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Behavioral Approach Best for Dealing With Kids Who Won't Go to Bed

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Jan 21, 2000 (Baltimore) --The best approach to coping with a young child who won't go to sleep is a behavioral one -- such as ignoring the child's crying or establishing a specific bedtime routine, according to Oxford researchers. But which approach to choose, says one expert, depends on the family.

The study, which appears in this week's British Medical Journal, also shows that the use of medicines to help a child sleep works over the short term in some cases, but not over the long haul.

One in five children between the ages of 1 and 3 will experience sleep problems, as will one in 10 4- to 5-year-olds, according the report. "It can be concluded ... that a variety of treatment options are available to healthcare professionals ... but longer term and probably greater overall benefit is likely to be achieved by the use of psychological treatments," writes Paul Ramchandani of the University of Oxford in England, who is lead author of the study.

Ramchandani and colleagues conducted their study by reviewing a series of studies on night waking and problems going to sleep (settling problems) in young children. "The lack of a single most effective behavioral program or method of delivery shows that further research is necessary to evaluate the various treatments (or combination of treatments) for this common and often distressing problem," Ramchandani concludes.

According to Robin Chernoff, MD, assistant professor of pediatrics at Johns Hopkins University in Baltimore, parents are most likely to experience problems with their children in four areas: sleeping, eating, toilet-training, and behavior. "We do not recommend the use of medicines to help a child sleep. We do recommend establishing a routine with your child early on, participating in activities with the child that make them sleepy before bedtime, but not putting them to bed asleep. This helps them to learn self-comfort," says Chernoff.

Chernoff emphasizes that sleep problems need to be evaluated within the context of the whole family and its situation. "If there's stress in the house, if a family member is sick or someone has died, sleep problems are not unexpected. If the child takes long naps in the afternoon, sleep difficulties may be experienced," she says. "It's too simplistic to try to evaluate a sleep problem and formulate a solution out of context."


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