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A simple new strategy may put bedtime struggles to sleep

(WebMD) -- It's been a long day for Lola Franco and her husband, Kevin Seaman. They have barely begun to unwind from a hectic workday when they both begin to nervously eye the clock on the wall. Bedtime is fast approaching, and so is the battle to get their only child, two-year-old Patrick, to sleep.

"It's just a pain," Franco says. "We have to read him three or four stories and then stay with him until he falls asleep. It can take an hour," she explains. Once asleep, Patrick wakes up three or four times during the night, crying out for his parents or getting up to get one of them to come put him back to sleep. "He doesn't sleep well and neither do we," Franco says.

An uncommon approach to a common problem

Patrick's struggle -- and his parent's resulting exhaustion -- is so common that entire books are written on overcoming it. Experts say that everything from separation anxiety to getting used to a new babysitter can disturb a child's sleep. But parents like Franco can now try a new approach that promises to reduce bedtime battles to minor skirmishes.

The deceptively simple method involves giving children a pass good for one trip out of the bedroom after bedtime. The study, which was published in the October 1999 issue of the Archives of Pediatric and Adolescent Medicine, suggests that this pass could eventually eliminate problems like Patrick's entirely. "It's so novel and so easy," raves the journal's editor, Catherine DeAngelis.

During the study, two brothers, ages three and 10, were each given an index card, the "bedtime pass," just before bed every night. Each could turn in his pass for one post-bedtime trip out of their room. The trip had to be a quick one with a specific purpose, such as a hug from mommy, a drink of water or a visit to the bathroom. By the end of the three-week experiment, neither child was crying or coming out of their bedroom at all.

"You might wonder why we'd publish a study involving two patients," DeAngelis says. The hope, she explains, is that pediatricians will explain the technique to parents and report back on its success among patients.

The power of the pass

The reason the pass works is unclear, admits Patrick Friman, one of the study's authors. He speculates, however, that there are three possible explanations. "A child saving the valuable pass may simply fall asleep waiting to use it," he says. Or the mere presence of the pass may offer a child a sense of security. It may also be that a child with a pass now has access to something he wants -- a trip out of bed -- so it loses its appeal.

Experts say that resistance to bedtime is normal. All children go through a phase in which their favorite word is "no." During this phase, the desire to disobey parents is often in conflict with lingering separation anxiety, causing the nighttime behavior problems.

In addition to relieving parents and children of bedtime stress, Friman says the simplicity of the method will allow physicians more time to address medical concerns during visits with their patients. "It takes two minutes to explain," he says.

Doctors welcome the pass

Despite the time crunch, many physicians feel it is part of their job to address these types of common problems. "Not only do parents come to you with these issues but it is part of the routine health care visit," says Tomas Magana, a pediatrician at Oakland Children's Hospital in Oakland, California. Magana says he welcomes the opportunity to give parents more options. "Most parents give up on the other methods because they don't want to deal with the harshness," he says. This is a problem, he adds, because consistency is essential to teaching children to behave in desired ways. "Parents need to follow through." Like the study's authors, Magana points out that more research into the use of the bedtime pass is necessary. "It may not work with every child," he cautions. He, however, is willing to recommend it to his patients and try it himself with his three-year-old son, Elías. Magana says he believes the bedtime pass has a good chance of working with his strong-willed son and other children. "I think it will provide a sense of control for the kid in a pretty out-of-control situation."

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