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    Limit-Setting Sleep Disorder

    Limit-Setting Sleep Disorder
    What to Look Out For
    Risk Factors
    Management
    Where to Seek Treatment
    KK Women's and Children's Hospital
    Contributed by Respiratory Medicine Services

    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 issues.

    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.

    Risk Factors

    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

    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 sleep onset.

    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 the child.

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