Tuesday, February 28, 2012

Toddler Sleep Problems

It is not uncommon to see sleep problems in toddlers. For some toddlers, getting them to bed is the issue. For others, it is keeping them in bed. Some toddlers fall asleep and stay asleep...as long as they are in their parents' bed. All of these scenarios can be challenging for parents and children.

First and foremost, it is important to try and understand what is behind the toddler sleep issues. When children's sleep is frequently dysregulated, this suggests there is something going on with them physically or emotionally. They may not be able to verbalize how they feel but their behavior is speaking for them.

There are myriad reasons why toddlers experience sleeping problems, including:

  • Physical health problems, illness (e.g., earache, toothache, allergies, swollen glands, problems with elimination)
  • Recent transitions (e.g., starting daycare/school, moving, room change)
  • Change in the family dynamics (e.g., birth of a sibling, relative moving into the home, sibling with a disability, physical or behavioral problem)
  • Family stressors (e.g., parental chronic illness, taking care of an sick relative, employment issues, financial concerns)
  • Parental relationship problems (e.g., divorce, separation, marital discord)
  • Parental mood and behaviors (e.g., anger, frustration, sadness, fear, worry, anxiety; withdrawal, aggression, substance use, excessive absence from the home)
  • Death (e.g., death of a loved one or pet)
  • Loss (e.g., friend moving away, loss of favorite blanket, toy or pacifier)
It makes sense that if children are experiencing a physical problem, they might be uncomfortable and have trouble sleeping. However, children's emotional states also have a significant impact on their regulatory capacity and can, thus, cause disruptions in sleep.

Often, when children are experiencing sleep problems, they report having bad dreams or being afraid of monsters and ghosts. Fantasy and imagination are not always clearly separated in toddlerhood and ghosts, monsters, and witches appear under the bed, in closets, and in dreams as symbolic representations of what worries children in reality. Transitions, loss, death or significant change can be confusing for toddlers; they may not understand these changes or have the words to describe their confusion. Further, children are very intuitive and pick up on the emotional environment surrounding them. Despite parents' best efforts, children are very attuned to their parents' moods and may feel worried, anxious, scared, sad, or angry when they sense something wrong with their parents. Some children even feel guilty, imagine that they are responsible for their parents' feelings and behaviors, and believe they must be "bad." Ghosts and monsters become the representatives of these confusing and frightening feelings. Needless to say, all of these feelings and attached symbolic fears can weigh heavily on children and contribute to toddler sleep problems.

What is important to help manage sleeping problems in toddlers is to understand the possible root causes. Once the potential reasons affecting toddler sleep are uncovered, they can be talked about and work through (i.e., children's feelings can be acknowledged, explored, and empathy and reassurance can be repeatedly provided). Parental issues can also be routinely examined and better managed so they are not projected onto the children.

Awareness of underlying problems is the first step to alleviating toddler sleep issues. Sometimes, simply bringing the underlying issues to awareness and processing related feelings in a supportive, calm environment is enough to help get children back on track with sleep. Sometimes, a little more structure and guidance is needed.

 In the next post, learn about toddler sleep training methods.