The Importance of Sleep Associations

Sleep associations can be a very important thing for helping your child fall asleep and stay asleep through the night. Sleep associations are what your child has or experiences in the few minutes before they nod off and fall asleep. For my daughter this is her nightlight, her stuffed animal, favorite blanket, the noise from the fan in the hall and her firm pillow. When sleep associations are a constant, they become habit and help her fall asleep.

Night wakefulness is a normal part of the sleep cycle, in between cycles people rouse a bit. Children gradually learn how to nod back off and basically sleep through the normal, brief periods of wakefulness. It can be an easier process if the child has all of their sleep associations throughout the night. When a child is falling asleep in their own space, with their sleep associations that are constant, such as a nightlight or white noise that plays all night, they are much better able to soothe themselves and continue sleeping during the wakefulness. If a child is held or rocked to sleep and then placed in bed, when they have normal night wakefulness, they are much more likely to fully wake and call out because overtime they are dependent on the rocking as a sleep association to be able to stay or fall asleep. If your children are waking and calling out often through the night, sleep associations may be part of the difficulty and are an easy thing to check.

Bedtime Routine Tips

Here are a few reminders to help with your bedtime routine:

  • Same place, same time, same order every night – The more routine you have, the better. In our house, it was and is bath, jammies, teeth, story, bed. As they’ve gotten older, we changed from us reading aloud for 20 minutes, to us for 20 and them reading in their rooms for 20, and that change is the new steady routine.
  • Avoid TV and rough house play – If there are any bedtime or sleep issues, tv and rough house play have been shown to be too stimulating within two hours of sleep.
  • Finish at least the last 10 minutes in their rooms – Avoid finishing the bedtime routine in the living room and carting them off to bed. Ideally, there is time to quietly acclimate to their own rooms.
  • Manage bedtime power struggles with positive discipline – If they stall through the routine, run amok after bath, won’t stay in bed or stay in bed screaming, learn positive discipline. There are so many techniques that can be helpful in these moments such as assertive voice, choices, contribution and logical consequences. If you are struggling, it is time to learn better ways.
  • If there is difficulty, pick a method and stick with it – There are so many ways to approach building healthy sleep habits. If there is difficulty falling asleep or staying asleep, the idea is to pick a method and stick with it. From co-sleeping, to gradual move-outs, to check-ins and cry it outs, each method is designed to get children falling to sleep and staying asleep easily. Learn about these approaches, and then pick the one that best fits your family.

6 Ways to Get Kids to Stay in Bed


I remember with my older daughter Alicen, the night she realized she could get out of her toddler bed, she was up something like 42 times in the first hour. I know, it can be infuriating. There are many options to keep them tucked in at bedtime.

The mantra – This is where you summon your most peaceful self and prepare to take them back again and again. When you do this, you either say nothing, or you say the same thing each time with same tone and emotion. In our house, this was a very flat, “you mut stay in bed.” You also want to strive to take them back in the same way each time. I did, hands on shoulders guided walking each time. Even if they go boneless and sloutch to the floor, you repeat as best you can. The idea here is they are getting out for attention, for a game, and you are not giving it to them. If you choose to do this, you must know that you will stay calm. If you can stay calm and outlast, the next night it is less, and then less again, and then done. If you snap and lose it at time 17 and yell, “I said STAY IN BED!” You have just taught the child, 17 is the goal, that’s when it becomes a game. If you can outlast them, it should be over in a few nights.

A consequence – Using this technique, you let child know, “if you stay in bed, your door can stay open. If you get out of bed, your door will be closed.” If child gets out of bed, you might close the door for one minute the first time and longer on later times. This only works if your child likes to sleep with the door open.

The check-in – This plan reinforces the positive. This is when you say to child at the end of tuck-in, “if you are laying down and quiet, I will pat your back (or come sit with you, sing to you, play with your hair etc.)” Then you leave and just a minute or so later return and say, “you are laying down and quiet, I will pat your back.” When you do, again say and do the same thing each time (or say nothing) and stay less than 30 seconds. Ever so gradually work your way up to longer stretches out of the room. A child who is laying down and quiet for long stretches will likely fall asleep. There are check-in methods like Ferber and Mindell that build this into the regular bedtime routine in a systematic way.

The babygate – We have known many families that when they tuck-in, it’s over. They put the babygate on the door and are done. Child may get out of bed, mill around, call for mom or fall asleep by the door, but it’s still done. Given a night or two they tend to fall asleep in bed. If you are going to do this, the room MUST be child-proof (dressers attached to walls and all).

The stay – This is the family that finishes the bedtime routine, tucks-in and then stays. The first week, you might sit on the edge of the bed with your hand on their back. The next week, sit on the edge of the bed with your hands in your lap. Have a comfy chair because the next week, you move a foot away. Gradually, week by week, you move yourself out of the room. The trick here is to do this with little to no talking. If you engage in conversation easily, this may not work for you. There are gradual move-out methods like Brazelton that describe this in detail.

Tickets – As children are four years old and older, tickets may be an easy answer. The idea is to give the child two tickets (small, cut out, construction paper rectangles) with each ticket representing one request or time to get up. If the child needs a re-tuck, one ticket. If the child needs a drink of water, one ticket. When the tickets are gone, the child stays in bed. Not quite sure why this one works, but often it does.

To learn more about ways to keep them in bed and about other bedtime routines and sleep issues, join me on Wednesday Sept. 24 from 7:00-9:00 p.m. for our workshop on Bedtime Routines and Sleep Issues. For more information and to register, please visit

Bedtime Routines

When they are done consistently overtime, bedtime routines can help children to fall asleep easier. Being structured can also help reduce the push back and power struggles that are common around this time of the day. Here are a few general guidelines.

  • Same time, same place, same order every night. For a long time in our house this was bath, jammies, teeth, story, bed. When there have been changes like my older daughter wanting to shower in the mornings, the change became the new consistent routine.
  • Spend the last 10-15 minutes (at least) in their bedroom.
  • If there are issues with the child falling or staying asleep, avoid screentime and rough-house play in the last two hours before bed.
  • Routines should be at a minimum 20 minutes and a ballpark maximum of an hour long.
  • Building reading into your bedtime routine can be an easy way to hit the Department of Educations goal of children being read to at least 20 minutes a day.

Please comment and share your bedtime routine tips!

Nap Time Question

Parent Question: My three-and-three-fourths-year-old doesn’t want to nap. It takes her time to fall asleep when she does nap, both at bed time and naptime. When she does nap, I would say that, on a 24 hour period, she sleeps 10-12 hours. How much sleep should she be getting in a 24 hour period? How long should her naps be at this age and moving forward? Any suggestions for those days (especially with the holidays around the corner) when she stays up late at night and still wakes up early the next day? Thank you!

Answer: 10-12 hours in the 24 hour cycle is the goal now thru late elementary school. Significantly less than 10 can be problematic, and eight is a low minimum. If it were my house, we would be transitioning to ‘quiet time.’ An hour everyday of playing quietly in their bed which you respect like a nap – same time, same length everyday. You can say, “you don’t have to sleep, just stay in bed and stay quiet.” I would give a quiet activity or book after the first 20 mins or so. If you provide this religiously, the idea is they are still resting, and if they need to should fall asleep. If she naps, think 60 to 90 minutes which is probably plenty. You don’t want it to vary widely from day to day. On really crazy holiday days, plan quiet breaks in the day. Maybe spend 30 minutes in the afternoon snuggling and reading a chapter book or time listening to quiet music.
Sincerely, Dr. Rene

Question about Child’s Sleep

Parent Question: I have a three-year-old who goes to bed at 7:30 p.m., and while he sleeps through the night, he wakes up at 4:30 a.m. and will not go back to sleep. He goes to sleep on his own at night. I have him go back to bed, even if he is awake, and he will generally stay in his room, quiet, for about 45 minutes. He is a mess all morning until his nap. This has been going on for about 9 months. Please advise.

Answer: You are doing the first few things I would suggest, having him fall asleep on his own and having a consistent time. It is good to have him spend quiet time in his room rather than going ahead and getting him up. You might try shifting the bedtime back. Doing this is just 15 minutes a week, so this week it would move to 7:45 p.m., the next week 8:00 p.m. You may not earn the extra time early in the week, but later in each week or the following you may start to get a later wake time. You might also check if it is light or noise and try blackout blinds or a white noise machine. You might also (and I know this one sounds scary) put him to bed like usual and wake him a bit a few hours in. Meaning, at 10:00pm or so, rouse him, just enough to be awake and help him back to sleep. I have heard this is successful in many families in getting kids to sleep a bit longer in the mornings. However, it’s scary because you could just end up with a child who had a two and a half hour nap and is ready to go, but this is supposed to ‘reset’ their sleep schedule and buy you some time. It’s likely worth trying for a few nights to see if it works. You might also push back his morning nap. Meaning if he naps at 11:45 a.m., push it back to 12:00 noon for a week and 12:15 p.m. for a week. I know this is difficult as he is miserable from being up early, but if you shift the bedtime and nap later it may help. By three years old, nap should also be in the hour and a half range; if it is significantly longer it could be interfering with nighttime sleep.
Sincerely, Dr. Rene

Sleep Issues – Children Sharing Room

Dear Dr. Hackney,
I have 26-month-old twin girls. They share a bedroom. One of my twins wakes up crying in the middle of the night a few times a week. In an effort to prevent the twin who wakes up from waking the other, my husband and I usually wait a few minutes to see if the if the crying will stop and then go in to remove the crying twin from the room. It has become increasingly difficult to get her back to sleep. Once she is out of the room, she asks to watch tv or go downstairs and play. She will sometimes stay awake for up to two hours before going back to sleep. She often asks for juice which we give her. How do we get her to stay asleep or help her go back to sleep more quickly when she wakes?
Thank you,
Grace, Mother of Two

Dear Grace,
The first thing to check if children are waking at night and calling out is how they are falling asleep at bedtime. Unless they are co-sleeping, the goal is for children to fall asleep in the same place and by themselves each night. The more able they are to nod off independently, the more likely they are to be able to self soothe if they wake later.

The idea when children wake at night is to do as little as possible. Avoid taking her out of the room. Better yet, avoid taking her out of her bed. Best if you can sit beside her quietly. Being able to get up and play or watch tv is very reinforcing to calling out the next time. I think I might even get up in the night if I knew there was juice and someone to play with. While she may wake the first night or two, hopefully she will learn to sleep through.
Dr. Rene

Scared at Bedtime

Dear Dr. Rene,
I have a three-year-old who recently started having bad dreams and would come into our room in the middle of the night. If I didn’t fall asleep, I would put her back in her own room. Now she’s afraid of her room saying there’s ghosts in there, is  afaid of the dark and literally shakes and screams when I try to put her in her room. She has a nightlight and I’ve ghost proofed the room. I hate to leave her shaking and screaming, so of course back in our room she comes. We also have a new six-month-old.
Please Help,
Mother of two, ages three years and six months

Dear Lori,
The first thing I would do is have a gentle conversation about how her room is a safe place and it is where she should be sleeping. I would have this conversation in the afternoon, not right at bedtime when it is more likely to develop to a struggle. Then, several times in the next few days, I would talk about how safe her room is and how safe the house is. I would talk about how her room is just for her and your room is just for you to sleep in.

Rather than all the fuss and the back and forth, you might opt for the “gradual move out method.” This is on the time-consumming end but gets kids to sleep on thier own with less crying and upset than the check-in methods. For gradual move-outs, you first finish your bedtime routine and you stay, for a week, while she is falling asleep. You sit beside her with your hand on her back. The next week, you sit beside her, but keep your hand off her back. The next week you move to a chair next to the bed. The next week you move the chair six inches away and so on until you are out of the room. With this method, if she wakes in the middle of the night you sit wherever you were at bedtime. By the time you have moved out of the room she has slowly gained confidence and is not needing you. The drawback, this takes some time!

There are other, smaller thangs you might do to help. Rather than you checking her room for ghosts (this sends the message there just might be some), do a room check together to see there are just clothes in the closet and just toys in the box. The language says there are no ghosts and not even a possibility. For a sense of control, you might give her a flashlight that she is welcome to use if she is in bed. You might offer to check on her “more often” if she is laying down and quiet. You might spend more fun time playing and reading in her room during the day.

Whatever you do, if she wakes at night, return her to her room. It is less reinforcing if you fall asleep in her room than her in your room. Her getting to fall asleep with you in your room strongly reinforces trying again the next night.
Dr. Rene

>Excuses for Sleep

>Hello Dr. Hackney,

I have a 3 ½ year old and a 2 ½ year who share a room. We have a bedtime routine of bath time and reading two to three books. My husband and I then try to put our kids to bed by 8:15. The problem we are having is once we put our kids in their beds, they try to come up with every excuse not to go to sleep. They cry, they ask us for milk, they want to tell us something, and then they repeatedly get out of their beds for about an hour. My husband I try to be firm and put them back in bed. We also will try to comfort them when they are upset. Do you have any suggestions they could help with our getting them to go to bed?

Thanks for your help,
Tricia Eckert, mother of two

Hi Tricia,

Consistency may be the key. Right now, you “try” to put them back in bed, and other times, you comfort when they are upset. They are likely finding ways to either keep you in the room or at least keep your attention.

Proactively, you might lay some ground rules, such as they can have one cup of water by the bed but no getting up or having milk. You might also do a bed check by asking, “Before we tuck in for the night, is there anything else you need?”

If you decide to repeatedly put them back to bed, you must do this in a consistent and low-key way to curb behavior. Being a broken record in these moments requires you to develop a mantra and maintain your cool. The broken record repeats itself with no changes in delivery. This is seen as being one of the better ways to break your child’s habit of getting out of bed over and over again. When we switched my daughter Alicen from the crib to a toddler bed, she got out over forty times before she fell asleep the first night. Each time, I said in the same tone, “You must stay in bed,” and guided her back in the same way. The second night, in took about twenty times, and the third night, it then took eight, and it was over. Occasionally, that behavior came back, but with a consistent response, it never seemed out of hand again. Be warned, if you are going to lose your cool at time seventeen, don’t even start. What happens if you get to time seventeen and then yell at the child, take them roughly back to bed or stop to comfort them? You reinforce the behavior because they got your attention. Seventeen is the new goal if not longer because they found your breaking point.

You might also try to reinforce the behavior you are looking for. At the end of the bedtime routine, as you tuck them in bed and say, “If you are laying down and quiet, I will come in and pat your back.” Leave the room, but if they are laying down and quiet, go back in within a minute or two, and pat their back. Do this with little language, and stay less than 30 seconds, and then state, “If you are laying down and quiet, I’ll be back to pat again.” Each time, stay gone a bit longer. We did this years ago, and I still check on the girls every 15 minutes or so to pat. It doesn’t have to be patting, it can be to “sit with you, rub your back,” or whatever you think would work best.

Rene Hackney, PhD.
Parenting Playgroups, Inc.

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