maddy dogAlthough we have the strong misconception in our society that babies are supposed to sleep through the night from an early age, luckily there are a lot of people that are aware that until your baby does this on his or her own (and some do it early, but most don’t), it is not a biological normal state of affairs.  They wake for many, many reasons .  However, many of these same people seem to draw the line at toddlerhood.  After all, they aren’t babies anymore and these parents have been promised better sleep as time goes by, right?

“Why is my toddler still waking at night?!”  They demand.

Well, I’m here to offer some answers that focus on the very normal reasons your toddler might be waking (i.e., these are not dealing with health issues that can cause disrupted sleep; if your child has health concerns, please speak to a specialist to determine if these concerns are likely to cause sleep disruptions so you address the underlying issues, and you can use my screening tool here to see if there are any potential issues)…

They want to nurse.  Nursing isn’t only for babies, you know.  Toddlers nurse and toddlers nurse at night, just like they did when they were little.  Granted, night feeds decrease with age and often toddlers are better at the “dream feed” (when they roll over and latch without waking) if you’re bedsharing.  In fact, if you’re following child-led weaning, estimates from cultures around the world where this is the case would suggest a natural weaning time of between 3 and 5 years of age[1] and as such, we can expect some night nursing for these toddlers.

They are hungry.  Even if your toddler isn’t nursing, they are growing at an astounding rate.  Parents often forget that although toddlers are not growing at the rate babies do, it is still far greater than we remember.  In addition, the brain activity at this time is actually greater than that of adults: Toddlers’ brains utilize up to two times the glucose that an adult brain uses, depending on age[2].  How do they get glucose?  Why food of course.  [If you have a toddler who is waking regularly and is complaining of hunger, I would recommend making sure he or she has a high-fat nighttime snack.  Avocado, peanut butter, and high-fat yogurt are all options that may help your child sleep a bit longer before waking.]

They are teething.  Often our babies adjust to teething after the first few teeth come in.  We get complacent as parents because of this and think that the stage “has passed”.  We forget about some of the most painful teeth to come in: Molars.  Molars coming in can disrupt sleep for as long as it takes for them to come down.  There are actually two types of molars: The first often comes in just past a year while the second comes in around two years of age, but can be around age 3 for some kids.  If your child is still nursing, you may expect some increase in nursing, especially at night, but regardless you can probably expect some restless sleep.  Unfortunately your child may not be able to articulate what is bothering them so if you see this behaviour, you may want to keep this in mind.

 

They need to go to the bathroom.  Toilet learning is commonly done in toddlerhood.  This includes nighttime learning for many kids.  Now, some children will go all night without needing to go to the bathroom, but many won’t.  If you ask around to the adults you know, how many go all night without waking to pee at least once?  I would hazard it’s not a majority.  If our toddlers are well-hydrated, they too will need to pee and will wake.  Some parents get confused because they have their child in a diaper at night, but many toddlers will want out of a wet diaper even at night if they are used to being dry during the day (which we hope they are).  Even if you’re using disposables, some kids will be aware that they peed and want the diaper off, meaning they need to wake to accomplish this.  Regardless, the step forward of having a toddler who is no longer in diapers does mean the possible step back of waking regularly to make sure your toddler hits the toilet (or change the sheets in the case of an accident).  One additional thing is that this can also lead to fitful sleep.  If you find your toddler tossing and turning a lot, this may be a cause and a simple diaper change or trip to the bathroom may be all the fix you need.

They are scared.  More so than babies, toddlers have nightmares.  They get scared of the dark, scared of the loud noises, the shadows, thunder, and more.  In fact, nightmares are more common in children under six than any other age group[3], likely because they have the cognitive awareness to notice a lot about their world without the cognitive capacity to truly integrate all the knowledge needed to put things into context.  This could mean their brain has to process a lot of information, some which may seem scary, at night.  Regardless, lots of parents report nightmares in their toddlers (75% of parents in one study[4]) and the best thing to do is comfort them to get them back to sleep.

They don’t want to sleep alone.  Toddlerhood is also the usual time when a child either (a) transitions to a new bed (crib to toddler bed) or (b) leaves the family bed for his/her own room.  Both of these transitions can lead to changes.  In the first case, as soon as the toddlers can “get out” of the toddler bed (something they presumably couldn’t do in the crib), some parents report their toddler coming into their room almost nightly.  Toddlers that have been in the family bed or room and who are now in their own room may not be ready for this transition and also seek to return to the family bed.  Regardless of the reason, the waking to come to the parental bed is often a sign of separation anxiety, which is quite normal in this age-range[5].  If you can, bear with it to help instill feelings of security.

They are experiencing a cognitive leap.  In line with the increased brain development mentioned in terms of food, there’s also the issue of, well, increased brain development (as there is in infancy as well).  This development leads to what have been termed “cognitive leaps” where we see children experience massive growth in their psychological, cognitive, or social development[6].  Sleep regressions are common during these leaps so parents may experience greater night wakings, nightmares, or separation anxiety.  You can read about sleep regressions here.

They are following our age-old sleeping pattern of two sleeps.  Although we currently live in a society of one, long sleep period, it didn’t used to be like this.  Humans used to regularly have two sleeps, the first 4-5 hours followed by an awake period of 1-2 hours (or longer) then another sleep period or 4-5 hours[7].  I will be the first to accept that this does not work well with our modern day society and structure, but keeping your child in the dark and hoping they go back to sleep isn’t helpful either for a couple reasons.  One, it probably won’t work.  Two, children who spend too long in the dark playing around make associations between bed and play instead of bed and sleep, which we know from work with adults is a problem[8].  If you can roll with it, often these stages pass as our children adjust to our artificial light and longer daytime awake periods, but it can take patience.  You can read one mom’s story about this here.

They just are.  The 3-year longitudinal study by Marsha Weinraub and colleagues[9]  showed us that by a year (the end of “infancy”), over half of children were still waking regularly at night.  Specifically, 67% of kids at 15 months were waking at least 1 night per week (with 12% waking every night), at 24 months, 64% were waking at least 1 night per week (9% waking every night), and at 36 months, 62% were waking at least 1 night per week (6.5% waking every night).  However, the trajectory for a given child isn’t so clear.  These researchers also found that 66% of toddlers were what they called “sleepers”, meaning that the number of wakings they had were steady across the 3 year period; the other 34% were “transitional sleepers”, meaning the children showed a steady decline in wakings over the 3 years.  If you haven’t seen much of a change in your child, it may be this is your child’s sleep pattern, but if you’ve seen decreases with time, know that your child is probably heading towards fewer wakings, but just at a slower rate than all those kids other people talk about.  And that’s okay.  Of note is that all the aforementioned reasons will be included in this study, but I’m sure some of these kids just wake because they do.

***

As with infant sleep, there are some considerations to make here.  If your child is waking in pain—squirming, screaming, etc.—then you need to consider something physically wrong.  The list here, although for infants, is actually applicable to toddlers as well and the possible causes for bad sleep are worth looking into.  The other consideration is that sometimes there may be gentle ways to guide your toddler’s sleep when you know there are no physical or health issues that could be impeding their sleep.  The are some suggestions in this series here as well.  However, it is supremely important to mention that, as with infant sleep, having a toddler who wakes is entirely normal.  Your toddler isn’t trying to make you mad or frustrated, so please take a deep breath and respond.

 


[2] Barnet AB, Barnet JB.  The Youngest Minds.  New York, NY: Simon & Schuster (1998).

[3] Catalano S.  Children’s Dreams in Clinical Practice (pp.183-7).  New York: Springer (1990).

[4] Mindell JA, Owens JA.  A Clinical Guide to Pediatric Sleep. Diagnosis and Management of Sleep Problems. Philadelphia, PA: Lippincott, Williams, & Wilkins (2010).

[6] Erikson EH.  Childhood and Society.  New York, NY: WW Norton & Company (1950; 1963).

[7] Erkich R.  At Day’s Close: Night in Times Past.  New York, NY: WW Norton & Company (2005).

[9] Weinraub M, Bender RH, Friedman SL, Susman EJ, Knoke B, et al.  Patterns of developmental change in infants’ nighttime sleep awakenings from 6 to 36 months of age.  Developmental Psychology 2012; 48: 1511-28.