The Curious Incident of the Toddler Who Wakes and Flails in Pain in the Night

Abstract

Difficulty falling asleep and frequent nocturnal awakenings are common sleep problems in young children. These are highly influenced by parent choices about sleep schedules, bedtime routines, and psychosocial factors but are usually very treatable with effective behavioral interventions. Parents may respond with actions that actually end up perpetuating sleep problems based on their beliefs about the nature of the sleep disturbances. Parents may misattribute the sleep disturbance to other medical problems or misinterpret benign sleep disturbances such as confusional arousals. Even if these conditions are ruled out or identified, the learned negative sleep-onset associations can be challenging to alter. Fortunately, children’s sleep habits are amenable to change when caregivers apply empirically supported behavioral sleep medicine strategies. Sleep physicians and psychologists specializing in behavioral sleep medicine can work collaboratively to solve the mystery of complex toddler sleep problems, tailoring parent guidance and behavioral treatments to the individual child and family dynamics.