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DEAR PIP: We really struggle with worries at bedtime.

Updated: May 14, 2022

Our 9-year-old comes into our room in the middle of the night. Any suggestions on how to break this habit?

Sleep anxiety in children is a real thing. Some studies have shown that 20-30% of kids face anxiety at night. I am a huge believer in root causes so the very first thing I would determine is what is causing the anxiety. Is it a fear of the dark? Monsters under the bed? Being alone? Wetting the bed? The solution could be as simple as solving the fear. Finding a calming night-light, keeping the closet door open or closed, etc. But if there is nothing specific about the anxiety, I would consider one of these points from a blog by the Children's Hospital in St. Louis...

Don’t skip the pillow talk: Sit on your child’s bed or snuggle beside them and talk about whatever is on their mind. Set limits– when you say it’s time to go, it’s time to go. Don’t give into whining about “don’t leave” or “sleep with me all night.” Tell your child in advance that you want to spend some special time with them but that you can’t stay too long. Then listen. Try not to talk too much. Sometimes the listening alone will allow your child to solve their own worries. Every once in a while you get a chance to give them the wise words they need to hear, and you’ll be their hero.

Allow your child to self-regulate his or her bedtime:  Your job as a parent is to put your children to bed– not to make them go to sleep. Keep wake-up time consistent with an alarm clock. If a child can’t sleep, allow him or her to read in bed. Keep the room lights dim or off. If your child needs a reading light, buy a clip-on LED reading light.

No screens before bed: Avoid all digital devices for at least an hour before bed, preferably two hours. The blue light emitted from screens can inhibit the body’s natural melatonin release.

Consider melatonin: Short term melatonin supplements can be an effective way to get a child sleep cycle back on track. Melatonin is a natural substance produced by our bodies that gives us that “oh so sleepy” feeling. You can also trick your body into natural melatonin release by keeping lights dim and blocking natural light before bedtime. Melatonin can help kids fall asleep, but it doesn’t do much for kids who wake up in the middle of the night. There are risks and limitations to melatonin use, and you should talk to your pediatrician before using this over-the-counter supplement.

Teach your child to give their worries away: There is a tradition in Guatemala of teaching children to give their worries to little colorful dolls called worry dolls or trouble dolls. Children can tell the dolls their worries and then put the dolls under their pillow. According to legend, the dolls then worry for the child while the child sleeps peacefully. You can buy these inexpensive dolls online, or just use the same idea of teaching your child to “give away” his or her worries to an inanimate object such as a stuffed animal or a doll you already own.

Routine, routine, routine: Remember that toddler bedtime routine of bath, brushing teeth, story, etc? Your school age child still needs a bedtime routine. Find what works for your family and stick to it.

Don’t skip the story:  A bedtime story can refocus your child’s mind in a positive, imaginary world, and help them forget their worries. Reading out loud to children has been shown to improve vocabulary and be beneficial to development, and bedtime is a perfect time to read to kids. There are also some neat books that talk about nighttime anxieties.

Get rid of the stimulants: Avoid caffeine and energy drinks, and beware of hidden stimulants in chocolate and second-hand smoke. Anxiety and sleeplessness are side effects of many medications, including over-the-counter cold medications and ADHD medications. If you think your child’s medications are part of the problem, be sure to call the prescribing physician before you stop them.

Regulate the fluids: Getting up in the night to use the bathroom is a common sleep disturbance. It seems simple, but your child might just need a reminder not to drink anything after dinner (except while brushing teeth), and to use the toilet before bed.

Call your pediatrician: Your primary care pediatrician will help you rule-out medical causes of sleeplessness and anxiety, including sleep apnea, allergies, snoring, medication side effects, and much more. Your pediatrician can also provide anxiety medications and may be able to treat uncomplicated anxiety without a referral to psychiatry. If necessary, your pediatrician can make a referral to a sleep center for a sleep study or other tests.

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