Better Bedtime Routines

A consistent and healthy sleep schedule is a vital part of a child’s healthy growth and development. Every year, we fall back an hour when Daylight Saving time ends, and this year that’s November 1. With the annual time change, it’s a good time to set new routines. What are some tips for building a better bedtime routine? In this episode, we hear from Children’s Physicians pediatricians Dr. Anthony Yaghmour & Dr. Hannah Donaldson, answering your questions about how best to help your family ease into a healthier sleep schedule, especially as the days get shorter.

Topic Breakdown

1:34 – How many hours of sleep children need every night
3:13 – How a child’s sleep is affected by their age
4:45 – Good sleep is all about having routines — from the very beginning
8:10 – Bedtime routines are for teenagers, too
9:16 – Activity during the day and before bed
11:35 – Snacking before bed
13:13 – Setting the scene for sleep
15:27 – The bed is just for sleep
16:16 – Helping your child stay in their own bed
18:10 – Healthy habits to incorporate into the bedtime routine
19:28 – Security items
19:58 – Helping your child fall asleep on their own
21:34 – Talking to your child’s pediatrician about sleep

Transcript

Here at Children’s Hospital & Medical Center in Omaha, Nebraska, it’s all kids — all day, every day. Our pediatric experts are here to answer your questions and weigh in on hot topics, helping you keep your child healthy, safe, and strong. We’re here for you. Listen in.

Dr. Tony Yaghmour: I’m Tony Yaghmour. I’m a pediatrician with Children’s Physicians at Creighton University. And with me is…

Dr. Hannah Donaldson: I am Dr. Hannah Donaldson. I’m one of the new pediatricians at Children’s Physicians in Plattsmouth. And today we’re talking about building better bedtime routines.

Dr. Yaghmour: Yes, so exciting, isn’t it?

Dr. Donaldson: It is very exciting, especially with Daylight Savings time coming up. We’ve got some shifts in bedtime. Hopefully, we can help some people out.

How many hours of sleep children need every night

Dr. Yaghmour: Yeah. So what do you, Hannah, tell parents about how much sleep should kids get every day?

Dr. Donaldson: It’s one of the — it’s the most famous answer to any question: it depends. So, you know, it totally depends on the —

Dr. Yaghmour: And what does it depend on?

Dr. Donaldson: It depends on their age. So all the way from newborns, the 0 to 3-month-olds, they need anywhere from 14 to 17 or 18 hours of sleep per day. So they’re sleeping on and off throughout the day and night. Versus as kids get older, the less amount of sleep they need.

By the time kids are 1 to 2 years old, you’re seeing more of that 11 to 14-hour range. And that amount of time actually includes your daytime naps, as well. By 3 to 5 years old, that preschool age range, thinking more 10 to 13 hours a day, also including naps.

Then after kindergarten and beyond, you don’t really need the daytime naps anymore. So usually 6 to 13-year-olds are sleeping maybe 9 to 12 hours a day — sorry a night, shouldn’t be sleeping in the day — and 14 to 17-year-olds, more than 8 to 10 hour a night range. Which, unfortunately, we do not see a lot of teenagers getting.

Dr. Yaghmour: That is so true, especially sometimes with these early activities, late activities, homework, early school days — that makes it tough for them.

Dr. Donaldson: Yeah, and now with all the virtual schooling and homeschooling, that kind of throws off some good sleep routines.

How a child’s sleep is affected by their age

Dr. Yaghmour: Right. Do you expect different things at different ages, as far as how their sleep is affected based on their ages?

Dr. Donaldson: Oh yeah. Jump in if you’ve got good examples of stuff, but basically — a kid’s ability to have a good night’s sleep kind of depends on — there’s a new things that are good for everyone. If the room is a comfortable temperature, if it’s nice and dark and quiet, that helps just about anybody sleep well.

But when you’re thinking about, I’ll start at newborns again, we always talk about safe sleep with everybody. I like to bring that up in any sleep talk — where you’re making sure that the baby is sleeping in their own bassinet or crib, sleeping on their back, and they have no extra pillows, blankets, toys, stuffed animals in the crib, because you don’t want to add any risk for sudden infant death syndrome.

So that’s safe sleep, but, you know, when you’re talking about how to get kids to actually sleep, that’s a whole other story. Do you have any thoughts about that?

Dr. Yaghmour: Yeah, I remember doing a talk not too long ago for Children’s Parenting U classes, and it was on sleep. That room was full of parents of toddlers who they couldn’t get to bed. Most of the questions were directed specifically for each of them.

Good sleep is all about having routines — from the very beginning

Dr. Yaghmour: What I told them really is, it really should start early. If you’re just starting with bedtime routines or trying to get them to sleep through the night at their toddler years, you’re kind of beyond the eight ball. We’ll try to advise you because of that.

But really, I start talking to my parents at the 2-week checkup on how to get good sleeping habits. 50% of babies have the capability of sleeping through the night by 2 months of age. In fact, not to brag, but all 6 of my kids slept through the night by 2 months.

Dr. Donaldson: There’s a lot of people angry with that statement

Dr. Yaghmour: I understand. But I will tell you — my wife just said, “Here, Tony, you take control and get them to sleep through the night by 2 months.” And we put them on routine and we kept to it. And it was difficult, but we did that. And so the routine is the most important thing to get your child to sleep.

I also say that it should be a culture of how important sleep is in your house. As parents, you should stress the importance of sleep from the get-go, so you’re not up in the middle of the night helping your teenagers with projects and stuff, because you’re keeping them up. So you have to be a good model for your kids throughout their childhoods. They see, “Wow, Mom and Dad really take sleep seriously. It must be so important.” And as we know, it has so many benefits, getting enough sleep. So I don’t know what your thoughts on that are.

Dr. Donaldson: I totally agree. And you said the keyword. It’s routine. Kids thrive on routine. It decreases anxiety for them to know what’s coming. It helps them to form good habits. And so by building a routine around bedtime, you’re going to get results.

And say, maybe you are behind the eight ball on starting the bedtime routine with your family or with your kids. I think we talk about that in a little bit. But it’s never too late. And you will totally get an escalation of pushback as soon as you start putting some limits in, but it is so worth it and it is worth holding on and putting your foot down and sticking to a good routine. Because that’s one of the best things you can do for kids. Again, like you said, there are so many benefits to sleep. It’s when kids grow the most, it’s when they learn, retain memories. It’s everything. It boosts immunity. There are so many good things about it.

Dr. Yaghmour: Very good point. One of the things we talk about with routines is that you should also, especially for the young ones, have — it’s not just a nighttime routine, but it’s a good scheduled daytime routine. Daytime naps, daytime meals.

We also use a nighttime routine of brush, book, bed. That’s a very — the 3 B’s. Brush. Book. And bed. You also have to be consistent. You don’t want to do it for 5 nights and then take a night off from that consistency. When you’re on vacation, try to keep it as close to possible.

Because I remember, one of my kids who I got to sleep through the night by 2 months, we went on vacation at 9 months. And we messed up the routine a little bit, didn’t think so. And it took about a week to two weeks by the time we got home to get her back to sleeping through the night.

People think that, “I don’t have to be consistent continuously.” Of course, there’s going to be illness days and other things that come up. But for the most part, try to be consistent on a consistent basis.

Bedtime routines are for teenagers, too

Dr. Donaldson: Absolutely. I don’t want to leave out our wonderful teenagers. The bedtime routine is still important, and it just looks a little bit different than it does for toddlers, right? They probably don’t want you to read to them anymore. If they do, great. It’s a great thing to do together. But I don’t know a lot of teenagers who love when their parents read them stories.

So for them, it’s going to be more about making sure that they go to bed at the same time and wake up at the same time. And that includes weekends. It’s so important. Because if they are sleeping in for hours extra on the weekends, that’s a sure-fire sign that they are just not getting enough sleep during the weekdays.

Dr. Yaghmour: Very good point. I usually say you have flexibility on the weekends between 30 minutes to an hour. And that can also help with Daylight Savings, if you slowly change it for 15 minutes, 20 minutes, 30 minutes, gradually. It will be a lot easier to make those changes during those times too.

Activity during the day and before bed

Dr. Yaghmour: One of the things that I also stress that can help with sleeping is kind of two-fold.

One is, your kids need to be active during the day. And with the electronics, I tell my parents all the time, it’s a different parenting now. Because when I was younger, there were no cell phones. When I was outside, I couldn’t have a phone with me. It’s just so different and the kids aren’t getting the activity they need and they aren’t getting outside.

And those are two important components that I think we miss that are very helpful for the sleep day cycle that goes on. When kids aren’t getting outside, not active, not seeing the sun, it really puts a cramp on the bedtime routine.

Along the same lines, you don’t want to overstimulate them. You don’t want them having soccer practice, football practice, basketball practice, and then they come home and they have to do 3 hours of homework. And they’re just so stressed out by all their activities. So on one side, you want them active in things. But you don’t want to overschedule things, because that will take a toll also.

Dr. Donaldson: Do you have an idea — do you have any recommendations in terms of how soon before bed do you have to slow things down? What are some good activities that you can do before bedtime?

Dr. Yaghmour: That is a great question. The most important thing is to turn off those electronics. And usually, the minimum is 30 minutes, but I usually recommend an hour before bedtime — no electronics, no screen time.

One of the worst, every child — I won’t say “every” child — but most children whose parents come in and talk to me about, “My kid doesn’t sleep. He doesn’t sleep. I’m telling you, he just doesn’t sleep.” I say, “Well, do you have a TV in the room?” And lo and behold, they all have a TV in the room.

Screens should not be allowed in the rooms at all times. I don’t allow my own screens into my room. So I model that for my kids. I don’t do screen time after a certain time. Again, it goes back to the modeling of that. We do know that the screen times inhibit the melatonin released at night that you need for the proper, again, sleep-wake cycle. So again, turning off those electronics is the first thing I can talk to you about.

What do you think, what else?

Dr. Donaldson: I agree, I think that’s fantastic.

Snacking before bed

Dr. Donaldson: There’s also — sometimes, parents will give me questions about, “My kid loves to snack. Is it okay if they snack before bed? If we have a treat before bed?”

And you never want to go to bed hungry, it’s very hard to fall asleep when you’re hungry, for anybody. You don’t want your kids to have that feeling either. But also, you don’t want them to having heavy foods and sugary snacks or absolutely nothing caffeinated.

Usually, it’s fine if they have a light, healthy snack. I love those little clementines. Those are great. They’re easy. Kids like them.

Dr. Yaghmour: I just had two today, so those are wonderful.

Dr. Donaldson: Exactly, they are wonderful. But something that is not going to upset their stomach or — because, you know, when you eat, it kind of wakes you up a little bit. Unless you eat too much, but that’s another story. But yeah. So, you know, a light healthy snack. You don’t want them going to bed hungry. That’s fine. They can eat before bed, as long as it’s something light and healthy.

Dr. Yaghmour: I totally agree, that is great advice that I think is sometimes overlooked by parents. Along the same lines — going back to what I’d talked about, you know, it starts early on, in infancy or even the newborn period. One of the things I think people make a mistake is, they leave their kid with a bottle or cup in the bed. And that becomes a habit, and that is just not good to leave those. Even thinking about that is strategies that can — if you’re keeping that bottle or cup in the bed, that can prevent or cause problems with sleeping later on. I think that goes hand-in-hand with the food, what you had mentioned earlier.

Setting the scene for sleep

Dr. Yaghmour: The other thing I’d wanted to talk about was, you had talked earlier about making the bed a safe place. A cool room is a lot better than a warm room. And so a lot of things — you don’t want too much light on. We talk about these nightlights, but if it’s really bright, bright light, that’s not going to help. So maybe a little dim light is okay. Maybe a little bit of background noise. If you want to give them a small glass of water beforehand. But don’t let them, “I need another glass, I need another glass.” You really can’t keep giving in to them.

You have to be patient and stress the importance of being asleep. When your child is off a routine, or is having sleeping problems, they may call for you multiple times at night. What you need to stress is, “You cannot get out of bed. You cannot get out of bed. Mommy and Daddy are here. We hear you. You are safe.” It may be 20 times during the night that you hear that, but you still can’t let them get out of bed.

And the worst thing you can do is let them in your bed. Do not let them in your bed. I stress that. If you want to have a poor sleeper, let them sleep in bed with you. If you want poor sleep, you let them sleep in bed with you. But that is a mistake. “I just want to get a night’s sleep and they’re keeping me up,” and so you kind of break down and they win. And then guess what — you’ve got another 2 or 3 weeks of dealing with that. The fact that you let them in the bed there. I stress consistency. This is so easy for me to say this. I can easily give you this advice. I’m not going through it with you and I know it’s really difficult to do. It works, but you cannot give in. You have to be consistent. Let them know that you’re there, but stress to them the importance of it. And it does pay off.

Dr. Donaldson: Absolutely, there is great advice. Again, easier said than done. But we say it all the time because it’s true and it works. It’s just about grinning and bearing it, and getting through the tough part, so you can reap the benefits.

The bed is just for sleep

Dr. Donaldson: Let’s see — oh, another thing about when you mentioned keeping the bed a safe place. Also, remind your kids, “That is a place for sleep.” Some kids will play all day in their bed. They will sit and watch TV in their bed. They’ll do homework on their bed. And then their mind doesn’t associate bed with sleep. So I also like to remind kids — and it’s a little bit for older kids — bed’s just for sleep. Do your homework somewhere else. Don’t play on your phone or tablet in bed. Keep that separate. It helps psychologically a little bit I think.

Dr. Yaghmour: I think that’s a great point. It’s great if you can have support of other adults to help you through this. Maybe one night the mom can do it, or the other parent can do it, or the adult can do it the next night that’s in the home.

Helping your child stay in their own bed

Dr. Donaldson: Yeah. We’ve talked a lot about trying to help the kids who are getting out of bed all the time, aren’t able to stay in their own bed at night. Do you have any other tips or tricks? The one that comes to my mind is sticker charts. But what have you found works for positive reinforcement for helping kids stay in bed?

Dr. Yaghmour: The most important is as soon as you see that they get out of bed, you’ve got to take them right back to bed. And that’s one of the hardest things. I was always the proponent with my kids. Luckily my kids — and hopefully no one comes back to tell them this stuff — my kids were always late in coming out of the crib. I tried to keep them in the crib as long as I could, as long as it was safe. Then, I tried to make — like you said — “This is the safe zone. This is bedtime.” And we just stressed that. “Mommy and Daddy — we get very unhappy if you get out of bed because we need you to stay in there to get a good sleep that’s going to help you.” And just say how important it is to Mommy and Daddy that you don’t get into bed.

The problem is, these kids sneak into their parents’ bed in the middle of the night. Their parents kind of know they’re there, but they’re too tired to take them back. And that’s where the problems lie.

You’ve got to get up and you’ve got to put them right back. But like I said — it may be 20 times in a night that your child gets out of bed and you’ve got to take them back. But maybe the next night, it’s only going to be 19 times. And it can go down and down. If they’re screaming in bed, let them scream. Maybe the first night, for a minute. The next night, let them scream for two minutes. Slowly go up on that. Eventually, the kid will say, “You know what? It’s not worth crying over that because mom and dad aren’t going to come in soon enough.” So those are some of the techniques. But like we said before, and we understand this, that’s a lot easier said than done.

Healthy habits to incorporate into the bedtime routine

Dr. Donaldson: Absolutely. Let’s see, what else. What about — any other healthy habits that parents can incorporate into their bedtime routines to help kids get better sleep? We’ve talked about a lot of them here.

Dr. Yaghmour: Again, I think even prepping a child ahead of time on the sleep patterns, and setting goals for the child. “Hey, you know, I think tonight’s the night where we can get 2 stickers for sleeping through the night.” Like you had mentioned, the sticker charts. So those are the things I thought about. What about you? What are some thoughts you have had on healthy habits they can teach?

Dr. Donaldson: Well, you remember that — you mentioned this with your “3 B’s.” One of them was brush. So always include dental hygiene in your routines. I’m just going to slide in a little promo there for your teeth,

Dr. Yaghmour: Good, that’s very good.

Dr. Donaldson: You know, make sure — try to make that part of the routine. Because again, all your doing with this — these are not just all cool, fun ways to torture yourself. These are just ways to help teach your kids healthy habits so that you don’t have to tell them to do these things forever. So doing that, getting them in that habit.

Security items

Dr. Donaldson: I think — we talked about most of the big important things. Also, I want parents to know — it’s okay for your preschool-aged, kindergarten-aged kid to be using a security item, like a blanket or a stuffed animal. That can be really helpful, especially if they’re getting out of bed a lot saying they’re having nightmares or scary dreams, things like that. That’s not an excuse to sleep in their parents’ bed. They should still go back to their bed. But they can have their special security item with them. That can be helpful sometimes.

Helping your child fall asleep on their own

Dr. Yaghmour: Yeah. Along the same lines — you don’t want them to sleep in your bed, which we talked about is important. When you’re putting them to bed and you’re laying with them, reading a book, don’t fall asleep in their bed so you find out 2 hours later you’re still there. The other thing is, don’t wait until they fall asleep to leave.

So don’t think, “Oh okay, they’re asleep, I’m going to sneak out.” No. You need to get out of the room while they’re still awake. And that actually goes back to my premise. The same philosophy I use with my newborns, my 2-month olds.

You want to rock them and feed them until they’re drowsy, but awake. And then put them, a little awake, in the bed so they learn to put themselves to bed. They have to know how to put themselves to bed. If the bottle’s in their mouth every time they fall asleep, every time they wake up they’re going to need a bottle to put themselves back to sleep. So every time you lay in bed with your child, and your child is there and sees you in their bed and falls asleep — every time they wake up, if you’re not there, they’re going to scream for you. So they need to learn that.

Dr. Donaldson: Yeah, I think that’s a great point. Because yes, there are a lot of things that sometimes seem like love and care, but is accidentally putting in a bad habit. Like rubbing their back to help them fall asleep. Or even — a lot of people leave the TV on to fall asleep. But that’s bad for your sleep health for so many reasons. But again, when they wake up, they’re going to need you to come back and rub their back to go sleep. It’s not sustainable forever.

Talking to your child’s pediatrician about sleep

Dr. Yaghmour: Then remember — talk to your pediatrician about that. There are some abnormal sleep patterns that we need to recognize. So, is your kid snoring and waking themselves up? Are they just restless the whole night? Are they having bad nightmares that could be leading to that? There are some issues that you should bring up.

So when your pediatrician says, “How’s your child’s sleep been at night?” really tell them. Don’t just go, “Oh it’s fine.” If they’re not really sleeping fine, discuss it. Because our job as pediatricians — we look at everything about the child. And if they’re not sleeping well, we need to figure out why that’s happening. And to be your aid. Bounce questions of your doctors, your pediatricians. They will know and kind of guide you through that, because they have that experience with their education and experience with other families.

Dr. Donaldson: Definitely.

Dr. Yaghmour: Well, Hannah, I really enjoyed doing this podcast with you. I appreciate your time and putting up with me through this. I want to make sure that the parents can tolerate listening to my voice also. Because you gave a lot of good advice. And I hope this was helpful. I don’t know if you have any last words yourself?

Dr. Donaldson: No, just thank you so much for your time. I enjoyed this. Hope everyone got a little bit of something helpful out of it, and hopefully you’ll hear from us again soon.

Dr. Yaghmour: Yeah. And hey — guys — have a great night, and I hope your children sleep for you.

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