Sleep Issues
Do you find yourself nodding off during the day and dreaming about SLEEP? Did you ever think you could be this tired? Are you wondering where your baby gets all that energy at 3 a.m. or why your toddler doesn’t want to go to bed…ever? If your answers are: yes, no and yes, you are probably the parent of a perfectly normal child who may need some help with the phenomenon called sleep.  St. Louis Children's Hospital pursues knowing in everything we do, including helping parents learn how to develop a good bedtime routine and understand the importance of sleep.

What is a bedtime routine and why is it important?
Whether it is called a routine, a ritual or a schedule, it is any process you use on a regular and consistent basis to get your child ready for bed. The bedtime routine you choose should be simple. You should have quiet time before bed, maybe read a book, sing a song or take a bath and put on pajamas.

Not only do routines help prepare your child for bed, it comforts the child and allows him to wind down from the busy day. By being consistent with your routine, you are helping your child develop his own appropriate sleep patterns and behaviors. He will learn to go to sleep on his own and go back to sleep if he wakes up during the night.  Routines will also reduce your stress level as well as your child’s. You will both know what to expect and bedtime struggles will become less frequent.

How to develop a bedtime routine
It is important to remember to keep your bedtime routine simple. By keeping it simple, the routine will be easier for you and your child to follow and deviation from the routine will be less likely. Start by lowering the lights in the house, keeping the noise level down and the environment calm and relaxed. Active play before bedtime may leave the child excited and unable to sleep. The quiet time will help your child unwind from her day and let her know that bedtime is approaching.

One of the most important things to know about children is that they thrive on routine and will do better if the same routine is followed each day for naps and nighttime sleep. Consistency is an important word to remember when talking about kids and sleep. Your child’s sleep pattern will adjust as a result of the consistency.

Tips and strategies


  • Be sure to differentiate day from night. Be active with your child during the day and keep the night calm and quiet.
  • Avoid feeding or rocking to help your child get to sleep. When he wakes during the night he will expect the same service to go back to sleep.
  • If your child wakes during the night, allow him time to go back to sleep on his own. After five minutes or so, you can go in and reassure him that everything is alright by patting him on the back and whispering softly.  Stay less than one minute.
  • Keep the crib safe by not having loose blankets or toys in the crib.
  • Car seat carriers and infant swings are safe for short periods of supervised sleep but are not intended for long periods of time. The safest sleep position for an infant is on his back.


  • There will be ups and downs in your bedtime routine – just remember to be patient and consistent.
  • If she wakes up during the night, a quiet toy or night light is helpful in getting your child to go back to sleep on her own. By using a favorite stuffed animal or blanket, she will have a familiar item in bed to comfort her back to sleep.
  • Limit the use of television before bedtime. The bright, colorful and loud images stimulate children. By taking these images to bed, it will be difficult for your child to fall asleep or to stay asleep.


  • Be aware of bedtime manipulatives such as drinks of water and “Just five more minutes, please.” Be firm and consistent with your routine.
  • Have your child go to bed and wake up at the same time on school days and non-school days. Bedtime should not change by more than one hour from day to day.
  • Regular exercise will burn some built-up energy and help your child fall asleep more easily. Avoid exercise or active play before bed.

When to seek help
When your child has problems with sleep, it can quickly lead to high levels of stress within the home. Specifically, chronic sleep problems place your child at risk for:

  • Behavioral outbursts
  • Emotional meltdowns
  • Decline in school performance

Ongoing struggles over bedtime routines or nighttime waking can negatively impact the parent-child relationship, as well as lead to parent irritability and exhaustion. With these concerns in mind, parents are encouraged to seek guidance from their pediatrician early to avoid developing unhealthy habits. If you find yourself and your child stuck with sleep-related problems, consult with a sleep specialist, such as a psychologist or neurologist, in order to develop a nighttime plan to get you and your child on a more peaceful and consistent schedule.

Suggested reading
Several philosophies regarding children and sleep issues exist. Here are a few reading suggestions; however, it is up to you and your child to find the philosophy that works best for you.

  • American Academy of Pediatrics web site,
  • Berry Brazelton, MD, Touchpoints, 2006
  • Richard Ferber, MD, Solve Your Child’s Sleep Problems, 2006
  • Harvey Karp, MD, The Happiest Baby on the Block, 2003
  • Jodi A. Mindell, PhD, Sleeping through the Night: How Infants, Toddlers, and Their Parents can get a Good Night’s Sleep, 2005


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