Solutions to sleep concerns (12) – toddlers 1 to 3 years

It can be hard to know whether your toddler has a genuine sleep or settling concern. If your toddler’s sleep patterns are not affecting you or your family, and you have strategies that work, then there may not be a problem to solve. You know your child best, so if something worries you, seek advice from your doctor or a child health professional.

What “severe night waking” means#

The description below is a guide, not a diagnosis. Severe night waking is when your child does one or more of the following five or more times a week, for one or two weeks:

• Consistently wakes more than three times a night
• Consistently takes more than 30 minutes to settle
• Stays awake for 20 minutes or more after waking
• Goes into the parents’ or caregivers’ bed
• Has difficulties with sleep and settling that cause parents or caregivers significant distress

Responsive settling#

Parents are encouraged to respond to their toddler’s needs. Responsive settling means recognising when your toddler needs help and responding appropriately.

It is important that your toddler knows you are emotionally and physically available if they become distressed. Positive sleep environments and routines also help your toddler settle at bedtime and learn to self-settle. Every family is different, so choose a strategy you feel comfortable with and that suits your toddler and your family.

Parental presence#

This strategy uses your presence to help your toddler self-settle. Research shows it works, but it may take longer than other methods and is more demanding for you. You stay in your toddler’s room for about 7 to 10 days whenever they are awake, so they know you are there.

The key is to be present without interacting. The aim is to break the link between your toddler’s sleep behaviour and your attention.

To use this approach:

• Decide on an appropriate bedtime and start a positive routine, such as a warm bath and reading a book.
• Place your toddler in their bed or cot, preferably while still awake or drowsy. Gently pat them and say good night.
• Lie down on a bed or mattress in your toddler’s room with a night light on, and pretend to sleep where your child can see you.
• If your toddler wakes during the night and is distressed, make slight noises or movements (such as coughing or turning over) so they know you are there. If they become very distressed, soothe them with gentle words and touch, but try not to pick them up.
• After one to two minutes, lie down and pretend to sleep again. Repeat this every time your toddler wakes and is distressed, and use the same approach for day sleeps and naps.

Continue for about seven nights. After three nights in a row of minimal sleep disturbance, you can return to your own room. If your toddler’s sleep becomes disrupted again, you can reintroduce the strategy. If there is no improvement after two to three weeks, talk to your doctor or child health professional.

Camping out#

Camping out is similar to parental presence. It may suit you if you do not want to sleep in your toddler’s room but find it hard to leave them to cry, even for a few minutes. It may take one to three weeks before your toddler can fall asleep by themselves.

You will be more successful if you plan ahead and take time over each step. Begin the same way each night: decide on an appropriate bedtime, start a positive routine (such as a warm bath and a book), and place your toddler in bed while they are still awake or drowsy, then say good night.

Work through these steps in order. Each step may take two to three nights, and it is important that you and your child feel comfortable before moving on:

1. Sit or lie next to your toddler and gently pat or stroke them until they fall asleep, then leave the room.
2. Place a chair beside the cot and sit without touching. Let your toddler fall asleep before you leave.
3. Sit at gradually increasing distances from the bed or cot, letting your toddler fall asleep before you leave.
4. Eventually, place the chair outside the bedroom door.

If your toddler wakes, repeat the step you were using at bedtime to help them learn to self-settle.

Bedtime fading#

Bedtime fading can be used for older toddlers, from about 2 to 3 years. It is based on the idea of building sleep pressure by limiting time in bed. Your toddler does not go to bed until they feel naturally tired or drowsy, which can mean fewer night-time wakings.

• Record the time your toddler falls asleep each night for a week.
• Identify the latest time and set this as the temporary bedtime.
• Once your toddler falls asleep easily and quickly, gradually bring bedtime forward by 15 minutes every two days until you reach a preferred bedtime with minimal night-time waking.

You can also use this approach to make bedtime earlier if needed. To be effective, the method must be done correctly and consistently, and it will not be right for every family.

Moving from cot to bed#

Toddlers usually move from a cot to a bed between 2 and 3½ years of age, but this can be as early as 18 months. Make sure the furniture and sleep environment are safe, which matters especially if your toddler gets out of bed while you are asleep.

• Keep dangerous items (such as blind cords and power points) out of reach, and limit access to places where your toddler could fall, such as stairs or windows.
• Involve your toddler in the change. Tell them about the new bed and let them help set it up.
• Give plenty of positive encouragement to make the move exciting, such as praising them for being grown up.
• Keep a positive, consistent bedtime routine. Letting your toddler bring a familiar blanket from their cot may help them feel secure.

Moving to a bed can bring new bedtime challenges, and toddlers may go through a stage of calling out.

Dealing with calling out#

If a positive, consistent bedtime routine is not stopping your toddler from calling out, and this is becoming a concern, you can try one of the options below. Being consistent is essential.

Option 1: Returning your toddler to bed#

Use your toddler’s name and ask them to stay in bed. Speak to them only once. Each time they get up, return them to bed immediately, gently and calmly. Do not talk, make eye contact or reprimand them. Repeat this as many times as it takes. It may take many returns before your toddler stays in bed, so you will need to be very patient. This option may not be the best choice if it leaves you feeling angry or upset.

Option 2: Restricting your toddler to their bedroom#

Use your toddler’s name, ask them to stay in bed and not leave the room, and speak to them only once. If they come out again, calmly tell them that because they did not stay in bed, you will now close the door, and that the door will be reopened when they stay in bed. Return them to bed and close the door.

Stay near the door so your toddler is not distressed by it being closed. A child gate can also keep them in the bedroom, and a night light may help if they are afraid of the dark. Ignore any further calling out.

If there is no improvement after two to three weeks of these approaches, talk to your doctor or child health professional.

Key points#

• It is important that your toddler knows you are emotionally and physically available if they become distressed.
• Maintain a positive bedtime routine.
• Whichever strategy you choose, be consistent.

Where to get help#