Here are some suggestions to improve the bedtime routine and success in your home.
Establish up a nighttime routine and follow it daily:
Heavy work and movement activities throughout the day and after dinner, then quiet/calming activities before bed.
Take a relaxing bath before bed – then when drying off, rub skin vigorously with towel to provide deep pressure to skin.
Wrap child up in sheets or blanket for a “kiddo burrito” for a few minutes, for deep pressure to body.
Read books before bedtime – with a small night light (not overhead light). Read in a rocking chair for slow/repetitive movement, or while cuddled up in bed.
Aim for an earlier bedtime. When children are overtired, they may become revved up and it becomes much harder to wind down and fall asleep.
Limit screen time before bedtime.
Limit drinks right before bedtime, to decrease chance child will wake up to use the bathroom in the middle of the night.
Limit sugar and desserts, especially in the afternoon/evening.
Set up bedroom to promote relaxation and sleep:
Soft sheets and pillow cases– whatever type child prefers (cotton, satin, jersey).
Weighted blanket and/or weighted stuffed animal.
Stuffed animal or blankey/lovey.
Try a warm rice pillow or a microwavable rice-stuffed animal.
Could try a bed tent so child feels safe and enclosed.
Blackout curtains on windows.
Turn off all lights, or leave on only a small night light or lava lamp.
White noise, fan, air filter, soothing music playing (use same music/white noise nightly to form a sleepy association with the music). Could also try a progressive relaxation meditation CD.
Lavender essential oil diffuser.
Could try an “Ok to Wake” alarm clock that glows red all night and then turns green at a set time when child is allowed to get out of bed.
Tuck in sheets and blankets tightly to provide deep pressure to child.
Massage their arms and legs.
Model deep breathing and ask children to imitate slow, deep breaths.
Speak slowly and softly to the child.
Stay relaxed yourself so the child picks up on it.
Ideally, stay in the room to tuck them in and get them relaxed and settled, and then leave the room right before they fall asleep, so they learn to fall asleep by themselves and don’t depend on you being there. If they cry or call for you, go back in their room, tuck them in or give back rubs as needed, then leave again.
Decrease nighttime fears:
Talk about happy moments of the day and have child close their eyes and think about those moments.
Label a water spray bottle “Monster Repellent” if your child is imagining monsters in the closet.
Encourage your child to simply “change the channel” on bad dreams that wake them up in the middle of the night — just as they would on a scary television program.
Discuss plans for the next day, plan the outfit for the next day – so child feels empowered and less anxious about tomorrow.
If child gets out of bed:
Try to limit talking to them – bedtime is quiet time. Try to not engage them in conversation and wake them up more.
Take them to the bathroom if needed (kids often wake up to the urge to urinate).
Take their hand and lead them right back to bed, tuck them in, say “it’s night time and you need to stay in your bed” and leave the room… over and over again if needed.
Consult your Pediatrician:
Talk to your pediatrician about how much sleep your child needs, how long naps should be, etc. If your child snores or has trouble breathing at night, ask the pediatrician to check their tonsils/adenoids.
Written by Kara Syrek, OTR/L, occupational therapist at NTS Therapy