Solutions to sleep concerns (12) – toddlers 1 to 3 years

Sleep concerns and your toddler

It can be difficult to know whether your toddler is experiencing a sleep or settling concern. If your toddler’s sleeping patterns are not affecting you or your family and you have strategies that work, then there may not be a sleep concern.

The following definition of ‘severe night waking’ provides a guide – however, you know your child the best, and if something is a concern for you, seek help and advice from your local maternal and child nurse, your doctor or the Maternal and Child Health Line on Tel. 13 22 29.

Severe night waking is when your child does one or more of the following things 5 or more times a week, for one or 2 weeks:

• Consistently wakes more than 3 times a night.
• Consistently takes more than 30 minutes to settle.
• Stays awake for 20 minutes after waking.
• Goes into the parents’ or caregivers’ bed.
• Has difficulties with sleep and settling that is causing parents or caregivers significant distress.

Strategies to help your toddler sleep and settle

Parents are encouraged to be responsive to the needs of their toddlers. Responsive settling is recognising that your toddler needs help and responding appropriately. You can do this by knowing your toddlers’ cues, tired signs and the intensity of their cry. It is important that your toddler knows you are emotionally and physically available if they become distressed. Developing positive sleep environments and routines can also support your toddler at bedtime to self-settle. Every family is different, and you need to use a strategy that you feel comfortable with and suits your toddler and family.

Helping your toddler with parental presence

Parental presence aims to use your presence as a way to help your toddler self-settle.

Research shows that this strategy is effective, but it may take longer than other strategies to reduce sleep concerns.

It is also more work for you, as you need to stay in your toddler’s room for 7 to 10 days whenever your toddler is awake, so they know you are there.

However, you do not interact with your toddler – the aim is to break the link between your toddler’s sleep behaviour and your attention.

• Decide on an appropriate bedtime.
• Start a positive bedtime routine (such as a warm bath and reading a book).
• Place your toddler in their bed or cot, preferably while still awake or drowsy.
• Gently pat your toddler and say good night.
• Lie down on a bed or mattress in your toddler’s room with a night light on and pretend to sleep where your child can see you.
• If your toddler wakes during the night and is distressed, make slight noises or movement (such as coughing or turning over), so your toddler knows you are there.
• If your toddler becomes very distressed, soothe them with gentle words and by touching them – but try not to pick them up.
• After 1 to 2 minutes, lie down and pretend to sleep.
• Continue doing this every time your toddler wakes and is distressed. Repeat the process for day sleeps and naps.
• Continue with the strategy for seven nights.
• After three nights in a row of minimal sleep disturbance, you can return to your own room.
• If your toddler’s sleep becomes disrupted again, you can re-introduce the strategy.

If there is no improvement after 2 to 3 weeks, consult with your maternal and child health nurse or doctor.

Helping your toddler sleep by camping out

Camping out is similar to the parental presence strategy. It may be useful if you don’t want to sleep in your toddler’s room but find it hard to leave your toddler to cry even for a few minutes.

This strategy may take one to 3 weeks until your toddler can go to sleep by themselves.

You will be more successful if you plan and take time to progress through each camping out step:

• Decide on an appropriate bedtime.
• Start a positive bedtime routine (such as a warm bath and reading a book).
• Place your toddler in their bed, preferably while they are still awake or drowsy, and say good night.

Camping out steps

Try each of these following steps in order. Each step may take two to three nights – it’s important that you and your child feel comfortable before progressing to the next step:

1. Lie or sit next to your toddler and gently pat or stroke them until they go to sleep, then leave the room.
2. Place a chair beside the cot and sit without touching. Allow your toddler to go to sleep before you leave the room.
3. Sit at gradually increasing distances from the bed or cot. Allow your toddler to go to sleep before you leave the room.
4. Eventually, place the chair outside the bedroom door.

If your toddler wakes, repeat the step you were using at bedtime, to help them learn to self-settle.

Helping your toddler sleep with bedtime fading

Bedtime fading can be used for older toddlers from 2 to 3 years. It is based on physiological theory of establishing sleep by limiting your toddler's time in bed. With this approach your toddler does not go to bed until they feel naturally tired or drowsy, resulting in less night-time wakings.

• Record the time your toddler goes to bed every night for a week.
• Identify the latest time and set this as bedtime.
• Gradually push back the bedtime by 15 minutes every 2 days.
• You can also make bedtime earlier (if needed) using this approach. Once your toddler gets used to falling asleep easily and quickly when put to bed, move their bedtime forward by 15 minutes every 2 days.
• Continue until your toddler falls asleep quickly and has minimal night-time waking, reaching a preferred bedtime.

Responsive settling

The responsive settling method has been around for many years. To be effective you need to ensure that you do this approach correctly and consistently. This approach may not be right for your family.

Moving your toddler from cot to bed

Once you notice your toddler is attempting to climb out of their cot, it is time to move them to a bed. This is usually between 2 and 3½ years of age but can be as early as 18 months.

Make sure your toddler’s furniture and sleep environment is safe, this is especially important if they get out of bed at night while you are asleep. Reduce their risk of injury by keeping dangerous items (such as cords from blinds and power points) out of reach and limiting access to areas where your toddler can fall (such as stairs or windows).

Strategies to help your toddler move from cot to bed

• Involve your toddler in the process of getting their new bed. Tell them about it and get them to help set up the bed.
• Provide positive encouragement to make the transition exciting and fun – such as praising them for being grown up and making the move.
• Maintain a positive bedtime routine.
• Let your toddler take a blanket from their cot, which might help them feel more secure and comfortable.

Strategies to deal with calling out

Moving from a cot to a bed can bring about new difficulties at bedtime, and toddlers may go through a stage of calling out.

If a positive and consistent bedtime routine is not stopping your toddler from calling out, and this is becoming a concern, you can try the following options. Remember, it is important to be consistent.

Option 1: Returning your toddler to bed

• Use your toddler’s name when you speak to them and ask them to stay in their bed. Only speak to them once.
• Return your toddler immediately, gently and calmly, to bed. Do not talk, make eye contact or reprimand them in any way. (Do this as many times as it takes until your toddler stays in bed.)

It might take many returns before your toddler stays in bed. So, you will need to be very patient. This might not be the best option if it makes you angry or upset.

Option 2: Restricting your toddler to their bedroom

• Use your toddler’s name when you speak to them, ask them to stay in their bed and not to leave the room. Only speak to your toddler once.
• If your toddler comes out of bed again, tell them that they have not stayed in bed and you will now be closing the door. Tell them that the door will be re-opened when they stay in bed. Return your toddler to bed and close the door. It is best to stay near the door to ensure your toddler does not get distressed by the door being closed.
• Another alternative is installing a child gate to prevent them coming out of the bedroom or a night-light if you think your toddler is afraid of the dark.
• Ignore any further calling out.

If there is no improvement after two to three weeks of using these approaches, talk to your maternal and child health nurse, doctor or call the Maternal and Child Health Line on Tel. 13 22 29.

Information in community languages

This fact sheet is available for download in the following community languages:

Maternal and child health nurse visits are important

Victorian parents have free access to the Maternal and Child Health Service, which is a great support after your baby is born.

Specially trained maternal and child health will work with your family to help you care for your child until they are ready to start school.

As part of this service, you will visit a maternal and child health nurse in your local area at 10 key ages and stages in your child’s development. These visits are important because they you an opportunity to identify and address any issues and concerns early in your child’s development.

Visits take place:

• following discharge from hospital (home visit)
• 2 weeks
• 4 weeks
• 8 weeks
• 4 months
• 8 months
• 1 year
• 18 months
• 2 years
• 3 and a half years.

Families can access the service at other times by telephone or through a centre visit.

Where to get help

• Your local maternal and child health service
• Your GP (doctor)
• Maternal and Child Health Line Tel. 13 22 29 – available 24 hours a day for the cost of a local call throughout Victoria
• Mercy Health O’Connell Family Centre, Canterbury Tel. (03) 8416 7600
• Mercy Health Woi-wurrung-yagila-wulumperi Whittlesea Early Parenting Centre, South Morang Tel. (03) 9407 6820
• Queen Elizabeth Centre (QEC) Tel. (03) 9549 2777
• Tweddle Child and Family Health Service, Footscray and Werribee Tel. (03) 9689 1577
• Aboriginal Health Service (VAHS) Tel. 03 9419 3000
• Translating and Interpreting Service (TIS National) Tel. 131 450 (24 hours, 7 days) – for callers who speak other languages
• The National Relay Service (NRS) is available to help callers who are d/Deaf, or find it hard to hear or speak to hearing people on the phone
• Nurse-on-Call Tel. 1300 60 60 24 (24 hours, 7 days) – for expert health advice
• Kidsafe Victoria Tel. (03) 9036 2306
• Red Nose (formerly SIDS and Kids) Tel. 1300 998 698 – for safe sleeping information, education, and all other enquiries