Sleeping FAQ: 12-18 Months – Night Waking

What can I do for my 16mth son who wakes and cries for up to 4 hours at night?

I am at my wits end and feeling very depressed as my happy little 16month old wakes in the night for sometimes 4 hours shouting, screaming and crying. It has been going on for a couple of months now and occurs usually every other night. Sometimes he doesn’t wake during the night but will wake around 6.30am – which is fine. I can then do the same thing each day and the next night he will wake around 12.30am and not go back off to sleep. He gets in a right state with coughing, screaming etc. I have tried both not going in his room and going in and doesn’t seem to make any difference. He is healthy at the moment although suffers from many coughs and colds and has been in hospital as gets asthma with colds – but the waking is when he is healthy and not from being ill. I am not happy to just leave him to cry as he doesn’t stop plus he is in such a state he will not just go back to sleep. I don’t pick him up unless I have to give him water as he then gets thirsty or if I have to give him some Medised. I also sometimes check he isn’t wet when he is in his cot as sometimes he has been and will change him. I am not happy to just leave him for hours without going in as in the past this hasn’t worked and I also not happy to leave him as sometimes he can get in a state and coughs and be sick I also believe he will not go back off once he has got like this. I am at my wits end as feel I do everything right yet failing. I think it may be to do with the day sleep e.g. not enough/too much/wrong time so working on this as will push sleep to 1pm to 3pm. Also not sure if I should swap tea and lunch around as all he will eat for tea is a sandwich and some chicken/meat so wondered if I should give his sandwich at lunch and his meat and vegetables at 5pm so he has a better tea to go to bed on? Your help and speedy response would be appreciated as I am feeling so low and down and I cant cope with this sleep deprivation and I am near to tears most of the time and getting cold sores, ulcers and have to work and have exams etc.

My son eats three meals a day: He is not that keen on breakfast but is offered cereal with milk, fruit and raisins and sometimes offered toast. Lunch is a protein meal of chicken, lamb or beef with vegetables including broccoli, peas or baby corn. Yoghurt is then offered. Cheese and a rice cake are given as a snack. Tea; my son is fussy at the moment and so dishes I offer such as pasta, rice or soups are rejected. He usually has a mini Dairylea sandwich, homemade burger or chicken pieces. This is followed by a milky pudding or similar and a rice cake is wanted. My son drinks milk from a cup. He takes 5-6ozs in the morning and 7ozs in the evening at 6.30pm. He drinks water at 9.30am, 3pm and 5pm. He has well diluted juice with his lunch.

My son naps at 12.45-2.30pm.

Finding a reason why these wakings are happening will help you deal with them. A child who is having too much sleep by day may wake in the night and be unable to get back to sleep, but they are less likely to be quite as upset as your son is. They would want to play with you when you are in the room, whereas your son seems distressed whether you are there or not. This could indicate he is chronically overtired through these repeated and long night wakings. Overtiredness can cause a baby to be more likely to “partial wakings”, which can happen when a child is passing from deep sleep into a lighter one. It is as if they get caught between the two stages. This results in his body being active but his mind is not. Your son may not be responsive to you trying to comfort him but by being there, and using the same reassuring words each time, you will be able to settle him back to sleep again without him waking fully and becoming so distressed.

At this age a toddler is using up a great deal of both physical and mental energy: walking, climbing and learning to talk. He wants to be on the go all day long, and may get a “second wind” after his bath so is completely exhausted when he goes down to sleep.

Many toddlers are too tired at teatime to eat their main meal of the day. If they have only had a sandwich at lunchtime and then do not eat a proper meal at 5pm through tiredness, they are likely to wake in the night through hunger.

Keep trying different finger foods with your son at teatime. He needs a meal which is high in carbohydrates. He will need a portion of protein at this meal, too, so by offering chicken, beef burger or cheese he will be getting this but he also needs some fillers. This can be difficult if your toddler goes through a fussy phase. Most toddlers of this age will enjoy eating with their fingers so use a wide variety of breads, such as wholemeal, granary or sunflower as well as pita breads, muffins and rolls to make him sandwiches and mini pizzas. Use a variety of toppings and fillings. He may be willing to eat small pieces of frittata or omelette which you can fill with diced meat and vegetables. Try different shapes of pasta covered with melted cheese. This can easily be eaten with the fingers. Rather than making a whole pasta dish cook a spoonful as finger food for him and you may find he is more willing to try it. Toddlers do like small portions of a variety of food. They are able to see what they are eating, especially if most of it is finger friendly. Use sticks of cheese or bread sticks in dips such as cream cheese and avocado, hummus, even a thick cheese sauce. Giving him easy finger food which will help fill him up but be easy to eat should help him have a good tea. You may like to try him with organic, sugar free baked beans which he could eat along with toast fingers.

Keep a detailed diary for yourself of everything your son eats and drinks, how much daytime sleep he has and whether he wakes in the night or not. Use this to get an overall picture of his week. By looking at the whole picture over a period of time you will be able to see if there is any pattern emerging which could indicate certain foods which may be causing a problem, or the relationship between the quantities of food he has at tea and how well he sleeps.

Your son has already dropped his morning nap. If this coincided with the beginning of his night waking, then overtiredness is definitely the cause. Getting the daytime sleep needs right at this age can be tricky. Moving his daytime sleep on to 1pm could help but, as he is awake for long stretches in the night and not napping in the morning, he may be happier with going down between 12.30/12.45pm. He is waking early in the morning so may well be tired before 1pm. You may need to juggle with the amount of time he needs for this daytime nap. Some toddlers need a full two hours until well over 2 years old, whilst others may cut back to 1.5hours before their second birthday. Whilst he is still waking in the night give him quiet times in the mornings, especially if he is very physical and walking everywhere. You could put him into his cot for 15-20minutes, around 9.30-10am, whilst you tidy round in his room. He will be resting in here, even though he no longer sleeps in the morning. Depending how long he sleeps at lunchtime you may need to build another quiet time into the afternoon, just before tea, when maybe you enjoy 10 minutes looking at a book together.

Make sure that after tea you begin to wind down your son’s day. Make his bath and bedtime slightly earlier, especially if you are aware that he is exhausted by the time he goes to bed. It is better that he chats to himself for 15-20minutes than falls straight to sleep. Keep things very quiet after his bath and discourage too much walking about afterwards.

Encourage your son to have a favorite toy with him at bedtime. Find a soft, cuddly toy which he can snuggle down with. If he does not already have a comfort object making sure he is tucked up at night with the same toy will help him feel secure. If he wakes at night make sure this special toy is tucked in beside him again so he gets used to having something to help him settle.

To get your son back to sleeping through the night will mean a period of sleep training. Your son has now been waking for some length of time and obviously you have tried different ways to get him back to sleep. He now needs a consistent approach each and every time he wakes. The two ways to sleep train at this age are controlled crying or gradual withdrawal. Since he becomes very distressed and is asthmatic the gradual withdrawal is probably the best option for you both. This should involve less crying on his part, but it can take longer and you do need to stick with it each and every night.

Before trying any kind of sleep training have your son checked over by your doctor. If he is unwell with a cough or cold you should not attempt any sleep training until he is completely well again.

Go into him when he first begins to cry. Lay him back down in his cot and stroke his head. Tuck him in well and keep using the same words, “It’s all right, it’s night time now, time to go to sleep”. If you do this as soon as he starts to cry he may settle back far more quickly than if he fully wakes himself up and gets into a state. Since this waking at night has been going on for two months now you know he is not going to settle himself back alone, so it is better to go straight in to him once you hear him crying. If he lies down and is quiet then sit near to his cot but don’t keep talking to him. If he stands up again and begins to cry, first tell him simply, “Lie down, it’s night time, it’s time to sleep”. If he remains standing then lie him down and use the same words again. It may take some time for him to settle on the first night but by you remaining in the room and using the same words he will begin to feel reassured. Leave the room once he has fallen asleep. The next night if he wakes again, do exactly the same thing but move yourself slightly further away from the cot. Continue to lay him down when you first go in and then use words if he gets up again. If he continues to stand and cry, lie him down. Reassure him with your words and go back to your position in the room. It may help to have a chair which can be moved easily so you can sit whilst waiting for him to settle. Each night move the chair further away from the cot. By the third night begin to not use so many words with him but continue to lie him back down if he stands up. “Lie down and go to sleep” should be enough now. Continue to move yourself further and further away from the cot until you are beside the door. By now he should be settling more quickly. Put the chair outside the door. If he wakes the following night, go in and reassure him then sit outside his room. If he cries then use your voice first. If he stands up go in and lie him down but come back out of the room. By now he should be much better at going back to sleep after the first time you go to him. As he sleeps better each night his original overtiredness, which could be the reason for him waking in the night, should be a thing of the past.

In the middle of the night it is difficult to remain calm when you are tired and desperate to get back to your own bed. Your tone of voice will tell your son if you are getting stressed so try as hard as you can to use the same calm, reassuring tone even though you may be feeling tense.

A sleep problem which has gone on for this long may need help from a professional sleep clinic. If you are unwell yourself, and feel you may not be able to cope with carrying out sleep training without help, your doctor should be able to put you in touch with a sleep clinic or you could contact Dr Rundle whose link appears on this website.