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.

Need a SLEEP COACH?

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.

cries so hard she pukes 4
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!

Is there an 18-month Sleep Regression?

Now to the question of the 18 month sleep regression.

You are the proud parent of a toddler (congratulations, by the way!) She started walking at 13 months, started running soon after (!?), and in addition to saying “Ma” and “Da”, has a very large vocabulary of largely gibberish, that she spews forth with the fluency of television talk-show host (I call this stage of speech development “fluent nonsense“).
And though she’s been sleeping like a champ for six months, all of a sudden it went straight to hell. She’s up every 2 hours screaming and banging the sides of her crib.

Need a SLEEP CONSULTANT?

Is this the dreaded 18 month sleep regression or something else?

I’ll cut to the chase: it’s something else.  You see, as I’ve explained here, here, and here, there really is no such thing as a sleep regression (with the possible exception of the illness regression, which we’ll address in a future post), there is only progression through the several developmental milestones. And as Pinky McKay points out, sleep itself is not a milestone (in other words, it comes standard).

18 month sleep regression
IS there a 18 month sleep regression?

Your toddler is charging through some really cool stages of her development, not least language development. She is just on the cusp of beginning to understand that these sounds she’s making relate to real things in the world, and if she strings them together just right, she might get just what she really wants, rather than pointing off into the distances and grunting! Pretty soon she will start acquiring words at a dizzying pace.

Another fun thing that most toddlers have mastered by this age is pretend play. For example, she may give a stuffed animal a cup to “drink” from. This simple act represents a huge leap forward in the development of her mental abilities, her ability to abstract from reality (a fascinating topic in my opinion, but beyond our scope here)

And then there’s teething

Yah. And teething. She’s growing molars and canines.  These are, respectively, huge and sharp teeth. And they erupt through a tiny human’s gums. Now when she’s laying in the crib with no other sensory stimulation other than the feeling of pressure in the most sensitive part of her body… still wonder why she’s getting up at night?

18 month sleep regression
Pure joy, right?

Either one of these developments would be enough to explain night-time awakenings, but these are only two major milestones that could be disrupting your toddler’s sleep. You can call it an 18 month sleep regression if you like, but I like teeth, as they come in handy in life. But why do they have to hurt coming in? (Note to self: must email the Manufacturer about this)

What about nightmares?

Parents often report that when their toddler wakes up screaming at night, she often repeats a word (probably what I call a “word-like-thing”) and points at something, as if she’s scared. And they ask me if she’s having nightmares.  This is an excellent question because the honest answer is ‘no one knows’. The child cannot recount for us what she was dreaming about so I can only speculate. And I speculate that yes, she can have nightmares. I say this because this is an age when many toddlers develop the ability to identify threats and to withdraw from them. So I reason that she may play images of threats she’s encountered during the day.

Night terrors?

Probably not. These are altered states of consciousness that tend to occur in pre-schoolers, starting usually around age 3. And they do not seem to be provoked by any trauma or stressor that occurs to children throughout the day.

While we’re on the subject, many parents worry that their toddler awakening at night screaming might be a sign that the child has been in some way traumatized during the day, out of their sight. As an isolated occurrence, I would say this is probably not the case. There are only three ways that a toddler can express that something isn’t quite right in her world, and most often she expresses her distress in all three of these ways: sleep goes south, she stops eating, and her behavior deteriorates (and I don’t mean the occasional self-limited tantrum, I mean serious scary deterioration. If the issue is isolated to  sleep, I doubt anything worse has happened.

18 month sleep regression
Dads. Enjoy this time while it lasts

Where’d the second nap go?

Here’s another phenomenon that has been mis-labeled as the 18 month sleep regression. This is the age where most children, sadly in my opinion, lose the second nap. I like sleep (obviously) and it makes me sad when there’s less of it during the day. It’s possible that the sleep disruption you’re seeing at this age is related to the fact that the child is napping twice but doesn’t really have to , so she’s staying up too late and getting overstimulated.

Or she’s not quite ready to drop that nap but is staying up during nap time and then she’s massively overstimulated at bed time and her sleep is screwed up.

What to do?

  • First, make sure that what’s going on is not illness.  The good news is that your toddler is now old enough to be able to localize what’s bothering her.  For example, if it’s her teeth, she won’t keep it a secret from you. And if it’s an illness like a cold, she’ll be sick during the day as well, so you’ll know.
  • Follow her sleep signals. By this age, you probably know when she’s ready or not to go to sleep.  The rest of the world might not understand her signals – hell she might not know when she’s tired! But you’ll know. Respect those signals and let her sleep if she needs it.
  • Resist the temptation to allow her to develop a bad sleep association with your attending to her when she wakes up. At her age, she’s at risk of developing a more subtle form of a sleep association that can be described as secondary gain. In other words, subconsciously she knows that if she wakes frequently and cries, she’ll win some quality cuddle time with Mom or Dad.  She doesn’t do this on purpose, but it happens.  I’d avoid it if possible.
  • Remind yourself that this is not an 18 month sleep regression, it’s a positive sign that she’s growing in the way she’s supposed to. Stay strong. This too shall pass!