There is a lot of writing online about how to get your baby to sleep through the night during infancy but not as much expertise to help those of us with toddlers and preschoolers who wake a number of times. Between age 2 and 3 when O was released from crib jail and moved to a big bed, he’d come to find me a couple of times a night. I’d often awake (and startle) to find him standing next to my bed! I tried many things to improve his opportunity for a full night’s sleep yet for those kids who never quite figure out that sleeping through the night starts around 7 or 8pm and ends with the sun coming up around 7am, we want to help. Recent data shows that 1 in 5 infants who have trouble sleeping may continue to have challenges during the toddler years. Clearly challenges with sleep that span multiple years affect many of us.

I turned to a pediatric sleep expert for help. Dr. Craig Canapari is a doctor I met on Twitter (of all places) who answered questions surrounding sleep challenges for toddlers. Dr Canapari is a father to 2, a pediatric pulmonologist & sleep expert, and is thinking of starting a blog! He told me that when he was a kid he, “definitely did have problems falling asleep sometimes,” so not only is he an expert, he’s experienced! Check out his responses here and leave comments and questions — I’ll get him back on the blog to respond as needed.

Why does my toddler wake up at night?

Every parents has experienced the dreaded 2 AM call. You hear your little one stirring on the monitor. Either you wait, fingers crossed, to see if they go back to sleep and they don’t, or you run in there as fast as you can to stuff the pacifier in their mouth before they really wake up. Most babies are capable of sustained sleep (6-8 hours in a row) at night by age six months. If you are nursing your child, it may take them a bit longer to achieve this. I think that it is reasonable that every child should sleep through the night most nights by 9-12 months of age. Now, every child wakes up sometimes at night. I view the awakenings as a problem if they are more than a few minutes in duration, occurring multiple times at night, or resulting in significant daytime irritability for either the child or the parents.

If your child is having problematic nocturnal awakenings, there are a few possible causes:

  1. “Inappropriate” sleep onset associations. This is the classic sleep disorder of childhood described popularized by Dr. Ferber. Your child falls asleep under conditions that aren’t present later in the night (that’s was “inappropriate” means here). For example, you are rubbing his back or holding her; she is nursing; he has a pacifier in his mouth.  During the night your child cycles through deeper sleep, lighter sleep, and then may wake up for a minute or two every few hours. If the conditions aren’t present (e.g. she’s not in your lap) she will cry out until you go back in and pick her up. You fix this problem by teaching your child to fall asleep on your their own by having them go to bed drowsy but awake. Sometimes, moving their bedtime later by 30 minutes may help with this process. They may fuss for a night or two but the awakenings should go away in a week.
  2. Learned hunger. This occurs in children who are drinking a bottle or two of milk or nursing for prolonged  periods at night. They are conditioned to expect food at night so they wake up looking for it. If your child is over one, healthy, and feeding multiple times at night and requiring diaper changes, this is likely your problem. If your child falls asleep eating or nursing you may have sleep association issues as well. I recommend reducing the volume of the bottles by an ounce or increasing the intervals between nursing by an hour nightly which should address this. Going “cold turkey” is hard because your child is actually hungry and you need to wean them off this.
  3.  Medical disorders. Many common medical problems are overlooked as a cause of sleep disruption. If your child coughs frequently at night they may have asthma which needs to be treated. Acid reflux can be associated with belly pain and vomiting at night. Obstructive sleep apnea is a very common problem associated with snoring which can disrupt sleep. I would definitely recommend seeing your pediatrician about any of these concerns.
  4. Environmental factors. These tend to be obvious. Is there a TV on in the room? If so, please take it out of there! Is there loud noise from neighbors or the road  outside? Does the child share the room with a sibling or parent who makes a lot of noise? A white noise generator or fan can be useful in these circumstances. If the room is hot or cold (>75 degrees or less than 60 F) it can also be a factor.

Do you think these four explanations are sensible for your toddler? What have you done that has ended the dreaded overnight awakenings?

Dr Canapari will offer tips to mitigate early morning awakenings for toddlers on tomorrow’s post.