Sleep Onset Association Disorder

If your child is experiencing sleeping difficulties, they might have a Sleep Onset Association Disorder (SOAD). This disorder can develop when a child associates a specific environment or a person with falling asleep.

It is very stressful being a new parent. No matter how much you read about parenting, you often find yourself not knowing what to do in some situations. You are always worrying if you are doing good, or if your child is okay, but that’s completely fine, everybody feels this way.

Sleep in children can be particularly problematic. They often wake up during the night, they fight to stay awake and don’t want to go to bed, and that can result in one very long and sleepless night for you too. Children between the age of nine months and two years wake up two times per night on average. However, some may wake up as much as nine times each night, and cause a lot of concerns for their parents.

If your child is experiencing sleeping difficulties, they might have a Sleep Onset Association Disorder (SOAD). This disorder can develop when a child associates a specific environment or a person with falling asleep. For instance, a child is used to be nursed, rocked, or held before sleeping, and every time they wake up, they require this action to fall back to sleep. Sleeping in a sibling’s or parent’s bed, or falling asleep in a car are common as well.

It is estimated that as much as up to 50% of all the infants, and 15-20% of toddlers experience SOAD.

Parents unintentionally reinforce the behaviors that are associated with Sleep Onset Association Disorder. You might think that rushing in every time your baby wakes up, picking them up and rocking them back to sleep might be a good idea, but it is much more important to reinforce independent sleep in children. By helping your child to sleep independently, you will have more time to rest, and the quality of your child’s sleep will be improved as well.

How to Treat Sleep Onset Association Disorder in Children

If your child has a SOAD, it is crucial to encourage them to fall asleep on their own. Sometimes it can be hard to eliminate the associations your child might have with falling asleep, especially when it includes your intervention. Be prepared for a lot of crying in the beginning, and always keep in mind that doesn’t make you a bad parent. It is essential to teach your child how to sleep on their own as that will improve their sleep. It can be hard, but be consistent. Expect for a child’s temperament to worsen at first, but then it gets better after a short period. Some of the evidence-based techniques for treating SOAD are:

  • Bedtime fading. This strategy includes temporarily delaying your kid’s bedtime and teaching them to sleep on their own. For instance, if your child usually takes about 30 minutes of fighting and crying, try putting them to sleep at least 30 minutes later. They will be more tired, and that will make them fall asleep easier. When the sleep onset latency (the time it takes to fall asleep) drops to 10 or 15 minutes after going to bed, move the bedtime routine a bit earlier every day until you reach the desired time. You should aim for 7:30 PM to 8:30 PM window.
  • “Camping out.” It is another gentle routine that consists of gradually removing your presence from the child’s bedroom over time. This approach can result in less crying, but remember that this technique usually takes longer than some more strict ones. You start by being close to your child, and then slowly moving away every night. For instance, first you sit next to the crib, then you slowly position a chair a little further each night until you can stand at the door, and finally leave the room one night. Remember that your child might look for guidance and that you should provide comfort and make them feel safe. Keep the interactions brief with reassuring words and a light touch.
  • The “cry it out” approach. The behavioral term for this method is extinction, and it consists of removing your presence from the child’s room entirely during sleeping hours. Remember that shutting the door and letting things play out until the morning can be very emotionally exhausting for your child and that we do not recommend this approach. Children need to feel safe, and you can do that by occasional visits to their room. First, you go out for shorter intervals, and then gradually make them longer until they can fall asleep on their own. Also, remember to check on your kid if they have been crying for more than a couple of minutes. You want to make them feel safe, but avoid turning the lights on or picking them up. Calm, reassuring words and a light touch will do the trick.
  • The “excuse me” drill. This method is used on children that are older than three years, and can talk and already do some abstract thinking. While staying in a child’s bedroom, you should say “Excuse me” and then make up some excuse to leave the room. The more boring the reason is, the better. At the start, be gone just for a few moments, and then gradually prolong the time you are gone until they can sleep on their own. It is essential that you give them positive reinforcement when you get back, as that way they’ll feel good about themselves and falling asleep

You should also manage your child’s daytime naps so that they feel tired in the evening, and fall asleep more natural when they get to bed. You can introduce them to a transitional object that can help as well. Giving them a soft blanket, a stuffed animal or a doll can teach them to self-soothe, and fall asleep on their own.

Optimizing Sleep Hygiene in Children

Proper sleep hygiene in children will improve the quality of their sleep. It consists of:

  • Establishing a regular bedtime routine. It will make sure that your child knows it is time to go to sleep and they’ll be more relaxed. Proposed bedtime routine includes eating a light snack, taking a bath, putting on pajamas, reading a story or singing a lullaby, saying goodnight and kissing them. Spending quality time before bed will make them feel safe and relaxed, which makes it easier for them to transition to sleep. A bedtime routine should take no longer than 30 minutes and should be a positive experience for your child.
  • Setting a regular sleeping schedule. It means getting your kid to bed and waking them up at the same time every day.
  • Don’t feed them too close to sleep. A light snack is okay, but avoid big meals before bed.
  • Manage your child’s daytime naps, so the child is not wakeful or overly tired when going to bed.
  • Do not allow your child to sleep in your or their sibling’s bed. Although this seems harmless, and shouldn’t matter if it’s not done too often, sharing a bed is shown to decrease the quality of sleep in children.
  • Check your child from time to time, but don’t stay in their bedroom too long.
  • Avoid giving them caffeinated drinks including coffee, ice cream, sodas, and dark chocolate.
  • Light exercise is good for your child’s sleep, but it shouldn’t be done too close to their bedtime.
  • Child’s bedroom should be kept dark, quiet and the temperature should be consistent through the night at around 68 degrees Fahrenheit.
  • Keep the TV and other electronic devices away from their room.

Good news is that with proper sleep hygiene and usage of the techniques we’ve covered, your child should learn to sleep on their own, and their sleep quality should improve in no time. Don’t feel bad if they are crying at first and be persistent that is crucial.

Keep in mind that if your child is sick, you should take special care, and check on them more often. Also, if there are other sleep-related symptoms, you should visit a doctor. They can tell you if your child has insomnia or some other sleep disorder that can be found in children.


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