Many families have problems getting their children to bed, especially preschool and primary school-age children. Many children will use excuses to avoid going to bed such as 'I need to go to the toilet' or 'I just need to tell you something', which can often delay sleep time significantly.
It is not unusual for children to have night-time worries or fears, which can prevent them from getting to sleep easily. There are a number of strategies that can help them overcome their night-time worries.
Whatever the cause of the bedtime problems, it is important that the family decides on (and sticks to) clear rules about a bedtime routine. Praising your child and reinforcing good behaviour will also help to improve bedtime problems.
For sleep problems in younger children, see our fact sheet
Sleep problems – babies and toddlers.
Strategies to improve bedtime behaviour
Be clear about what your child needs
What a child wants is not always what they need. Although your child may want to stay up, they may not understand the importance of sleep. As the adult, you need to decide what is reasonable bedtime behaviour and be clear about the behaviours you expect. Setting limits often benefits
children in more ways than just improving sleep, as they feel secure and contained.
- Explain the new rules to your child during the day. Don't leave it to tell them for the first time when they're stalling at bedtime. You do not need to go into a lengthy discussion.
- Remember, this is not a punishment, so try to engage your child and explain the importance and benefits of sleep (e.g. growing up to be strong and healthy, being awake for exciting activities).
- Expect some resistance. Your child probably doesn't want to change, so things may get worse briefly before they get better.
Implement a consistent bedtime routine
Behaviour change can be challenging and it may take some time before you see improvement.
- Have a predictable, enjoyable routine with calm activities such as a bath or a set number of stories.
- Avoid stimulating activities, such as watching TV, running around or computer games.
- Have a set bedtime that has already been explained during the daytime.
- Try to avoid negotiating with your child at bedtime and do not enter into a battle if they protest. Calmly remind them of the new rules and continue. Remember, this is what they need.
- Put your child to bed and leave the room while they are still awake.
- Be consistent and stick to your routine.
Dealing with resistance
If your child calls out:
- Calmly tell your child it's time to sleep.
- Do not enter into a discussion.
- If they get upset, return to reassure them but be brief and limit what you say.
If your child comes out of their room:
- Calmly return them to bed, while holding their hand. Remember, this is not punishment, but be firm.
- For some children, any attention (even a parent getting angry with them) is better than sleep, so limit what you say. Be calm, repetitive and boring, and do not enter into a discussion.
- If they get out of bed again, return them to bed again. Repeat as many times as is necessary.
Positive reinforcement
Positive reinforcement and rewards are an important part of any behaviour change.
- Praise your child first thing in the morning for things they did right the night before. The idea is to focus on success, not on failure.
- Consider rewarding them for sticking to the rules (e.g. sticker charts work well, even in older children).
- For children who are very resistant or struggling with the new routine, break the process down into different parts and reward your child for each part (e.g. a sticker for getting into bed, staying in bed and sleeping through the night).
Strategies to deal with night-time worries
Some children have difficulties getting to sleep because they are worried or anxious, and they start to think too much about their worries when they go to bed. The following strategies will help them overcome their night-time worries, and teach them skills they can use in other areas of
their lives.
Talk about it
Talk to your child about what is worrying them. Young children may say they fear the dark or monsters. Older children may not be able to explain what they are worrying about, or they are simply worried about not being able to fall asleep.
It is important not to disregard your child, but at the same time you shouldn't place too much importance on irrational fears.
It is important to give your child the message that you have confidence in them to deal with their worries. It is a good idea to discuss them during the day, away from bedtime. During the day, your child is more likely to be feeling confident and can listen to reason.
Stick to your routine
It's important to stick to your child's bedtime routine, even if they seem very worried or upset. Your child may need reassurance and support, but try to avoid getting into a routine where your child depends on you to fall asleep (e.g. you need to lie with them, or they need to sleep in
your bed).
Setting limits and being gentle but firm will help your child to feel safe. It also tells your child that you have confidence in them to manage this. Giving in to your child's requests may give them the message that there really is something to worry
about.
Dealing with fears
There are various creative ways to help your child to deal with their fears and worries. Plan your strategy ahead of time and talk about it during the day, when your child feels confident, and this will help them feel confident at night.
- A special fairy or protective dragon utilises a child's imagination to help reassure them. The fairy or dragon looks after them while they sleep and takes away their worries and bad dreams.
- A worry box can be helpful for older children. They can write down their worries and put them in the box and not think about them until the morning.
Relaxation
Even young children can learn relaxation techniques, which will not only help them feel more calm and relaxed, but will distract them from any worries.
- Breathing exercises: Ask your child to breathe deeply into their tummy or imagine they are blowing big bubbles, or blowing out candles on a birthday cake.
- Muscle relaxation: Concentrating on tightening then relaxing their muscles (starting with the feet and moving up to the muscles of the face) can distract your child and help them relax.
- Positive imagery: Otherwise known as 'going to a happy place', children use their imagination to create a happy place they can visit in their minds, when they are in bed.
Other ideas
- A night-light can be helpful for children who are scared of the dark as long as it does not stop your child from falling asleep.
- Security objects (e.g. a soft toy or favourite blanket) can help your child feel safe and more relaxed at night (don't use with children under six months old).
Positive reinforcement
Children often get lots of attention for having fears or worries, and this can encourage the undesirable bedtime behaviour. Positive reinforcement is important for children who are affected by worries at night time.
When to seek help
- If sleep problems are causing you and your child significant problems, see your GP or paediatrician. You may be given a referral to see a sleep specialist.
- If your child wakes frequently during the night because of their own loud snoring, see your doctor as your child may have obstructive sleep apnoea (OSA).
- Some children suffer from a more general anxiety that affects them during the day as well, and they may need further treatment. See your GP, who may refer you to a psychologist.
Key points to remember
- Be clear about what your child needs, set limits, and implement a consistent, predictable bedtime routine.
- Avoid negotiating with your child at bedtime, and try to remain calm and consistent.
- Positive reinforcement and rewards are an important part of behaviour change – praise (and reward) your child for doing well at night first thing the next morning.
- If your child has night-time worries, give them the message that you have confidence in them to deal with their worries.
For more information
Common questions our doctors are asked
How much sleep does my child need?
Children vary in how much sleep they need each night (or day if they have naps), but as a rough guide: one to three year-olds need 12–14 hours, three to six year-olds need 10–12 hours and seven to 12 year-olds need 10–11 hours.
I've tried many different strategies to help my child sleep
better but nothing is working. Should we try melatonin?
Behavioural strategies should always be tried before using a medication such as melatonin, but melatonin may be considered when other strategies are not working. Melatonin is a hormone that has been used successfully to treat sleep problems in children who need help to regulate their sleep pattern. Melatonin
requires a prescription in Australia – always discuss melatonin use with your doctor as part of managing your child’s sleep problems overall. The melatonin products available on the shelves in pharmacies are homeopathic versions, so to get an effective dose, you should see your doctor for a prescription.
Developed by The Royal Children's Hospital General Medicine department. We acknowledge the input of RCH consumers and carers. We acknowledge the input of RCH consumers and carers.
Reviewed July 2018.
This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.
Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit
www.rchfoundation.org.au.