Limit-Setting Sleep Disorder
In limit-setting type BIC, inadequate
enforcement of bedtime limits by
parents result in the child delaying
bedtime or refusing to go to bed.
How common is it?
Bedtime resistance is estimated to
be present in 10 to 30 percent of
preschoolers. About 15 percent of
children aged 4 to 10 years old may
still have significant limit-setting sleep
What to Look Out For
Bedtime stalling behaviours are
attempts by the child to delay bedtime
(e.g. requests for another book, another
hug, another drink of milk). Some
children may also exhibit bedtime
refusal behaviour: such as refusal to get
ready for bed, or refusal to stay in bed.
Some children may indicate night time
fears in order to stall bedtime.
In some situations, parents do not set
appropriate limits or are inconsistent in
their limit-setting (e.g. allowing the child
to fall asleep while watching television,
or to fall asleep on the parent’s bed).
Other daytime behavioural problems
and limit-setting difficulties may also be
present in these children.
Factors that increase the risk of
limit-setting disorders include the
child sharing the parent’s bedroom,
conflicting parental disciplinary styles
and family tension.
Management includes good sleep
practices mentioned earlier, specifically
setting a fixed bedtime, reviewing sleep
schedules (e.g. avoid late afternoon
naps), and consistent parental limitsetting.
Parents should aim to establish a set
bedtime that coincides with the child’s
natural sleep time. The method of
’bedtime fading’ may be practised,
where the bedtime is initially set at the
current bedtime, and brought forward
gradually to the desired bedtime, to
reduce struggles between bedtime and
Clear bedtime rules need to be set
with the child (e.g. staying in bed, not
calling out for parents), and ignoring
complaints about bedtime (e.g. ‘I am not
tired yet’). Check on the child briefly if
needed, provide reassurance and return
the child to bed if he/she gets out of
bed. A transient worsening of behaviour
may occur in some children at the
beginning. Caregivers are encouraged to
be consistent and firm each time.
Positive reinforcement (e.g. sticker charts
and small rewards) may help motivate