Practical strategies for managing behavioral sleep problems in young children

Children with sleep disturbances frequently present with coexisting medical, neurodevelopmental, or behavioral conditions that require clinicians to enhance or alter evidence-based treatments. The primary aim of this article was to provide additional tricks of the trade to help practicing clinicians effectively manage behavioral sleep problems in young children. Efficacious treatments for children with disruptive behavior disorders, fears and anxieties, and sleep disturbances have many overlapping features. Optimal sequencing and integration of these treatments, however, has not yet been adequately investigated. Clinicians may choose to intervene during the day if a child displays obvious skill deficits, or when severe anxiety impairs sleep. This choice would allow gradual skill attainment at a time when children and parents are less subject to frustration and reduced willpower at days end.88 Children with mood disorders or disruptive behavior may be better served by first targeting the sleep disturbance, especially if the child is obtaining insufficient sleep or the occurrence of the behavior is linked to daytime sleepiness. Clues might include a predictable increase in behavior problems after missed naps or sleepless nights, behavior problems that tend to occur during a specific time of day (often late afternoon), or a child who routinely falls asleep when placed in timeout for misbehavior. Many young children obtain sufficient sleep despite lengthy bedtime struggles and frequent nighttime awakenings; therefore, parents may wish to start with a behavioral parent training program to reduce disruptive behavior throughout the day.