Clinical Reference Systems: Pediatric Advisor 10.0
Bedtime Resistance or Refusal
This handout applies to children who are over 2 years old
and sleep in a bed (rather than a crib). These children
refuse to go to bed or stay in the bedroom. Often, they go
to sleep while watching TV with a parent or they sleep in
the parents' bed. In a milder form of bedtime refusal, a
child stays in his bedroom but delays bedtime with ongoing
questions, unreasonable requests, protests, crying, or
temper tantrums. Such children are often tired in the
morning and have to be awakened when it is time to get up.
If the child occasionally comes to the parents' bed because
he is frightened or not feeling well, he should be
supported. However, if the child postpones bedtime or tries
to share your bed every night, he is taking advantage of
your good nature. These are unreasonable attempts to test
the limits, not fears.
Ending Bedtime Refusal
These recommendations apply to children who are manipulative
at bedtime, not fearful.
- Clarify what a good sleeper does.
Tell your child what you want her to do: At bedtime a
good sleeper stays in her bed and doesn't scream.
During the night, a good sleeper doesn't leave her
bedroom or wake up her parents unless it is an
emergency. A good sleeper gets a sticker and a special
treat for breakfast. A bad sleeper loses a privilege
for the following day (for example, all TV or access to
a favorite toy).
- Start the night with a pleasant bedtime ritual.
Provide a bedtime routine that is pleasant and
predictable. Most before-bed rituals last about 30
minutes and may include taking a bath, brushing teeth,
reading stories, talking about the day, saying prayers,
and other interactions that relax your child. Try to
keep the same sequence every night because familiarity
is comforting for children. Try to have both parents
take turns in creating this special experience. Never
cancel this ritual because of misbehavior earlier in the
day. Before you give your last hug and kiss and leave
your child's bedroom ask, "Do you need anything else?"
Then leave and don't return. It's very important that
you are not with your child at the moment of falling
asleep; otherwise he will need you to be present
following normal awakenings in the night.
- Establish a rule that your child can't leave the bedroom
Enforce the rule that once your child is placed in the
bedroom, she cannot leave that room, except to go to the
bathroom, until morning. Your child needs to learn to
put herself to sleep for naps and at bedtime in her own
bed. Do not stay in the room until she lies down or
falls asleep. Establish a set bedtime and stick to it.
Obviously, this change won't be accomplished without
some crying or screaming for a few nights.
If your child has been sleeping with you, tell her,
"Starting tonight, we sleep in separate beds. You have
your room and we have our room. You are too old to
sleep with us anymore."
- Ignore verbal requests.
Ignore ongoing questions or demands from the bedroom and
do not engage in any conversation with your child. All
requests should have been dealt with during your
prebedtime ritual. Before you give your last hug and
leave your child's bedroom, ask, "Do you need anything
else?" Then don't return unless you think your child is
sick. If your child says he needs to use the toilet,
tell him to take care of it himself. If your child says
his covers have fallen off, promise you will cover him
up after he goes to sleep. (You will usually find him
- Close the bedroom door if your child is screaming.
Tell your child that you will open the door again when
she stops screaming. If she pounds on the door, you can
open it after 1 or 2 minutes and suggest that she go
back to bed and stop screaming. If she doesn't, close
the door again. If the screaming or pounding continues,
open the door approximately every 15 minutes and remind
your child that if she quiets down, the door can stay
open. Never spend more than 30 seconds talking to her.
Although you may not like to close the door, you don't
have many options. Rest assured if your child is over 2
years old and has no daytime separation fears, it is
quite reasonable to do this.
- Close the door if your child is leaving the bedroom.
If your child comes out of the bedroom, return him
immediately to his bed. Avoid any lectures and skip the
hug and kiss. Get good eye contact and remind him again
that he cannot leave his bedroom during the night. Warn
him that if he comes out again you will need to close
the door. If he does come out again, close the door.
Tell him, "I'll be happy to open your door as soon as
you are in your bed." If your child says he is in his
bed, open the door. If he screams, every 15 minutes
open the door just enough to ask your child if he is in
his bed now.
- Lock the bedroom door or put up a barricade if your
child is repeatedly leaving the bedroom.
A helpful device is a half-door that you keep locked
throughout the night. A heavy dresser, gate, or plywood
plank may also work. If your child then screams at
night, go to him and say, "Everyone is sleeping. I'll
see you in the morning." If your child attempts to
climb over the barricade, a full door may need to be
kept closed until morning with a push-button lock, hook
and eyelet screw, piece of rope, or chain lock.
Although this step seems extreme, it may be critical to
protect children less than 5 years old who wander
through the house at night without an understanding of
dangers, such as fire, hot water, knives, or going
- Send your child back to her room if she comes into your
bed at night.
Sternly order your child back to her own bed. If she
doesn't move, escort her back immediately without any
show of affection or pleasant conversation. If your
child tries to leave her room again, temporarily close
her door. If you are a deep sleeper, consider using
some signaling device that will awaken you if your child
enters your bedroom (such as a chair placed against your
door or a loud bell attached to your doorknob). Some
parents lock their bedroom door.
Remind your child that it is not polite to interrupt
other people's sleep. Tell her that if she awakens at
night and can't go back to sleep, she can look at books
or play quietly in her room, but she is not to bother
- If she awakened you at night with screaming or demands,
visit her briefly.
Reassure her that she is safe. If she needs blankets
readjusted, help her do this. Then leave. On the
following day teach her how to independently solve any
complaints she makes during the night. (Remind your
child that it is not polite to awaken people at night.
Tell her that if she awakens at night and can't go back
to sleep, she can read or play quietly in her room.)
- Help siblings sleeping in the same bedroom.
If bedtime screaming wakes up a roommate, have the
well-behaved sibling sleep in a separate room until the
other child's behavior has improved. Tell the child who
has the sleep problem that her roommate cannot return
until she stays in her room quietly for three nights in
a row. If you do not have a separate room available,
have the sibling sleep in your room temporarily.
- Awaken your child at the regular time each morning.
Even if he fought bedtime and fell asleep late, wake him
up at the regular time so he will be tired earlier the
- Start bedtime later if you want to minimize bedtime
The later the bedtime, the more tired your child will be
and the less resistance he will offer. For most
children, you can pick the bedtime hour. For children
who are very stubborn and cry a lot, you may want to
start the bedtime at 10 PM (or whenever your child
naturally falls asleep). If the bedtime is 10 PM, move
the bedtime back by 15 minutes every week. In children
who can't tell time, you can gradually (over 8 weeks or
so) achieve an 8 PM bedtime in this way with many fewer
tantrums (this technique was described by Adams and
Rickert in 1989). However, don't let your child sleep
late in the morning or you won't be able to advance the
Call Your Child's Physician During Office Hours If:
- Your child is not sleeping well after you try this
program for 2 weeks.
- Your child is very frightened.
- Your child has lots of nightmares.
- Your child also has several discipline problems during
- You have other questions or concerns.