My Toddler Keeps Waking Up at Night—Help!

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Liberty, Liberty, Liberty, Liberty. Welcome to Toddlers Made Easy. I'm your host, Dr. Cathryn Tobin, and today we're going to be discussing one of the most challenging parts of parenting: why night wakings happen and how to fix it. In other words, we're going to talk about why do kids wake up in the middle of the night and what you can do about it. Now, there was a time in my life when I thought I'd never get sleep again, but my husband and I, we learned from our mistakes, particularly with our second child, and we got the kids into some good routines after that. Now, when you understand the mistakes you're making and how to fix them, you don't need reward charts or locked doors. Or even tears. So I want to share a story with you about our biggest sleep mistake. I call this the Marissa story. I visited my parents in Florida when my daughter was about 9 months old. So this is a long time ago. And my husband and my son, my eldest, stayed home. Marissa was my second child, but it always felt like she was my first child because there was 10 years between her and her older brother. I called them my before and after medical school kids. On the first night of my visit, as I was putting Marissa to bed, I was rocking her to sleep when my mother looked at me and said, what are you doing? And I said, I'm putting Marissa to bed. And she asked, well, why are you rocking her? And I said, that's the only way she'll fall asleep. Believe me, I've tried everything. Well, my mother gently took 'Marissa from me,' and she said, 'Don't be silly, sweetheart.' And she put Marissa in her crib, and then my mother went and sat quietly in the corner of the room as she read a newspaper. Of course, Marissa fell right to sleep, but my lesson didn't end there. When Marissa woke up in the middle of the night, I was a little bit slow to get up and to get her, because typically it's my husband who would race to get her the moment she made even the slightest peep. Well, needless to say, Marissa fell back to sleep before I even got to her. And I realized we were actually waking Marissa up and not the other way around. Now, the point of this story is not what nincompoops my husband and I were, but how easy it is to get into ineffective habits and not see things clearly. And in this episode, we're going to take a look at some of the common mistakes that lead to these middle-of-the-night wakeups. But before we do, let's take a quick look at sleep deprivation. Sleep deprivation isn't just about feeling tired. It can actually lead to some serious consequences, like increased risks of accidents. In fact, Did you know that driving sleep deprived is comparable to driving impaired? And for parents, the lack of sleep affects their emotional regulation. Yes, I know we're always talking about a toddler's emotional regulation, but parents have emotional regulation. Everybody does. But emotional regulation is crucial in managing all those tricky toddler moments. Without losing your cool. Now, I did a recent poll on social media about what parents consider to be their biggest problem, and losing their cool on their kids was by far the number one problem. Typically, as parenting experts, we focus on teaching mantras and deep breathing as ways to stop losing your cool. And while those are all very helpful ways, Getting more sleep is really what it's about. Now let's circle back to why kids get up in the night. We're going to be focusing on just a few of the most common reasons. There are more, but these are the biggies. And without a doubt, the most common reason for kids to be making mad dashes into your room or crying for you to come to their room are because of what's called ineffective sleep associations. And let me explain. How you fall asleep at bedtime is directly tied to whether you wake up in the night. Human beings are creatures of habit and we become accustomed to a routine and any deviation from it causes us grief. So if your child is dozing off at bedtime with you cuddling them or lying in bed with them or rubbing their back or holding their hand, that's what your child is going to need when she hits that light sleep state or that brief night awakening in the middle of the night. In other words, she's learning if there are no cuddles or whatever the conditions are that help her fall asleep at bedtime, well, when she wakes up in the night, if those conditions aren't there, she can't fall back to sleep. Now, as adults, we also wake up in the night and think about it for a moment. A typical response to a night waking for an adult is adjusting your pillow or just turning over. Toddlers, however, become dependent on those certain conditions they use to fall asleep at bedtime. So here's the thing. Your toddler goes from shallow to deep sleep and this cycle repeats itself multiple times throughout the night. Many toddlers wake up briefly after a brief night awakening because they don't know how to soothe themselves back to sleep. They've grown accustomed to your being there to help them doze off, and that's what they need at bedtime and in the middle of the night. Night awakenings are a biologic fact, but how a toddler manages these moments is learned. Now, from a toddler's perspective, they've learned, okay, when I go to sleep, I need my mom or dad to rub my back or whatever the conditions are. So when your child wakes up in the night, yes, I know I'm repeating myself, but it's such a big point. Your toddler has come to associate whatever conditions they use at bedtime to need these every time they doze off, whether it's at bedtime or the middle of the night with those brief night awakenings. Now, there are other reasons, and another significant reason kids get up at night is fear. The dark, closets, and noises can interfere with a child's ability to doze off. If you haven't listened to the December 28th, 2022 episode called Overcoming Bedtime Fears, I'd highly recommend you listen to this episode about nighttime fears if that's a problem you're struggling with. Because there's a lovely strategy on that episode that helps kids stay in bed in the middle of the night when fear is the issue that's getting them up. Another reason children have difficulty at night is simply because they miss you. Just like saying goodbye at daycare can be challenging, well, bedtime is the same challenge. It's the longest time a child is away from you, and they're away from you in the dark. For a long time. So there are a few little strategies to help with that, like putting a photo album by the bed, putting pictures of the family up in the bedroom. And another one that we did this with our kids and I really liked it is there's a little button you can buy from Amazon. Actually, it's a big button. In our day, we'd get it at Staples. I'm not sure if that's in the U.S., but it's in Canada. And basically it's a big button, easy to see, and when you hit it, it will play whatever is recorded. And so I would tell my kids stories and it would play. I'm not sure what the length of the recordings are now, but your child can hear your voice. There's also stuffed animals that you can buy that you can record a message and when they hug it, it says the message, but it's a way to create connection when you're not there. Now, before we finish off, I need to include a few medical causes for sleep disruptions as well. As a pediatrician, these are all things I've seen, but not nearly as frequently as sleep associations being the cause of night awakenings. But anyhow, the first medical cause for sleep disturbance would be something called obstructive sleep apnea. And when this is an issue, you typically have snoring, but not just snoring, also gasping and choking at night. Restless leg syndrome is something most people have heard about. It's really tricky to diagnose with kids, but it's really easy to treat. And from a kid's perspective, what they say is they have this incredible urge to move their legs and it gets worse when they lie down. And another common reason is eczema. Children with very bad eczema that's poorly controlled, the itchiness can interfere with sleep. Now, before we finish up, let's take a moment and look at, well, how much sleep does a toddler actually need? So let's start with 1 to 2-year-olds. They need about 11 to 14 hours sleep a day, and this includes naptime sleep. Preschoolers, meaning 3 to 5-year-olds, They need about 10 to 13 hours a day, again, including nap time. And then as kids get older, the sleep requirements go down a little bit. So school-aged children, that's 6 to about 12 years old, need 9 to 12 hours sleep a day. Insufficient sleep in children can lead to behavioral issues, impaired decision-making, and difficulty in learning. Now, if you're feeling stumped by what to say to your child at bedtime or even other challenging moments, take a look at our new resource, Words That Work: 200 Scripts for All Those Tricky Toddler Moments. You'll find the link for this in the show notes. Have a wonderful week and keep up the good work.