wakes up at night?
- Rule number one: do not to let your child sleep with you. Teaching your child how to fall and stay asleep on their own is an important life skill.
- Wait a minute or two before responding when they call out. They might surprise you, self-soothe, and fall back asleep.
- If they need reassurance, do so verbally and do not take them out of bed. Remind them verbally that it’s sleep time.
- If your child comes to you, calmly walk them back to their room without talking or engaging too much. Simply put them back into bed and remind them it’s time for sleeping.
- Avoid getting frustrated or upset with them. Reward them with praise in the morning for what they did well even if partial. Celebrate small successes.
What should my teen do if they can’t fall asleep or wake up in the middle of the night?
- If they can’t fall asleep after 20 minutes, it might be helpful to get out of bed. Bed should ideally be associated with sleep and not anxiety about sleeping.
- A light, nutritious snack or a glass of warm milk can help.
- Jotting down worries in a journal to remove concerns from their minds can also help. .
- They can also try a warm bath, relaxing music, or an uplifting, light book.
What do I do if my child just won’t let me go at bedtime?
Please, just lie with me for one more minute.’ Sound familiar? Many children have separation anxiety at bedtime. Here’s a few things you can do:
- Set expectations. Do not alter bedtime routine. Let them know exactly how much time you will be spending with them at bedtime.
- Give your child a replacement object such as a mommy or daddy bear that they can snuggle with. Alternatively, give them an article of clothing that smells like one of the parents.
- Make them a small photo album with pictures of the family to remind them they’re not alone.
- Draw a picture of the house, clearly showing where they’re sleeping and where you’ll be during that time. This helps them see that they’re truly never alone in the house.
- Never sneak out of the room at night. Tell them you’re leaving before they fall asleep, and check on them at designated intervals. They’ll learn that you always come back to check on them!
What if my child is still sleeping in my bed?
Here are 2 potential approaches:
- Gradually increase their distance from your bed (or your distance from theirs). i.e. set out a mattress next to your bed where your child can sleep, and gradually increase the distance from your bed (or vice versa)
- Play a game of ‘making believe’ where your child sleeps in their own bed. In this imaginary scenario, they’ll be ‘tricking’ the audience (you) into thinking they intend to sleep in their own bed (though they know this to be untrue). The child then goes through a full dress-up rehearsal- making their bed and getting ready to sleep in it. Parents set a time limit for the game, gradually increasing it night after night but never going beyond the stated time. By assuring the child this is a game, their anxiety dissipates, and they might even fall asleep. A new association with their bed and bedtime is being built!
What do I do if my child has nighttime fears?
It’s very common for children to be scared around bedtime. At night, a child’s imagination takes off as it processes the events, sights, and sounds of the daytime – and unlike daytime, there is nothing to distract them. Here are some tips for addressing nighttime fears:
During the day:
- Discuss specific fears during the daytime, not at night. For instance, help your child identify the shadows and sounds that make them anxious and then address those thoughts with rational, logical solutions. e.g. when your child hears the icemaker at night they might think it’s an intruder or monster. Challenge them to think about what it actually could be and then go investigate! Have them close their eyes and listen to the sounds of the house during the day and do your sleuth work then! (Do not suggest things that might be scary!)
- When they talk about their fears, empathize but don’t tell them they don’t need to worry!
- Separate the child from the worry. This lets them know worrying is a choice. For example say: ‘Let’s hear from worry. What does worry say? Then let’s hear what you think.’
- Avoid scary television and books
- Play in your child’s room during the day. This reinforces it as a safe, comfortable space and creates a positive association.
- Involve your child in making their room a cozy space for them
- Set up a challenge. Pick a goal for each week and earn a prize for staying in bed all night
At bedtime:
- Keep a small light on, use a nightlight, or keep the door to their room slightly open
- Distract your child’s mind at night with soft music, story-telling, or guided imagery.
- If your child is scared of shadows, have fun with shadows using a flashlight
- Create a book that explains in detail their bedtime routine and ends with them waking up happily in the morning
- If their fear is really intense, consider sleeping in their room (but not in their bed) for a couple of nights. When waking up in the morning, be sure to emphasize to your child that their room is safe and cozy.
How do I manage nightmares, night terrors, and confusional arousals?
Night terrors
As opposed to nightmares which happen closer to morning, night terrors tend to occur 2-3 hours after your child goes to sleep. A child with a night terror will wake up suddenly screaming, agitated, flush and inconsolable. They may seem as if they don’t recognize that you’re there and are usually unresponsive to calming efforts. In the morning, they won’t remember the episode. Night terrors tend to happen in spurts up to 3 to 4 times per week for a month or more and usually resolve on their own.
Confusional arousals
Similarly, confusional arousals tend to occur within the first third of the night in toddlers. They will sit up suddenly in bed, whimper or cry, and be resistant to efforts at consolation. Unlike night terrors, the child does not usually sweat or flush. Episodes can last up to 30 minutes. In the morning, the child wakes up as if nothing happened and does not recall the event.
Managing night terrors and confusional arousals
- Naps during the day can help prevent night terrors and confusional arousals since sleep deprivation can be a trigger.
- When these events occur, it’s best not to awaken the child since it can prolong and even worsen episodes.
- If your child snores or episodes happen multiple times per night, you should consult your child’s physician.
Recommended books for children with nighttime worries
Night Light: A Story for Children Afraid of the Dark by Jack Dutro
What Was I Scared? By Dr. Seuss
The Sleep Fairy by Janie and Macy Peterson
What To Do When You Dread Your Bed by Dawn Huebner
