My child wakes up at night and screams
Child wakes

Dear Dr Justin,

I am at my wit’s end and I’m hoping you’ll have some insight.

My baby was born at 24 weeks and four days gestation, so his actual age is 17 months but his adjusted age is 13.5 months. He has always slept well in his crib, since the first month he was home from the NICU. Even when he started crawling and standing, he slept well.

Three days ago, this all changed. What I’ve put it down to is that he simply doesn’t want to sleep in his crib anymore. He falls asleep on me after his bottle in the living room and when he’s completely asleep, I’ll bring him to his room, place him in his crib and he IMMEDIATELY wakes up crying.  He has always woken up several times throughout the night and he sits up, stares at the monitor light for a bit, lays his head back down on the mattress and goes back to sleep. Not anymore. The second he wakes up, he is full-out crying, tears and all, and wants out.  Neither of us have slept well these last three days (I’m a single mum so I get no relief from night-duty). I feel like he’s afraid of something but I don’t know what. He is getting molars in but I don’t think he’s in pain because he will be fine all day long and he falls asleep with me on the couch or in bed.  I have had to bring him to bed with me one night, and last night, we slept in his rocking chair for a bit and then on the couch.

I don’t know what to do.  If he were sick or if it were his molars or an ear infection, I feel he’d be upset no matter what I did but he’s not. He’s only upset when he realises he’s been put in the crib.
What do you think?
Thank you,
Jen

Dr Justin responds

We all want our children to sleep well. In fact, we rely on it. It is almost impossible to function effectively with consistently interrupted sleep. Being a single mum without that extra support only makes it tougher.

While your suspicions about fear or teething may be relevant, I’m inclined to suggest they are unlikely candidates for the real issue. Teething is a controversial among some with various experts claiming it really does not cause disruption at all. (With six of my own children, I have seen both ends of this, with some children heavily affected and others, not at all.) Either way, if it is a teething issue it will resolve itself quickly.

Fear may be part of the issue, but I suspect that it is a symptom rather than a cause. Your little boy may be waking up afraid, or disoriented, but I believe that this is related to his desire to be close to you as that was where he was when you laid him in bed. Now you’re moving away from him and he cannot understand what you are doing or why you are doing it. While it may not have been an issue earlier in his life, his ongoing development may be creating stronger desires to alleviate separation and stay close. (It’s also pretty normal for children up to around age four to wake up during the night.)

My suggestions are therefore entirely practically oriented, and are built around trying to change his associations with sleep. Right now something has changed. The change is leading to protest. As such, I recommend the following two steps consistently and I would consider that things should be improved within about three days:

Step one

When you place him in his cot, make sure he is awake. One of the problems with putting a child to sleep and then putting him into bed is that when he wakes up and you’re not around he becomes scared. You were there! Now you’re not. What happened? This can cause negative associations with going to bed which means that rather than being relaxing, bedtime becomes a time that he becomes hyper-vigilant and overly sensitive. Ideally our children will wake up where they fall asleep. This means that falling asleep in your arms isn’t going to work so well. Have him fall asleep in his cot.

Step two

Second, pat him off to sleep gently. Once he is calm, you can leave while he is still awake. It’s likely that he will cry. That’s normal. If he is whimpering, you’re probably fine to leave. If he’s screaming, you might try to persist, but if it’s clear he won’t calm down, pick him up, calm him down, and try again. Just remember that he must go down awake.

Important reminders

It’s likely that the first couple of days you work through these two steps, putting him to sleep will take a LONG time. Continue to do it as many times as necessary. After about night three if you are consistent, he’ll get it.

Remember, though, that the idea of this is NOT to make him cry. No one sleeps well when they are upset. You’re simply putting him in bed awake and patting him off, leaving him when he’s calm. If he gets upset, pick him up, hug him, calm him, and try again.

Sometimes children will whimper a bit, and then escalate to crying, and then screaming. Other times, they’ll whimper a little, cry for a moment, let out a squawk, and then settle themselves. Be responsive, but not too responsive. Let him calm down if he can, but if it’s clear he isn’t, then help him immediately.

Your son won’t get what you are teaching him instantly. Very few children do. Going to sleep like this is something that he has to learn to become comfortable with. This is best learnt with lots of love and patient parenting.

Finally, give clear consistent messages. Don’t give up after an hour or after two nights, or you’ll end up back at square one. He’ll think it’s all confusing. His little brain will be asking, “Why put me through all of this and then give me what I wanted in the first place?”

This process is not easy. It requires patience and self-control. It also requires you to be attentive, responsive, and compassionate. But it’s a process that helps you establish good sleep practices and set clear limits around bedtime in a way that is gentle and kind. It will take a few days, so start close to a weekend or at a time when you can be a bit more tired than usual. As you work through this process, you’ll find you’re both more likely to sleep easy.

This article was written by Dr Justin Couslon for Kidspot.com.au and has been adapted for Kidspot.co.nz

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