20 November 2007

Helping an anxious child get to sleep

Rachel has a lovely, gentle way to help her anxious daughter prepare for sleep:

My first grade daughter has recently begun having anxieties about bedtime. She lays down and remembers all sorts of bad thoughts about the day, which tend to increase her anxiety and make her scared to be alone to sleep.

To get her mind in a more positive frame, we’ve begun having her tell us one thing she’s thankful for about her day for each step up the stairs on the way to bed. She stands on a step and names the thing, while I stand next to her and stroke her head or some other comforting physical thing. The combination of the positive thoughts with the reassuring touch helps her be in a much better frame of mind by the time we get to bed. If then she remembers something negative about her day, I listen, but don’t let her dwell on it. I remind her of all the good things that outnumber the bad thing, and say we’ll talk more about it tomorrow. It’s a simple thing, but doing this on our way up the stairs has greatly lessened her nighttime anxieties, and hopefully it will help any other parents who are also dealing with a similar situation with their children.

This is wonderful. I believe that positive thinking is a trait we're born with, and those who aren't must explicitly learn how and be reminded to do it (see my Gather.com "nature vs. nurture" article, Was the slate ever really blank?).

We encourage lots of deep breathing at bedtime. Another trick that helps overcome my kids' resistance to settle down is to have them "pretend" to go to sleep. They think it's fun to pull one over on me by closing their eyes and lying still, but after a few minutes, their natural fatigue takes over.

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i'll have to remember that for later, but for now my 2-year-old takes an hour - sometimes more - to go to sleep. anyone have any suggestions for that? we've started "yoga" before bed and no tv and moving bed times around and so far, i'm laying there with her for an up to 1.5 hours a night, waiting. yeah, it's driving me a little batty! :-)

To Maya, fwiw:
My daughter used to take up to two hours to fall asleep when she was two - until I stopped lying down with her. At first lying down with her helped her to fall asleep faster but then she started forcing herself to keep awake for longer and longer stretches, just for the delicious coziness of being with Mommy. To say the change "met with resistance" is putting it mildly, believe me, but when I stopped lying down with her magically in three nights she went from taking 1.5 to 2 hours to fall asleep to taking 3 to 5 minutes to fall asleep.

I love this tip and I love the "pretending to sleep" thing. I'll have to store them away for future use. Right now my almost 2 year old goes to sleep without any struggle. We just put her in her crib and she'll lay there for a few mins and then falls asleep. I'm not sure why this is so easy for us... she's difficult for everything else.

For the previous commenter, my only suggestion (if you're not already doing this) is to have a regular bedtime routine like: jammies, brushing teeth, reading a book or 2, having a stuffed animal to cuddle with and then off to bed.

Only thing I would do differently is that I wouldn't stay in the room waiting for them to fall asleep. I'm not an expert, but maybe your child is staying awake simply because you are there? You could try laying there for a minute till they get settled, then maybe stand by the door for another minute, then make your way out of the room. Hope this helps.

Ah yes, therein lies the rub.

We've been cosleeping with her since she was 5 months old because I got tired of getting up to rock her when she woke up every 30 minutes. She's always had trouble with sleep. She occasionally still thinks 4:50am is an appropriate time to get up in the morning.

We do have a routine, etc. A few months ago I started putting her into the crib to go to sleep because I had had enough. Then I'd transfer her to our bed when she woke up the first time. That worked really well for about a week - then she still went to bed well, but started having night terrors, sometimes more than once a night (this was usually at 3am or so, after I'd put her in our bed, not while in the crib). Once I stopped putting her to sleep in the crib, the night terrors stopped. I guess Dr. Sears woudl say she's a "high need" kid.

I've thought about trying again - except she can climb out of her crib now. She's a determined little girl.

Thanks for your responses. You're both right, I'm just not sure it'll work for her.

The "positive thoughts" conversation has helped a lot with my 19 month old. I have started (again) having a tough time putting him down for bed, similar issues as you, Maya. So I have been sitting with him in the rocker in the dark and talking about all the good things that happened during our day, as well as describing all the fun we'll have the next day. He sits there and echoes every word he knows, and eventually runs out of conversation and dozes off. Sometimes getting him into his crib works, sometimes it doesn't.

Maya, it's maybe a longshot, but check out sensory hyposensitivity or sensory integration dysfunction as well. There's a whole spectrum of function levels, and IMHO, they're largely normal not 'dysfunction' - but it does mean that some kids need different stimulation to get their bodies to calm down, compared to others. If you provide it before bedtime, they settle more easily, if you don't, they will strive to stimulate the system themselves - often by tossing and turning, rolling, fidgeting, etc. (This is one of the places our mini-trampoline comes in very useful - granted, they're not entirely 'safe', but if you have a child who needs that extra stimulation to settle, it's WELL worth it!)

For example, we JUST figured out that R (one of the twins) is vestibular hyposensitive - that is, her vestibular system (including large and small motor coordination, balance, position, and rotation) doesn't communicate well with her brain. She'll nap fine at school (where she's been having a lot of vestibular stimulation all day) but at home, it's free play (often art), dinner, and bed. At that point, she needs some large-muscle-group stimulation to help her settle down. A firm massage with some leg bending and arm bending (flex and extend), (which would totally wind UP my oldest) helps her calm down and settle.

So that's another avenue to explore if it is persistant - cosleeping can be a factor, but it might not be THE factor. (We still cosleep, and the sensory processing plays a bigger role than the cosleeping, for our kids.)

Another anxiety-help for our kids is to just kind of change the mental track - when the one with the clinical level anxiety has trouble getting to sleep after a challenging day, and it's clearly 'too much thinking' and not 'a need to move and bounce and roll and touch and crawl and dance and stand on head and somersault and sing LOUD and be rocked and ...' (aka sensory issues), I just ask her what she is going to dream about, and give her prompts for things that she might really enjoy. The main one, for her, is: "Are you going to dream of fields and fields of flowers? Beautiful gardens of flowers of all colors, that are *all* yours and all there for you to pick - as many as you want, as long as you want to pick them?" (She loves gardens, but public ones don't let you pick the flowers apart.) She'll nod, close her eyes, and settle in with a small smile on her face with that suggestion.

I love the stairs one, though. That's *really* nice.

The book "The No Cry Sleep Solution of Toddlers and Preschoolers" has a LOT of great tips and helpful information. We went from several hours to get our daughter to sleep to just under a half an hour. The book isn't very expensive - especially if you get a used one on Amazon, and it REALLY helps in a gentle way with an emphasis on being tear-free - FOR EVERYONE!

Maya,
My daughter (now 4) co-slept with us for the same type of reasons (namely, I needed sleep more than I needed her to be in her own bed). She's always had trouble with sleep, and still asks us to cuddle with her once in a while. One thing that helped with the length of time was this: If she was squirrelly and not settling down, we would tell her "It seems that you're not ready to lie quietly; I'll come back to snuggle when you're settled down." Then we would leave the room for a minute or two. Sometimes she would still take a while to calm down, but most nights she settled down. This broke the cycle of "her wanting to snuggle, me getting upset because she wasn't settling down and going to sleep, her realizing that I was upset and getting upset herself, thus leading to even greater need for snuggling to prove that I wasn't mad at her... etc."

As for the happy thoughts before going to sleep, I'm currently trying this because she's started having disruptive dreams (not quite nightmares, but upsetting nonetheless). I think it has to do with her closest friend moving away, but I hope this helps as she works through the loss of her friend.

I tried "Snuggle Down and Say Goodnight" cd (recommended here on Oct 6, 2006) for my restless nearly 4yo. It took about 2 weeks to et her conditioned to it, but now I start it at the story, and she is usually asleep before the music starts.

I have thought of sensory and similar issues. We got her a toddler trampoline for her birthday and she loves it. She seems to have gotten both her parents' worst sleep issues - my fidgeting and inability to fall asleep easily and my husband's waking up early.

She's getting to the age where she really understands what you're saying and where explaining things to her really helps. Yesterday I figured out what I did wrong the last time (nursed her in the bed then got her up to put her in the crib - so mean of me! How did I not see this?!) so I'm trying it differently this time. We're nursing/rocking a bit in the rocking chair and I'm talking to her and going through the whole process with her and telling her how brave she is and how proud I am of her, etc. Then she goes in the crib. Then once she's asleep, I come right in and put her in the bed. I did that for the first time last night and it went really well - she was asleep inside of 10 minutes! And I got some quality time with my husband before we both had to work on other things (him = school/work, me = work).

If she starts having night terrors again, I will stop doing it this way and will start looking for other answers again.

Thanks everyone for your input. It's nice knowing other have had similar issues and made it through successfully.

My daughter is 2 1/2 and wakes up around 5:30am sometimes earlier and sneaks into our room. I have no idea how to break this habit. She says shes scared? Is there a chance shes having a nightmare EVERY night? I put her back to bed but she screams and comes out of her room.. its tough when I get up at 6:30. Now I apparently get up at 5:30..
Any suggestions?? Anyone?

My son has anxiety and sensory issues. He has always struggled to settle down, even when he is exhausted. He also gets up CRAZY early. The only thing that seems to help is a routine. When he knows what's coming, or what's expected, it really reduces his anxiety.
As for waking up in the morning, when he was 2 and a half, we put a clock in his room. (he is 3 now) He knew his numbers by sight...so we told him that he could only come out of his room when the first number was a six. So when he woke up earlier, he would look at the clock (which also works as a night light) to know whether he could get up, and when he saw that it was 6 he would get out of his room. This also gives him a sense of responsibility, and control.
He will still wake up earlier than that fairly frequently, but he will simply talk to himself and play...but stay in his room.
Before he was old enough we resorted to the safety knobs...so he couldn't leave. I didn't like that as much, neither did he.
We have also begun incorporating calming music, and have plans to paint his room a more sedate color.
He's old enough, that he does know that there are certain things that it's okay to get up for...if he's scared, or doesn't feel well, or needs a kiss, or a drink, or needs to be tucked in. (of course we go through a number of these before he finally settles down) But, then he feels secure that he's not trapped in his room, and he eventually calms down...generally within 15 - 20 minutes.

When my grandson was troubled with bad nightmares, I used to tell him before bed what sort of dream he was going to have. I'd tell him a lovely dream about dancing with mummy (he *loves* to dance with his mother) and I'd tell him that if any Aah Monsters came to bother him while he was dancing with mummy, he could just tell them that they had to wait their turn. He loved the idea of the Aah Monsters trying to dance with mummy. :-)

Then his mother would go in to say goodnight, and she'd tell him that she was going to dream of dancing with him, so that they would both be having the same wonderful dream at the same time.

It didn't work forever, but it did work for a while.

We also pointed out to him that if the Aah Monsters got too close, he should try to wake himself up, because Aah Monsters can't get out of the dream, and once the dreamer is awake, the dream dries up and blows away, taking the Aah Monsters with it. :-)

One of the ways my mother dealt with monsters was logic. I'm old enough that there were lots of children in and out of each others houses up & down the street. Different families with different mealtimes, bedtimes, rules.

When my younger brother claimed to be frightened of the monsters in his room, my mothers simply told the monsters that their monster mommies called and said come home right now. Then she'd tell them goodbye. Basically, my little brother couldn't maintain any monsters were there, their mommies had called them home, our mom had sent them. End of story. I think he tried once or twice to say one or two had hidden & stayed behind. Well, THOSE monsters got in so much trouble that they were GROUNDED by their mommies, so they never would do that again.

For my girls, we used monster spray. (Water in a plant spritzer.)

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