Episode 18: Kids and Sleep (Part 3): Listener Qs and Expert Answers

Show notes:

Toddlers jumping into your bed at 2 a.m.? Need to sleep train a 4-year-old? Or change a sensitive kid’s wake-up time? In our third and final episode as part of our Kids and Sleep series, Dr. Shelby Harris, Dr. Allison Shale, and Dr. Andrea Roth answer questions from Sleepopolis readers about the most difficult sleep situations happening in houses across the world.

Transcript

Dr. Shelby Harris: How are you sleeping? Are you sleeping? I’m Dr. Shelby Harris, licensed clinical psychologist and Director of Sleep Health at Sleepopolis, where we dive deep into all things sleep.

If you like Sleep Talking with Dr. Shelby, take a second right now to like this video on YouTube or give us a 5 star rating through Spotify or Apple Podcasts.

I know it seems simple, but it helps us reach a lot more people to get them the rest they deserve. And if you’re tired of hitting that snooze button, hit the subscribe button instead. A new episode of science backed sleep tips is available every other Wednesday.

Welcome back, listeners, to part three of our special three part episode on kids and sleep in recognition of Children’s Awareness Month this month to reflect on how we can prioritize our children’s health and wellbeing.

In Parts 1 and 2, Drs. Andrea Roth, Allison Shale, and I discussed common sleep behaviors and treatment for children, from newborns through grade schoolers, including when to talk with a psychologist.

Today, in part 3, Dr. Andrea, Dr. Allison, and I will wrap things up by answering your questions, listeners. Everything you’ve submitted through YouTube, Instagram, Facebook, and of course, our website, sleepopolis.com. We are really excited to dive into them. We got some really great questions.

Remember, if you have questions for future episodes, you can always add them to the episode comments below if you’re watching this on YouTube. You can also send questions via Facebook or Instagram @sleepopolis and @sleepdocshelby.

Now let’s reintroduce our guests. With over 10 years experience treating children in schools, hospitals, and private practice, psychologist Dr. Andrea Roth is known for her expertise in sleep and anxiety for children. Versed in a wide range of childhood concerns, Dr. Andrea loves providing insight and support to parents to ensure that when kids master new skills, their caregivers also gain the knowledge and confidence to be as supportive as possible.

Bringing another 10 years of experience to us today is Dr. Allison Shale, a psychologist and director of Shale Psychology, specializing in anxiety, ADHD, depression, sleep disturbances, and behavior problems, Dr. Allison aims for children to feel understood and heard while providing parents with tangible strategies and insight that can benefit the entire family and last a lifetime. And I’m also so honored to be co-authoring an upcoming book for parents on kids’ sleep with them as well. So keep an eye out for that.

Dr. Andrea, Dr. Allison, welcome to Sleep Talking with Dr. Shelby. I’m really excited to have you here.

Dr. Allison Shale: Thanks.

Dr. Andrea Roth: Thank you. We’re so excited.

DS: So, the first question I’m going to ask you that a viewer and a listener asked us was, my toddler is consistently coming into our bed every night. We don’t mind a quick snuggle in the morning when we’re getting ready to wake up and start the day, but it’s usually around 2 to 3 a. m. Oof. It’s disrupting all our sleep schedules. Do you have any tips for helping our toddler stay in bed all night? Andrea?

AR: Are they too big for the crib? Can we bring it back?

AS: Yeah, right.

AR: No, I think it’s hard. I think that this expression, toddler, I think it’s really tricky for us sometimes because I think toddler is used to describe a one and a half year old, but toddler can sometimes also be used to describe like a three and a half year old.

I think it’s a complex response. I think all of us would say we want to look at bedtime first. We want to understand how this child is going to sleep. Are they going to sleep independently. Are they going to sleep with someone else? Are they going to sleep with assistance? I think if not, if they’re not falling asleep independently, that would actually be personally where I would start so that they can kind of learn how to put themselves to sleep so that when they wake in the middle of the night, they feel like they can do it again.

And then I think that there are other mechanisms and strategies we can use to help them either learn to stay in their bed or kind of wake up, roll over, fall back to sleep. It’s so hard. Depending on age, we can use things like bedtime passes. If this toddler is like a slightly older toddler, which we actually had a disagreement on recently.

I put bedtime passes on the door out of the room. And you said, Shelby, that you put bedtime passes right on the nightstand.

DS: Yeah.

AR: But the concept behind the bedtime pass is that they have two, three across the night and once they use it and they get out, they lose it. They have no more. And then across time, we decrease those.

If they’re a younger toddler, you know, you can kind of use like the quote unquote like robot return method where you’re just consistently returning them every single time without engaging, without, you know, making any sort of real overture toward them. And then sometimes I’ve actually had kids in clinic that my students have seen where they’re doing that. And the kid still just like, like clockwork is getting up every single time and we have even tapered down how much the parent brings them back. So they bring them back, like, to bed, they bring them back to the door, and they kind of just really decrease it. And again, if it’s an older toddler, we can use a lot of behavioral shaping, like rewards and things like that on the other end.

What I’m neglecting to say, of course, though, is that we would also want to make sure that there’s nothing medical underneath first. I feel like these questions are tricky because I want to say 18 things. We want to make sure that there are no kind of medical underpinnings before we kind of go into a behavioral approach.

DS: I want to hear what Allison has to say, but you said something about, are they old enough for the crib?

AR: Oh, yeah.

DS: What would that be for a recommendation?

AS: Do it, Allison. You tell ’em.

AR: A lot of times people, when their kid doesn’t stay in bed, they’ll then say that it’s really because their kid is like 18 months even, two. Really a little bit too young to be out of the crib.

And a lot of times people say, well, they jumped out. And so we did it for safety. Or sometimes it’s a young kid. They needed the crib for another child. Right? So sometimes there are real reasons, but we’ll talk to parents a lot about children, not really having the impulse control, the body regulation to kind of know that they need to stay in without the physical barrier keeping them in.

So sometimes we’ll talk about that piece with people, but I think another part of it is when parents say, that question, I hear all the time of, well, we’re okay with it at 6 a. m., but we’re not okay with it at 2 a. m., as if their three year old can tell time. As if their three year old knows the difference between it being time to wake and it being time not to.

And so I’ll talk to them about how, you know, there really isn’t a time where we can offer those snuggles unless it is time to wake for the day. Because that’s sending a really confusing message. So even with little kids, sometimes we’ll do like an okay to wake sort of clock. Even a three year old I’ll do behavioral plans with, where we’ll really reinforce staying in the bed until that light goes on. And if your goal is 630, maybe, but they’re waking up at 530 now, we won’t set it at 630. We’ll set it somewhere realistic to build up their confidence, to have them be successful. And so again, you know, I think consistency is so important and also really remembering, can your child handle what we’re asking them to do?

DS: We didn’t really talk so much about camping out. So the idea of the parent is in the room with the child and then slowly removes himself, we often will do that at bedtime. How are you if a child is coming in in the middle of the night and they won’t stay in their bed. Let’s say it’s an older toddler. Would you recommend that at all?

AR: I think it’s interesting. I also like am really just, I’m so phased right now. All I do is keep picturing like a three year old with like a watch being like, what time is it? Sorry, I can’t get past the mental image that I’m having from Allison’s line.

AS: Well, it’s true. I think about it.

AR: I think about it too. Sorry. Just like a nice wristwatch.

DS: Yeah.

AR: So camping out. I think that there are ways in which we do this sometimes to break the habit, and I think that we use this expression camping out, I think, to describe different things occasionally. Sometimes to break the habit of the child waking, we will temporarily, and I think parents literally want to like reach across and just shake me when I say this, temporarily have the parents sleep in the kid’s room to just break that habit of waking at three o’clock in the morning to get out and come to them.

And then we slowly work them out of that. And then I think the other way in which we talk about camping out or parental presence, we talk about the different ways in which we kind of slowly train them to fall asleep, stay asleep independently, in regards to the different methods that we can use.

DS: Okay.

The next question I have here is my toddler, whatever age that might be, let’s just say it’s like a two year old. My toddler goes down at 7 30 p. m. And starts to wake around 6, 6 30. How do I train him to sleep in so that I can also sleep in? Allison?

AR: Who wants to give the bad news?

AS: Oh, I guess I can. Yeah. I think that that sleep schedule sounds really incredibly wonderful and I think that your toddler sleeping 730 to 630 is really, really great and I don’t know that we could necessarily expect most toddlers to sleep more hours than that overnight, first of all. Second of all, I think that there are ways that we can get your child to stay in his or her crib or bed until a desired time, right?

DS: Yep.

AR: There it is.

AS: You can have a toddler who gets up at 6: 30, but maybe you don’t get them till 7. And there’s a lot of different things we can do for that. So sometimes we’ll have books or other things that are quiet things in the room. When their light turns on, they’re allowed to get out of bed and be on the floor and do those sorts of things.

And they just have to wait then for mom or dad to come in a little bit later. So I tend to come at it behaviorally, as is kind of a theme with a lot of that I talk about, of how can we kind of reinforce them staying in at that time. So we can offer a little reward in the morning or other things for staying in.

But again, it’s being really mindful. If your child’s sleeping 7: 30 to 6:00 or 6:30, it’s really not likely that we’re going to get them to stay in there till eight o’clock or suddenly sleep till eight o’clock, because that’s a really wonderful, great, I say, go you for having that great sleeper.

AR: Yeah.

DS: Yeah.

AR: I think it’s really hard. I think this speaks to like what we just keep talking about. Not necessarily shame, but this comparison of how my kid’s sleeping versus how your kid’s sleeping and we’re talking about it and it’s like, you know, toddlers, young children are meant to be more morning oriented, going to bed early, waking up early, like that’s the norm.

But the neighbor might have one of those like, unicorns, that either A, sleeps 12 hours a night still, or B, sleeps in a little bit easier. And I think that it’s important to recognize, like, that that’s not necessarily the norm and that this is your kid’s kind of typical sleep schedule and they’re not presenting as overtired during the day. This likely could just be them.

AS: That’s a great point.

DS: And it’s a totally normal wake up time for a kid.

AS: Yeah.

DS: Totally normal.

AS: Sounds great. Yeah. That sounds like a nice night and morning.

DS: Yeah.

All right. We sleep trained our toddler back when she was four months old, but she’s showing signs of sleep regression now at age four. What’s going on with your sleep? And do we need to sleep train all over again? Andrea?

AR: Come on. You’re just setting me up. Okay, I’m gonna be cool man. So I think that people that are in the field really get nudgy like me when we hear the expression sleep regression.

DS: Thank you.

AR: Because sleep regression really refers to very appropriate developmental changes in children that then impact their typical functioning. And sleep is one of these typical functions. So when a child is having a moment where something is changing developmentally, it is expected for their sleep, their appetite, their behavior to have a little bit of a shift with it too. And it’s not necessarily indicative of the fact that like something is wrong, and this is like clockwork and we should expect a one year and a two year and a four year…

Sometimes it’s a hiccup and we can just kind of look at it and be calm for a week, maybe even God forbid two weeks, and kind of see if this just kind of writes itself because again it’s just a little moment of development.

If we are seeing this become a lengthier pattern that’s getting worse and worse and worse and is really interfering with their functioning, our functioning, then we can absolutely do something about it. I don’t know how, you know, into it you want me to get because I think that there’s a myriad of options we can go into with a four year old. But I think that I would start by just examining the basics. I would look at their general sleep habits. I would see what’s going on with them during the day. I would ask kind of what their behavior looks like. And then if push comes to shove, and there really are big concerns, to seek out someone who’s trained like one of us to help find a solution or some sort of strategy or plan to help their child sleep more.

AS: Yeah. And I think the other just part of it that’s important to remember is that a child having a couple of bad nights of sleep doesn’t mean that you need to change everything.

DS: Yeah.

AS: Right? Like we don’t sleep like robots. We don’t sleep at the exact same time and wake up the exact same time every single day. So sometimes a huge part of the education with parents is your child is not a robot. And just because they slept exactly 11 hours last night does not mean they will sleep exactly 11 hours every night. So if they wake up a little early, that can just be that they woke up a little early. It doesn’t mean you need to change your bedtime routine and do all this stuff. So take a little data, pause, you know, give yourself a little time. You don’t have to react and do something immediately and then see what happens in five days, seven days, where you are.

DS: I love that.

All right. When you have an elementary schooler sharing a bedroom with a new baby, how do you manage the bedtime routine and the nightly baby wake ups?

Allison?

AS: Yeah. I mean, that’s a really, really hard one. And I would have to think that having them in the same room is out of need and space and all these other sorts of things, right? In a perfect world, we would pull that newborn out and get them in your room with you. But I’m going to guess that there’s a reason, you know, that you can’t do that.

So noise machines are always a big one. That’s kind of the first thing, having a noise machine in that room to kind of mute out the baby. One thing that I think we all know and have noticed is that a lot of times that worry about an older sibling waking up doesn’t come to fruition. They can often sleep through that. They are in a deep stage of sleep when that kind of thing is happening. It’s usually okay.

In terms of the bedtime routine, I think when they’re a newborn, the beauty of the newborn stage is there’s a lot going on. So you might feel a little less pressure to say this is bedtime, right? So maybe you let your elementary school kid really keep their schedule and still do their bedtime routine as is.

And either put down baby before or baby a little bit after or do most of the baby’s bedroom routine in another kind of dark room and just enter to put baby into the crib or bassinet wherever they’re safely sleeping. So I think that for most people, the bigger worry would be the overnight wakings, less about the bedtime routine because you can hopefully stagger it.

Even if it’s just a single parent home, you can hopefully stagger it in some way. And noise machines. And trusting that your child, your older child might sleep through more of it than you realize. And tons and tons of waking doesn’t last forever. That’s temporary, too, even though it feels like it’s forever. It won’t be.

DS: Andrea, anything you want to add?

AR: I was going to add the piece that I think sometimes we talk about when there’s room sharing for siblings, we talk about if they are approaching an age where it’s an appropriate time to sleep train. If we can kind of move, if there is a possibility within the space to separate the kids. Move someone out, let the infant have a space while they sleep train, you know, learn to sleep through the night a little bit better. They can then kind of return into the other sibling’s room. But I think the way that Allison responded to it was beautiful and perfection.

DS: Yeah.

All right. My kindergartner is seemingly addicted to iPad time at night, spending hours watching YouTube or playing Roblox before falling asleep. What’s the best way to curtail this, especially when taking away the iPad just results in tantrums?

AR: We didn’t talk about this before. We didn’t talk about the behavioral aspect of taking away screens and how like the takeaway is a huge piece that we have to take into consideration too.

AS: It’s the hardest part. Oh yeah.

AR: Allison, this is totally your strike zone.

AS: Yeah. You know, I love this kind of like behavioral work. This is like my-

DS: This is your jam?

AS: This is my jam. I love this. Andrea always says to me, take them all. You know, I think that it comes down to a couple of really simple things that are simple concepts, hard to implement and hard to kind of break routines.

Number one is reminding parents that they are in charge and they actually get to decide when their child accesses that iPad.

DS: Yeah.

AS: You know, sometimes you feel like we have a little mini dictator, but it’s your decision when your child gets to have those screens and you have allowed them to have it at this time. So it’s no surprise that they keep asking for it. I wouldn’t rip it off like cold turkey, like out of nowhere, you don’t get it anymore, right? Sometimes they do need a little bit of time or a decrease in how much time they’re getting.

And then I think the third part is from a behavioral standpoint, when people joke and they say, oh, it always gets worse before it gets better. That’s a real thing. That’s called an extinction burst where it really does get worse before it actually improves. So of course your child is going to scream louder because he or she is saying, what do you mean? You always give me my iPad. Like, maybe you don’t hear me. And you kind of do have to really find a way to tolerate that.

It’s maybe, you know, setting yourself up for success. Maybe you’re going to make this change on a weekend where there’s less pressure in the morning if you are tired or bedtime is delayed because your child’s tantruming. Maybe it’s making sure it’s a time where a partner can help you or somebody else is there to maybe help with another child if your toddler is going to be losing it and freaking out for a long time.

But I think in most cases, it’s like really sticking the course. Once you say, this is how much we’re going to do, it’s really doing it. Because we know if we give them this much, they’re gonna always ask for it again. If I buy you a toy at the supermarket today at checkout, of course you’re gonna ask me next week for a toy at checkout.

And you’re gonna be really mad when I say no, because you’re expecting me to buy it again. Because I just said yes! And they don’t know all the criteria that go on in our heads. So it’s consistency, and really being able to tolerate that extinction burst. It is a real thing, and your child’s tantrum, you can handle it, even if it’s hard.

AR: Yes. What she said.

DS: Yes!

Here’s the last question. It’s an interesting one. It’s a tough one. What do you recommend for kids and families that are dealing with late sports practices or games and the dinner and bedtime dilemma? So for example, my girls have soccer practice three times a week from 6 to 7:30, but practice always runs late. And by the time we’re home, it’s eight. We typically finish our bedtime routine by 8 45, but on soccer nights, it’s practically impossible to feed them, get them to shower, then get them to bed on time, or we do get them to bed on time, but then they don’t actually go to sleep because they are still too stimulated from their evening activities.

Do you recommend feeding them more before soccer and then encouraging a protein rich snack afterward? Is there another way to help them wind down on these evenings? Andrea?

AR: I think it’s tricky.

DS: It’s a challenge.

AR: It’s a challenge. It’s really hard. I think it’s also hard for me to hear this and not just like climb up on a soapbox about like, why are we doing this to our children as a society? But I’ll step down. We’re not 100 percent sure how old your kids are and what an appropriate bedtime is. Or how much sleep they might need. But this is a challenge.

I think that this has to be a little bit of flexibility. I think that this idea of like maybe giving them a really big dinner or a larger meal beforehand and then giving them a protein rich snack afterward I think can be helpful.

DS: Yeah.

AR: I think small, small things that you can do to help that idea of like they’re really running, running, running and then they come home and they can’t fall asleep even if we get them in quickly is to either A, allow them to go to bed a little bit later these nights and give them that time to like rest and relax because we know that they need that downtime.

DS: Yes.

AR: And then B. I don’t know if anyone else, any of the two of you have done this. When you’re outside, I always joke, because my husband goes like, gah, you’re such a sleep doctor. If we go on a walk late at night and it’s like getting close to bedtime, especially in the summer when it’s light out forever, my kids wear sunglasses in the evening if it’s still really, really sunny, just to block that kind of natural light that’s coming in.

DS: That’s a great idea.

AS: That’s a good tip.

AR: Oh my god, I mean, my kids are little and so they go to bed early, but oh yeah, we’re out on walks and it’s like 6:30 and they’re wearing their sunglasses.

DS: Yeah.

AR: They feel cool, but it also really helps a little bit of, you know, that natural light affecting their melatonin production, but I think a little bit of flexibility in these times is, is, is helpful and understanding that like a couple of nights of a little bit late of a bedtime is not that bad.

You know, research indicates that, like, an hour of change can be felt and if we can kind of keep it lower than that, it’s good. If we’re just talking about like maybe a 30 minute difference in bedtime, I wouldn’t stress. I just wouldn’t stress. I think if those days afterward you’re seeing them, like, falling asleep accidentally, if they’re really crashing out or struggling to wake up the next morning, then you might want to, you know, consider making a larger change. But if they’re not really looking like this is impacting them that much, I think it’s probably okay.

AS: That was the first thing that I thought of, that in that question, the writer didn’t say, and their child is really tired in the morning or their child can’t wake up. So, is this just a parental worry of my child’s not sticking to the bedtime routine that I have set for them, and maybe their child can actually handle?

Maybe it’s just for basketball season. Maybe it’s just for the baseball season. Maybe this isn’t forever. And if it is, they play something year round, and they always have practice on Tuesday and Thursday. Well, then you might need to shift. Maybe that normal bedtime really just isn’t normal anymore, and maybe this just is kind of their new normal as they’ve gotten older, and the sports are this or that. So I think it’s really thinking about who is more nervous about that bedtime shift, me or my child? Who’s it impacting more, me or my child?

DS: But if they are not routinely falling asleep, because it’s hard because we don’t know the age, right?

AR: Mm hmm.

DS: But I’m guessing, you know, three times a week.

AR: That sounds serious.

AS: Yeah, it sounds like a lot.

AR: Are they in FIFA? It’s like professional.

AS: Yeah, it’s got to be older.

DS: Yeah.

AS: Eight to twelve is in my head, eight to twelve range.

DS: Yeah, I mean, I think about like my child, who’s eight. She goes to bed around 8: 45, sleeps until 7, a good amount of sleep, she’s doing great. And if they, you know, 9: 30 once in a while, okay, that’s fine. But if they’re not falling asleep for a long time, then that is something that needs to be addressed. Like a half hour, 40 minutes later, two, three times a week, and like you said, you don’t notice anything during the day, fine. But I love the idea of the switching the dinner to earlier.

AS: Yeah.

DS: But the things you do need to consider as kids get older, and this is what I struggle with is, and I- with patients and my own children- is that they start having more homework. They start doing more activities and this is when, I mean, this is my soapbox, right? It’s the school start times.

AR: I was gonna say you’re putting me right back on the soapbox.

AS: Right.

DS: The school start times are so early, these kids are having more homework. They’re overscheduled. And I think there is a point where sometimes we do have to say no, and we have to set some limits because of their sleep health, their health in general.

So sometimes we do have to set those limits or at least work with our schools on having the school start times a little different and homework. And that’s a whole other discussion.

AR: I was gonna say, is this where we plug start school later?

AS: That’s a separate, a whole separate thing.

DS: Right? And I talk a lot about that in my episode with Lisa Lewis that was from earlier on the podcast. So highly recommend that if you’re interested in that.

AS: Right.

DS: Ladies, we’d like to end each episode with a segment called Something to Sleep On. One last point you’d like to share with anyone looking to change their sleep habits. So when it comes to everything that we just discussed today with all these viewer and listener questions, do you have a final thought for our listeners, something to sleep on, Allison?

AS: Don’t be afraid to ask for help. If you feel like something’s off, it is always worth it to consult with someone. And I often say to people, you’re not committing to a lifetime of sleep work with me, right? We could meet a handful of times and you could feel like you are ready to launch and that is my goal.

It’s a really great thing that you’re able to ask for help and you’re able to kind of have that reflection of something’s off here and you just need an outside set of eyes. We are your gals for that, you know, so ask for help. Don’t worry about the shame.

AR: I think mine is almost a little counter to yours a little bit too, is this idea of, like, don’t panic. If something is changing and different, what I feel really fortunate about is that, Allison, while you were giving a response previously about how kids aren’t meant to sleep the same way every single night because they’re not robots in the same way that we don’t sleep the same way every night, I actually was recalling one of my children. I think my first one, being a newborn, and Allison telling me that. Me panicking about her sleep and what was going on and being like, something’s wrong. And her saying, your kid’s not a robot. She’s not a robot. You don’t sleep the same every night. They’re just little humans like we are, they’re meant to have differences.

Take a pause, gather some data. Look at some patterns and give it a beat before you really kind of panic and assume that something must be off and awry.

DS: Ladies, thank you so much again for joining us. This was really wonderful. So exciting. Thank you.

AS: Thank you. So great.

AR: Thanks for having us. Bye.

DS: Thanks for listening to Sleep Talking with Dr. Shelby, a Sleepopolis original podcast. Remember, if you’re tired of hitting the snooze button, make sure to hit that subscribe button right now in YouTube, Apple podcasts, Spotify, or wherever you’re listening. And for even more sleep tips, visit sleepopolis.com and my Instagram page @sleepdocshelby.

Today’s episode was produced and edited by Freddie Beckley. Our Senior Director of Content is Alanna Nuñez. Our Head of Content is Molly Stout. And I’m Dr. Shelby Harris. Until next time, sleep well.