When a Toddler Refuses to Sleep in His Crib

A 20 month old boy presented in my office with a chief complaint of refusing to fall asleep in his crib. The parents said that whenever they put him in his bed and try to leave the room, he starts screaming until he works himself up to the point of vomiting. They heard many different suggestions from family, friends and their former pediatrician on how to handle the situation, and tried them all: from taking their child out of the crib after every sound he made to not coming into his room and letting him cry. Neither approach worked. By the time they they came to my office, their son was spending every night in their bed and the parents could hardly get a wink of sleep.

The method of “letting him cry” never worked for me as a mother, so I do not recommend that to the parents of my patients.

All people, children and adults alike, have periods of superficial sleep through the night, when they wake up and fall asleep again. They learned as infants the skill of putting themselves to sleep. This is the skill you want to teach your child by giving reassurance and comfort of your presence — not rocking him to sleep but letting him do it on his own.

This particular situation was aggravated by vomiting: parents were afraid that the child will vomit from crying and just did not put him back if he did it once. Their son was a smart little boy and quickly figured out what he had to do to end up in the parent’s bed. “What do we do if he starts crying and vomits again?” they asked. I recommended to wash his face, clean the mess and put him right back in his crib, but not to leave the room.

I suggested putting the child to bed when he is still awake and staying in the child’s bedroom next to his crib for a little while and either quietly talk or sing to him without taking him out of the crib. It’s OK to hold his hand or rub his back, but resist the urge to pick the child up: this sends the message that the crib is a bad place to be in, that he needs his mommy or daddy to “save” him. And he will demand it again next time.

Three weeks later the same patient came back for an unrelated reason. His mother said excitedly that all the sleep problems are gone. “We did what you said and he is a different child now!” she told me.