Suddenly, My Toddler Won't Sleep - Advice w/ Dr. Lynelle Schneeberg

Photo: William Fortunato

We are fortunate to have with us the incomparable, Dr. Lynelle Schneeberg who, along with all of the official accomplishments listed at the end of this piece, is a guru of sorts when it comes to children and sleep.

Thank you Doctor for making time to educate us!

Sleep Regression, or Just a Bad Night?

Photo: Pavel Danilyuk

DontPlayWithThat.com (DPWT): For the most part, people associate sleep regressions mostly with children under 2. Though, obviously, sleep regression is technically possible at ages above 2 as well.

How can a parent assess whether a child is having a true sleep regression?

Dr. Schneeberg: A regression will last longer than a night or two, so that's the easiest way to tell.

It's quite normal for a child's sleep to get worse briefly, here are some examples for when happens:

- after the child recovers from an illness. 

- after the family stayed all together in one space when traveling. Kids usually want to keep that party going when the family gets home again and may resist going to sleep in their own bed.

- when the child was transitioned from the crib to a toddler bed.

- when there was a recent change in the family. For example: a loss, an illness, the arrival of a new sibling, and so on. 

DPWT: Are the methods you advise applicable to a total sleep regression as well?

Dr. Schneeberg: Yes, no matter what, I like to see a parent help a child gently learn to self-soothe and fall asleep more independently.

DPWT: After the age of 2, in which cases do you see sleep regression most?

Dr. Schneeberg: I see it most often during the crib to bed transition. This often causes quite a difficult sleep regression.

Child Is Afraid To Sleep Alone

Photo: Karolina Grabowska

DPWT: What, in your view, are the main reasons why a child is having difficulty falling (and staying) asleep?

Dr. Schneeberg: In my view, there are two. One reason why a child may be a poor sleeper is if parents provide a bit too much help to get the child to sleep.

If a child needs a parent's help to get to sleep, it can take the child a long time to fall asleep (because the child may worry that the parent might leave before the job is done) and the child may need a parent's help again after a night-waking.

DPWT: What is your advice to parents that wish to mitigate this problem?

Dr. Schneeberg: Helping a child become a great sleeper is almost always about gently helping a child learn to drop off to sleep more independently, and doing some gentle limit setting at bedtime.

DPWT: How long would you advise for a parent to stay in the room after the bedtime routine has been completed?

Dr. Schneeberg: If the child is accustomed to a parent staying until the child is completely asleep, I would recommend having them give their child "something to do" in bed until the child is drowsy and then working their way out in steps over days/weeks (by sitting in a chair that moves closer and closer to the door, for example). 

If the child is not used to having a parent stay, I would recommend that the bedtime routine have a clear endpoint such as finishing the last book, giving a final kiss and hug and leaving.

DPWT: Are there any examples where you would make an exception and advise a parent to stay around longer e.g. illness or tantrum?

Dr. Schneeberg: Yes, a parent can always stay nearby if the child is sick. If the child has a tantrum, the parent can stay nearby calmly until the tantrum is over and then finish up the bedtime routine.

DPWT: Any advice for a parent that must stay in the same room due to space constraints?

Dr. Schneeberg: Yes, I'd recommend that each person have their own bed, if possible. Most parents and kids get more quality sleep this way because children are very restless sleepers.

DPWT: Is there any emotional tidbit you can give to a parent who has a hard time "tearing themselves away from their kid?"

Dr. Schneeberg: Yes, I'd tell them that every child benefits from a cozy, comforting and consistent routine with a clear endpoint and then learning how to fall asleep more independently.

If a parent has a hard time tearing themselves away, they may end up becoming a "sleep crutch" for their child and then the child will have a hard time falling asleep without that parent staying each night until the child is deeply asleep. The child is likely to need help getting back to sleep at night as well. 

How To Keep a Toddler In Bed

Photo: Keira Burton

DPWT: What was the second main cause of trouble in children's sleep?

Dr. Schneeberg: The second reason why a child may be a poor sleeper is if parents do not have a good way to limit the extra requests after lights out that all kids like to make.

If a parent doesn't have a gentle, reliable way to limit these, there will often be a lot of stalling around bedtime.

DPWT: Do you have any practical tactics to help solve this problem?

Dr. Schneeberg: I recommend two things to help with these goals:

- Giving the child a little "bedtime basket" (a basket with a book, toy or drawing pad) and a reading light. 

The child can use this after the routine is over until they are drowsy enough to get to sleep on their own. This is a much better choice than a screen.

- Using "bedtime tickets" to limit stalling and a zillion extra requests after lights out. 

These are tickets (which can be made out of index cards or post-it notes, for example) that a child can trade for "one more thing" after lights out. I usually recommend giving a child two tickets when the routine is over. Once the tickets are gone, the parent wouldn't grant additional requests and would remind the child to use their basket until they are drowsy enough to fall asleep. For more explanation, see this piece. 

DPWT: Should any item be completely barred from the basket, due to how distracting it is from bedtime? 

Dr. Schneeberg: Yes, I like to have parents include quieter activities such as books, picture books and drawing pads into the basket. 

DPWT: On that note, are there any tasks a parent should refuse, despite the spending of a ticket?

Dr. Schneeberg: Yes, parents should refuse any request that takes more than about a minute and should refuse serving the child more food since the bedtime routine should have a bedtime snack as the first step anyway.

I worked with a family whose child wanted to use the ticket to order a take out pizza! (Not such a great idea at bedtime...!)

DPWT: So, do you give the green light for the child to play in their room for a while, so long the lights are off, a parent isn't involved and the items come from the basket?

Dr. Schneeberg: Yes, this is exactly what a parent can aim for: a cozy, comforting and consistent bedtime routine with a clear endpoint and then a child who can settle themselves into sleep independently by using the basket items until drowsy, just the way older kids read themselves to sleep.

Screens Before Bed

Photo: Harrison Haines

DPWT: As of the last few decades, screens have been shouldering a lot of the blame when it comes to bedtime woes. In your professional opinion how much sleeping trouble stems from watching too much?

Dr. Schneeberg: A sudden difficulty with sleeping would likely not be due to screen use (unless screen use was just introduced/allowed).

With the same token, how much screen time the child has had will not cause a sudden difficulty sleeping (again, unless this was a sudden increase).

DPWT: Generally speaking, how much screen-time is too much?

Dr. Schneeberg: I recommend: 

-  having no more than two hours of screen time a day if possible

-  blocking the blue light on all screens from dinnertime on.

-  turning off all screens one hour before bedtime. I think it's harder to transition to bedtime mode if screen use occurs just before bed. It's even hard for an adult to turn off Netflix and get to bed on time! 

DPWT: Is disturbing content something that should be avoided before bedtime?

Dr. Schneeberg: Yes, I think that frightening or overly exciting shows would ideally be avoided before bedtime.  

DPWT: How much do the night modes on electronics make a difference?

Dr. Schneeberg: Blue light blocking modes on screens are always recommended after dinner since blue light can make the brain think that it is still daytime.

What a Child Should Eat Before Bed

Photo: Charles Parker

DPWT: Now for a quick lightning round.

Sugary foods: How much of a role do they play in a child not sleeping?

Dr. Schneeberg: I recommend that the bedtime snack not be too sugary. Sugar can cause a burst of energy and that's not what any parent wants around bedtime.  

DPWT: How much time would you advise between the consuming of an extra sugary food and sleep?

Dr. Schneeberg: at least an hour, I'd say.  

Dr. Schneeberg: I like to recommend something like yogurt or nut butter on toast, for example. These snacks have a nice mix of carbs and protein and a snack is best about a half hour before sleep. 

How Long To Nap

DPWT: To which extent do long naps affect nighttime sleep?

What is the Ideal length of a midday nap for a child over 2 years old?

Dr. Schneeberg: "Sleep begets sleep" we always say in the world of sleep medicine. I'm not a fan of giving up a child's naps to improve their sleep at night.

A long nap does not usually lead to bedtime issues as long as the child can fall asleep independently. If they can't, a long nap can indeed lead to more bedtime resistance. Most 2 year olds nap an hour and a half to two hours.  

Travel Ruining a Child's Sleep

Photo: Oleksandr Pidvalnyi

DPWT: Travel/change of scenery/: Are there any ways to mitigate the sleeplessness that results from these things? What are they?

Dr. Schneeberg: A consistent routine used at home or on the road is always helpful to cue reliable sleep. 

How To Calm a Child's Nightmare

DPWT: How to calm the little one back to sleep after they've had a nightmare, without them growing too reliant on the parent?

Dr. Schneeberg: Gentle, brief reassurance without any discussion of the content of the nightmare is best. Remind them that all kids have nightmares and that they are always safe in their home.  

How To Block Night-Time Noises and What is White Noise

DPWT: Should a parent introduce a white noise machine in the case of sleeplessness?

Dr. Schneeberg: A white noise machine can be used if a parent would like to use this but the white noise machine only is almost never the "magic bullet" that causes a child to become a great sleeper. Helping them learn to fall asleep more independently usually is the answer.

DPWT: Any advice for masking a disturbing noise coming from outside the home?

Dr. Schneeberg: A floor fan usually masks more noise than a white noise machine if there are very loud noises such as construction.  

DPWT: Thank you Doctor! We wish you further success in your career!

Dr. Lynelle Schneeberg, PsyD is a Fellow at the American Academy of Sleep, an Assistant Professor at the Yale School of Medicine and a Licensed clinical psychologist. She recently authored: Become Your Child's Sleep Coach: The Bedtime Doctor's 5-Step Guide.