Set Limits at Bedtime

I have mentioned several times how important it is to set limits on toddler behavior around bed time. But I haven’t fully explained why limits are so important to parenting in general and to bedtime routines in particular.

Why You Need To Set Limits: The Dark Room Story

I want you to imagine you live in a large room. The room is completely dark. No lights in the ceiling, no lamps, no pocket flashlights. Complete darkness.
You need to move about in this room, so what do you do? You walk slowly with your hands out, feeling for the walls. When you find the walls you keep a hand on them as you move to maintain your balance and to keep you from banging into anything. You need to know where the walls are in order stay oriented.

There’s one more important feature of the dark room. A guardian holds the walls in place, making sure they do not move.

The Walls of Can Do and Can’t Do

For a toddler, the world is one big dark room.

There are several sets of walls in the child’s room. Maybe we can think of them as boundaries. One is a literal set of walls, gates and safety locks that keep a child from harming herself. And another set is a metaphoric set of walls: the walls of proper behavior.

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A child has a natural desire, probably innate (created or evolved, as you prefer) to know what is and is not okay to do. She doesn’t ask for reasons and explanations, neither does she need them. The need to know why things are right and wrong develops later in childhood.

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This need has two desires: to know the “location” of the boundary between okay and not okay, and to know that the boundary is being guarded. Very early in life the child designates a “Setter of Limits”, usually one parent (although some children look to more than one person as a designated limits setter.)

The Guardian Nods

Now, back in your dark room, imagine that the guardian of the walls goes to sleep and the walls magically move or worse, disappear. What happens when you reach out to feel for the wall and it isn’t there? For certain you will become disoriented. You may feel as though you’re lost in your own room. That’s an anxiety-provoking situation!

This is what happens to a child whose designated limits setter either cannot or will not set limits and enforce them. Rather than feeling liberated and elated, the child is more likely to feel disoriented, lost and anxious. Children need to know that the boundaries of right and wrong are being guarded by you just as much as the person in the dark room needs to know that the walls will stay in the same place.

Testing the Limits

This is why children test their parent’s limits. This is why they stare fixedly at you as they slowly push the bowl of cereal to the edge of the high chair and over on to the floor.  They are looking for a particular response from you. And the response they are looking for is “No. Do not do that.” Then she smiles and laughs.

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It’s around here somewhere…

So what is the smile and the laugh all about? Are they being little devils? Are they just bad kids? No. Neither. The smile is not the smile of impishness, it’s the smile of true happiness. The child is happy that she has reached out and felt the wall. She’s happy because the walls are being guarded. She feels safe and secure and happy.

Again and Again and Again and Again

OK, wise guy, you say: if all she wants to know is that I’m guarding the walls, how come she has to knock the bowl over repeatedly? Doesn’t she get the message? Why isn’t she happy with one demonstration and leave it at that?

This is because of another endearing feature of our little ones: their pleasure response does not dampen easily. If you make a funny face that amuses her, she will laugh. Then if you stop and make the same face. She’ll laugh again. Try it: toddlers can keep this up for an hour. You’ll get bored with it long before she does. They never get tired of pleasurable stimuli. This is why they test limits repeatedly. It feels good to know you’re there and you’re in charge.

Now, what happens if the child knocks the bowl of cereal off the table and the limits setter just shrugs and ignores it? Wait, she says, You were supposed to say “No! Don’t do that!” Why did you stop guarding the wall? Even if you are totally bored with the game, you must play it or risk confusing her, or worse, making her anxious. If you truly are bored, or exasperated, you must “set limits on the limits setting”, and divert her attention to something else. Pick her up from the high chair. Distract her with some new activity. Anything but abandon your limits setting post!set limits 3

Set Limits at Bedtime

The same principle apply at bedtime. You’ve paid attention to her cues and figured out at good time to begin the bedtime routine. Everything that happens between dinner and night-night is regular and predictable. Now is the time when she may test the limits because she’s tired and she really really needs to know that you are there guarding the boundaries of her world. More so now than perhaps any other time of day.

  • When she tests the limits, give her the answer she wants to hear (“no”) calmly and matter-of-factly.
  • Try hard not to deviate from your routine. Toddlers do better with routines. People do better with routines! Start the routine at dinner, or one hour before bed, which ever is longer.
  • If you think you are going to lose your cool and you can’t take any more of her limits testing, re-direct her attention elsewhere. Trust me. This trick works!

My Baby Cries So Hard She Pukes!

Help! I don’t know how to handle my toddler at bedtime! She cries so hard she pukes!

Ah, Toddlers! Such clever creatures! How on earth did they figure out that they can delay bedtime by massively throwing up all over the crib?

I wonder sometimes if there is an International Toddler Convention at which they come up with ideas like this. Imagine what the brainstorming sessions must be like:
“Ooooh! Ooooh! I know! We could light the house on fire and that would activate the fire alarms and then we wouldn’t have to go to bed!”

“I have an idea! Let’s massively throw up all over the place and then mom has to change the sheets and we don’t have to go to bed!”

“Sheer genius. All in favor?…”

Why She Cries So Hard She Pukes

Appearances to the contrary notwithstanding, toddlers really don’t share ideas. Certainly not at international conventions (but wouldn’t it be neat if they did?) It only seems that way. The truth is more prosaic: babies and toddlers are more likely to throw up when they get upset than adults are.

So when your toddler throws a tantrum in the crib and cries so hard she pukes, it does not mean that something is terribly wrong, or that’s she’s sick, or that you’ve scarred her psychologically. She’s only doing what she tends to do.

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But when mom, having heard the retching, rushes in and makes a big scene, the toddler may say something to herself that goes something like this:

“I’m not really sure what just happened, but look at this reaction from mom! I’m gonna do this again!!!”

Secondary Gain

What starts out as a gastrointestinal accident can quickly develop into a habit. This is especially so if mom or dad makes a big show of emotion and pays a lot of concentrated attention to the puker after the event. This is what the psychologists call “secondary gain“. The toddler doesn’t get much benefit from throwing up. Very few people do. However, she gets a fair amount of benefit from the aftermath! She gets to delay bedtime and she gets attention from mom!

The Sears Way

Dr. Sears recommends that you try to identify the trigger for the tantrum and then to engage in “holding therapy”:

Hold your child in a relaxed and comforting way (even if he squirms) and reassure him with the most soothing voice you can muster. The message you’re trying to convey is that he’s lost control and you’re there to help him regain it. Later in life, when your son is past the tantrum stage, his memories of calm during the stormy behavior will prove valuable.

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Not sure what I did but I’m gonna do it again!!!

Well… First, we know what the trigger is. The child is ticked off that it’s bedtime and she has to go to sleep. Second, holding therapy is giving the child exactly what he wants: relaxed comfortable holding with a caregiver. Who doesn’t wan’t that? I’m not sure how this solves the “cries so hard she pukes” problem. To the contrary. It’s only likely increase the odds it happens again tomorrow night.

The Obleman Way

My colleague Dana Obleman has a much more practical, and in my view, effective way of dealing with the bedtime puker. Dana recommends standing your ground and insisting that bed time is bed time and no amount of tantrum-induced throwing up is going to cause you to deviate from the routine!

Although you might feel like she will continue doing this forever, creating chaos and piles of laundry, the truth is that when she sees that it doesn’t change what she’s allowed or not allowed to do, she will stop. If the problem occurs at bedtime, just matter-of-factly clean up the mess, change her pj’s and stick with the routine. She should stop within a few nights once she gets the message.

Exactly right.

The trick is to do all this “matter-of-factly” as Dana says. No emotion, no comment, no “holding therapy”. If you avoid all this there will be no secondary gain. And the behavior will go away.cries so hard she pukes 3

Limits setting

I can report from bitter experience that consistent limits setting and enforcement was one of the toughest things I had to do as a parent. And here’s something even tougher to do: understand that your children need you to set and enforce those limits! Without clear boundaries that are guarded by vigilant caregivers, children tend to be more anxious less secure in their world. Don’t set limits for the sake of the laundry, do if for the children!

Breath-holding Spells at Bedtime

One of my most memorable clients is a 15-month old girl who threw tantrums at bedtime. Recently she had begun crying so hard she began breath-holding. One night in particular, she held her breath so long she collapsed. Her mother became so scared she called 911.

The little girl was fine. She woke up moments after collapsing, but it was too late for the 911 call. EMS was already on the way. When they heard the story, the paramedics and the doctors immediately understood what had happened. They had received many cases of breath-holding spells where someone panicked and dialed 911. But there was one funny twist to this story: mom witnessed the entire episode and she swears the baby’s lips did not turn blue before she passed out. She was quite sure the baby stayed her usual (somewhat pale) color throughout.

Breath-holding Spells

Of all the “normal things” that can happen to our children, breath-holding spells have got to be the scariest.  They are triggered most often by temper tantrums, but they can also occur when the child becomes suddenly frightened, frustrated or any other form of emotional upset.

They cry so hard they actually stop breathing. And anyone who stops breathing long enough will eventually faint from loss of oxygen to the brain. The good news is that as soon as the child faints and falls down, she starts breathing again, and “wakes up” often a moment later. Sometimes the child’s body will jerk briefly, causing witnesses to believe the child is having a seizure. These are myoclonic jerks, not seizures. These fainting spells are not harmful to the child and there are no lasting effects whatsoever.

Here’s the important point: the child is not doing it on purpose! It’s actually very difficult to make oneself pass out purposefully. Certainly no toddler can do it.

Tears Before Bedtime

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She’s holding her breath

I hear a lot of stories from parents of toddlers who perform a consistent bedtime routine, at the same time every evening. But it always seems to end with the toddler dissolving into tears the moment she’s put in the crib, or when a parent leaves the room. In cases like these, the crying has become part of the routine! The toddler (and the parents) know the sequence: dinner, bath, PJs, book, bed, cry… then pick the child up, put her down, more crying, etc. Clearly, this isn’t the bedtime routine anyone wants.

This is the time to sit down and re-think the bedtime routine. Is the toddler really tired enough to go to sleep? It makes sense to keep a log of the number of hours she sleeps. At 15 months, she should be getting a total of 12-14 hours, 11-12 of which happen at night. If the toddler has had an afternoon nap, perhaps late in the afternoon, it could be that she’s not ready to sleep at the prescribed bed-time. In that case I recommend pushing the bedtime routine later in small increments, say 15 minutes at a time.

What if there has been too much time between the last nap and bedtime? Perhaps the child is overstimulated (some say “over-tired” – I say it’s the same phenomenon: tired brain). Or the child is overstimulated because her day is just too full of sensory overload? In these cases, it may be time to change things up.

Mid-course Correction

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No more sweets, please!

Very often, in the course of a consult, the parents and I can identify some factor that we can adjust, and test to see if it has effect on bedtime tears.  Reducing stimulation is easier said than done, but it is often helpful. Paying attention to the child’s diet can be important as well.

Do you give her juice? You don’t have to. In fact, you shouldn’t! Juice is not fruit, it’s sugar-water. Better to have her drink water. The same goes for sweet cereals and snacks.

Some children are sensitive to the things that are added to processed foods, such as dyes, flavorings, and other additives. Very few children I know of react badly to real food. By “real” I mean food that resembles the thing that came out of the earth or the livestock pen.

Limits setting

It’s also possible that the toddler may tantrum at bedtime (even to the point of breath-holding), because she knows this will delay bedtime. In cases like these, I recommend that parents become actors. They need to pretend that they are not fazed at all when the child passes out. This isn’t easy to do, and should be considered a last resort. But just as you want to avoid bad sleep associations, you want to avoid convincing the child that breath-holding is an effective way to get you to stay with her. Like any behavior you want to modify, limits setting and enforcement are key to raising a happy, secure child.

Back to the Twist

What about the 15-month old who didn’t turn blue when she fainted from breath-holding?

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Diet matters, folks

Because the EMTs took her to the emergency department, she had blood drawn. One test showed that the girl was severely anemic. Anemia is known to be associated with breath-holding spells. She was so anemic that she didn’t have enough red blood cells to turn blue when she passed out!

The anemia in this girl’s case was due to her diet. This girl drank about 40 ounces of whole milk per day. She ate very little or no food. Why should she? She was full of milk! In about 40% of infants, drinking cow’s milk causes them to lose small amounts of blood through their gut. Since this girl drank only cow’s milk, she became profoundly anemic as a result.

This girl’s anemia, and her breath-holding spells, were cured by taking her off milk and giving her an iron supplement.

So this breath-holding story had a happy ending. Virtually all of such stories do. The behavior goes away in a few months. If you have any questions or concerns about breath-holding, or if you are having a difficult time managing these episodes, consult your pediatrician.

 

 

Bedtime Ritual: How to Set Limits

For Boy#1, I ran the bedtime ritual.

“Bedtime” began at dinner. We’d eat, where the challenge was to keep a reasonable amount of food on the table. Then we’d have a bath, where the challenge was to keep more water in the tub than on the bathroom floor. Then we’d change into pajamas which was surprisingly free of challenges.

The real challenge happened at book-reading time.

I loved book reading time. I mean I really loved it. I loved how we sat together on the floor. I loved inventing voices to read the various characters. I loved how he sometimes crawled away to play with a toy but was clearly listening carefully (when he got older he would correct me if I made a mistake). But there was only one problem with book reading:

He wanted me to read every book on his shelf.

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Sometimes I’d nod off during book-reading

This was a problem. I was usually exhausted as well by bedtime and I especially ran out of energy at book-reading. After the third book I would sometimes nod off in mid-sentence. Also his bedtime was 7PM: extended book-reading time sometimes pushed us closer to 7:30.

I began to realize that perhaps Boy#1 was doing this on purpose! He wanted me to read more books so as to delay going to sleep. He must of known that I loved reading to him. I was a pushover when he would ask for another. But things were getting out of hand. We were risking messing up a good thing: a consistent, regular schedule.

Something had to be done.

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The Importance of the Bedtime Ritual

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…and so to bed

As I never get tired of saying, consistency is everything. Children thrive on consistency. I also never get tired of stressing the importance of healthy sleep, diet and exercise. But even when I say this, what also I mean is consistent sleep, diet and exercise. I find that when a child’s day is regular and predictable, they sleep better than when the schedule is erratic or unpredictable.

Perhaps I am projecting here: I’m a creature of habit. I ate the same sandwich for lunch for eight years. Fortunately, other experts agree with me. And the principle certainly has held up in practice. I find that clients who find the way to introduce more consistency, regularity, and predictability into a child’s day are rewarded for their efforts with better sleep.

Pick Your Battles, But Set Limits

Another important principle of parenting is limits setting. I believe firmly that children do better in life with limits that are clearly defined, and just as importantly, enforced. But, as any parent knows, you can set limits on practically everything. For example, in my own bedtime ritual, there was the challenge of dinner time. I could have tried to set a limit on how much food ended up on the floor, but this would have been a practical impossibility for my toddler. I could have tried to set a limit on the splashing in the tub (and as he grew in size and splashiness, I did). Instead, what I did was pick my battles. You have to pick battles or you risk disciplining your child during every waking hour.

There are some obvious places where limits setting is essential. These are things that have to do with safety. You obviously need to set limits on running toward the street, or bolting away from you in a crowded place. After this point you need to prioritize your values: what matters most to you? Those are the things that you should consider setting limits on. But do yourself and your child a favor: pick your battles. You’ll give your kid a break and it will be less stressful for you as well.bedtime ritual 1

How I Set Limits on the Bedtime Ritual

So rather than end up face down snoring in the pages of “Barnyard Dance!” every night, I decided to take action.

I began book-reading with a declaration: “Three books!” I would announce. Then I’d let Boy#1 pick which books we’d read. I’d do the best job I could on those three books, making sure did the most dramatic readings, and of course, the character voices.

I confess to surprise at how well this worked. Boy#1 knew what to expect. There would be three books only. It was predictable. He got to pick the books, so he had some “ownership” in the process. And when it was done he’d get into bed without a fuss.

 

How to Get Your Toddler to Sleep in Her Own Bed

Half the battle is over: You moved the baby from a crib to her own bed.

Well… let’s say that one-quarter of the battle is over. Now you have to figure out a way to get her to sleep in her own bed. Maybe you’re one of the lucky few whose sweet little angel sleeps all night in her brand new bed. Not likely, though. Here’s how to close the deal:

How to Get Your Toddler to Sleep in Her Own Bed

Step One: Lay the Groundwork

If possible, let the toddler know her “big girl/big boy” bed is coming. This may not be possible if you had to buy the bed in a hurry on the day she climbs out of the crib for the first time. But if you do get the chance, let the little one know that a terrific present is coming. If she can stand it, you might even go shopping for the bed with her. Be as positive about the event as possible. If you are genuinely enthusiastic about the toddler bed, she’ll pick up on your enthusiasm.

Some parents score by buying the bed and setting it up in the toddler’s room before she makes the transition. You might even have her try to take a nap in it. This is a similar technique that works in toilet training: you introduce the potty long before the child actually sits on it to poop! In a similar way, the toddler bed becomes an “acquaintance” before it becomes a “friend”.

What if There’s No Time to Lay the Groundwork?

What if one day you hear “the thud” followed by the cry of the frightened toddler who didn’t realize it was that far to the floor when she climbed over the rail? No time to introduce the bed (although there may be time to shop)? In this case, you may need to rush the process of introducing the her own bed… like down to less than a day. Your toddler might not like the idea of such a dramatic change. I understand.

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But changes happen in her life, often suddenly and she always adjusts. This time will be no different.

Step Two: Be Consistent

One thing doesn’t have to change, and that’s your bedtime routine. For me, the “bedtime routine” begins at dinner. After that time, every single thing that happens is regular and predictable. Dinner should be at the same time. Bath at the same time. Book reading at the same time. Everything. Consistency is the key to troubleshooting any sleep issue and this one is no different.

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They’re not sleeping, but they’re happy!

As long as you are staying consistent, it is best to use the same mattress she slept on in the crib, with the same sheets and bedding. Most toddler beds are designed to accommodate a standard crib-size mattress. Perhaps you had already splurged and purchased a crib that converts to a toddler bed. Even better! The point here is that the surface the toddler lays on will feel exactly the same as the crib. This is important to her keeping good sleep associations. You might even consider placing the toddler bed in the same place where the crib stood.

Step Three: Set Limits

If you have a perfectly normal bedtime routine and your little one drifts off to a blissful sleep, then you’re done. But more likely than not, your toddler is going to want to get out and find you at night. Most likely this will happen sooner rather than later.

If you have not done so already, this is the time to baby-proof your house. Gates should be placed on stairs. Cords and outlets should be safely secured and out of reach. Every item of furniture that could be pulled down, including chests of drawers, should be secured.

If you haven’t gotten into the habit of setting limits with your child, this would be a terrific night to get started. The first limit ought to involve your bed. Just because the little one has her own bed, doesn’t mean she can sleep in any bed, least of all yours. Now, some parents are fine with this and I cannot judge them. However, if any or all occupants of the bed are not okay with this arrangement, then it’s not okay, period! Also ask yourself if you still want the little one in your bed in four months. Or what if there’s a new baby coming? What if the new baby has already arrived? Clearly, a limit should be set.

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Now THAT’S what I’m talkin’ about!

The limit goes something like this: “You’ve got your own bed. [Partner] and I have our own bed. Everybody sleeps in their own bed!” Simple and matter-of-fact. No reasoning and explanation is required. If you do not know already, you should know that your toddler does not care about reasons! All she wants to know is: What are the limits and are you (mom) going to enforce them?

Step Four: Enforce Them

Here’s the toughest part. Once a limit is set, it’s got to be enforced. Among the worst things you can teach a child is that the limits you set are phony and you aren’t really serious about them. Children who grow up without enforced limits are more anxious and less happy. They may not show it, but they need limits! Kids test limits not because they are unhappy or imp-ish, but because they need to know that the limits are there and are being enforced by the “Limits Setter(s)”.

Every time she gets out of bed and comes to yours, you should bring her back to her own bed. The tough part of this act is doing it calmly and without emotion. I cannot stress this enough. Remember: no explanation or reason is going to help. It’s just wasted breath. Your toddler is never going to say to you “Gee, Mom! I never thought of it that way! Thank you for explaining it to me”.

Step Five: She’s Got Her Own Bed, Now She’s Got to…

When you return her to own bed, the routine should be the same. Brief, matter-of-fact, and to the point. This is much easier said than done. Your toddler’s main job in life is to find the chinks in your armor and plunge through them. Maybe she’ll ask for water, or a bottle (don’t get me started on this one!) It will be tough, but you are tougher. Stay firm, stay calm, and stay consistent.

The Easier-Said-Than-Done List

  • Be Consistent: Keep the entire bedtime routine exactly the same as it was when she slept in a crib.
  • Set Limits: Everybody sleeps in their own bed. Children thrive on limits. Without them they are lost.
  • Enforce the Limits: No limit is any good if you don’t enforce it. Remain calm. Take deep breaths. And enforce the limits you set. You’ll be glad you did. So will your toddler.