Children’s Sleep

The following was written for a client providing some information about sleep routine for their sleep-deprived child and the way to establish a sleep routine. 

Re-establishing a stable and regular sleep routine with a two-and-a-half-year-old sleep-disturbed child takes some doing. That is what this children’s sleep program is designed to do. 

This programme was developed when I was a Social Worker/Family Therapist in the Psychiatry Consultation Unit at the then Adelaide Children’s Hospital in 1979 and first applied with my own two-and-a-half-year-old sleep disturbed son and subsequently used with other children.  

A great deal of work has been done on children’s sleep disturbance quite notably by Karyn France, a clinical researcher at the University of Canterbury in Christchurch, New Zealand.  

To do this program you need to allow 14-days – minimum.  

Some people do it in less than 14-days and I’m ok with that BUT if you try to do the program in less than 14-days you may sabotage yourself and the program – you may constrict yourself for time and impatient and that may impact directly on the child.  

The program takes longer the second time round – more like 21 days – and that is torture. 

You need to accept that continuous uninterrupted sleep is unusual for humans.  

We all have to learn and relearn how to have uninterrupted sleep many times in our lifetime.  

Children who automatically sleep through are rare – most children need to be taught this by their parents or someone else they are deeply attached to. 

Lily has not learnt or been taught how to have uninterrupted sleep and because she is sleep deprived, many of the behaviours and symptoms of concern to you may be caused, created or influenced by sleep deprivation. 

It is certainly true that the resolution of ordinary behavioural and emotional problems will be constrained by sleep deprivation. 

Sleep deprivation makes it difficult for an ordinary person to solve a personal or relationship problem. 

Sleep deprivation fundamentally alters brain biochemistry central to mood regulation. 

Good uninterrupted sleep has the effect of clearing the brain of ‘crap’ allowing us to feel good and feel good about ourselves. 

Our task with Lily is to teach her how to have good uninterrupted sleep so she can feel good about herself all the time. 

That may have an impact upon her interactions with each of you as her parents and it may impact on her appetite and eating behaviour. 

It may impact upon your ability to insist on her managing herself and her own emotions and eating properly. The whole thing is circular and feeds off itself. 

The entire routine takes several hours each evening and must be set up properly and followed to the letter. 

The more you deviate the longer it will certainly take. 

Lily is two and a half and requires between 11 and 12 hours sleep per day. She will require one nap per day. That the nap is important and will contribute to her having good uninterrupted sleep at night. The removal of the nap is discouraged. That nap may have a major positive impact upon her sleeping routine. More and better sleep begets more and better sleep. 

To have the best chance of achieving a positive outcome, the program is best undertaken with a minimum of two people. It is best to do the entire programme in a single location over the 14-day period rather than having Lily move between different locations. 

If it is possible for Jim to do this at your house, then that would be best.  

From there we can look at how it is transferred from your house to his house and any other location we need to consider.  

This is all best done after the first 14 days. 

We can then work out how easily Lily’s sleep routines are disrupted and what we need to do to restore those routines and how firm we need to be with her. 

One important outcome is to ensure Lily never becomes sleep deprived again. 

We know the negative outcome for Lily in terms of behaviour, emotions and cognition. 

An entire routine for the evening needs to be established around a relatively inflexible bed time – say 7:00 p.m. 

I am at ease about the time you choose provided the length of her sleep conforms to what two in a half year old child requires 11 -12 hours per day. 

If it is 7.00 p.m. the sleep routine process commences at least one hour earlier and includes bath and dinner and whatever happens after dinner and before bed 

The whole process needs to be highly ritualised. 

Going to bed and going to sleep are integral to a contextualised and lengthy ritual, they are not a stand-alone piece. 

When she wakes up at night the ritual is re-established in an abbreviated form to get her back to sleep as fast as possible. 

The ritual will offer very tight control over the language you use and the exact words you say to Lily in each of these processes. This is especially given the fact that she’s bright and will contest all sorts of things with you. 

In terms of the sleep routine, it’s best that the least engaged person or parent with the child is the person or parent who takes control of this part of the process. It means that the more engaged person or parent must actively support and back up the person or parent doing the job with Lily. 

Lily’s bed needs to be set up in a specific location away from where the adult or adults sleep, preferably a separate room. Put a comfortable chair alongside her bed. Establish the exact words and phrases you will use when you take Lily to the bed and put her into bed and insist that she stays there.  

“Lily, you are going to bed – you are going to stay in bed – you are going to bed – because I love you and because I say so.” 

You need to use the same script with Lily– over and over and over – without deviation. 

It must not include any long explanation – the best explanation is “because I say so” and “because I love you”. 

It must not include any negative emotion of any kind including frustration, anger or disappointment. 

It must include the regular use of a positive affirmation; that you love her and want the best for her. 

The truth is you are doing this because you love her. 

You know better than Lily. 

Establish a pre-bed routine which Includes quiet, de-escalating, rituals, including a story and things that quieten, settle her and comfort her. Make a 100% decision that there will be no access to electronic technology from 5:30 p.m. Electronic technology mimics sunlight which interferes with the natural production of melatonin in the human body and brain. Melatonin is central to sleep and most adults experience melatonin kick in sometime during the evening which is when they feel sleepy and drowsy 

For children melatonin kicks in earlier. 

For adolescents melatonin kicks in later 

We want to establish rituals and processes that don’t interfere with Lily’s body doing its own right and natural business. Serotonin is the chemical in the brain that makes us feel up and good, happy and expansive and generous. Melatonin is the chemical that makes us feel drowsy and sleepy. 

Give Lily enough notice she is going to go to bed, in say 30 minutes and regularly reinforce this every 5 minute or so. Do this gently, kindly and benignly, without any anger or frustration of any kind no matter how you feel about this and about her. Sleep deprivation in children produces emotional dysregulation in that child that can in turn produce emotional dysregulation in the adult. The emotional dysregulation in the adult must not be ignored or underestimated. 

Both parents can be equally engaged in the pre-bedtime rituals or this can be reversed. The more engaged parent can do the pre-bedtime rituals with Lily. The less engaged parent takes over when Lily is about to be put to bed. 

Only use the agreed script. 

Put Lily into bed, sit in the chair alongside the bed and repeat to her the exact script that was agreed. e.g., “Lily you’re going to bed and you are going stay in bed because I said so – I love you. “That script is repeated, over and over and over, no matter what Lily does. When she attempts to get up or get out of the bed, just gently put her back down into the prone position, put your hand on her and say, “Lily you going to stay in bed because I say so – I love you”. The parent stays there, sitting alongside the bed, in the chair, awake until such time as Jemima goes to sleep. 

You may have to repeat this 20 or 30 times – who knows? 

Once Lily is asleep and the parent alongside in the chair is genuinely satisfied, she is fully asleep that parent leaves the room, to be greeted by the other parent who will have prepared something special to reward them for having undertaken an especially difficult and emotional task. 

The first step in this process may take a long time, especially if Lily is seriously sleep deprived and determined not to sleep. Your determination as parents to engage with her about staying in bed and sleeping must be greater than Lily’s determination. 

If she wakes up in the night, then the same process is entered into once her immediate requirements (nappy change etc.) are attended to. 

The same process is entered into on the 2nd night and so on. 

Then comes the process of moving the chair. 1-metre at a time every second or third night and not changing anything else. The movement of the chair toward and out of the room depends a great deal on how well Lily is sleeping. Once the chair is at the door it must remain there for 3-nights before you move it outside the room and outside the door. 

This entire process takes infinite patience.  

Communicate with me by email a minimum of twice per day for the first week then we will work out the next part of the process.