Case Study #1 - Toddler Transitions
Bedtime in my crib? No thanks!
A journey through toddler sleep challenges, transitions, and solutions
The Challenge
Meet Sophia, a bright and loving 26-month-old toddler who recently experienced a significant sleep transition. After falling out of her crib and breaking a tooth (requiring an ER visit), her parents had to quickly transition her to a floor bed for safety reasons—much earlier than they had planned.
This transition came with unexpected challenges. While Sophia had been an excellent sleeper since sleep training at 6 months, the past couple of months had shown signs of struggle, with increasing bedtime battles that ultimately led to the crib accident.
BACKGROUND - ALL ABOUT SOPHIA
Sophia's parents describe her as "a happy girl who is extremely loving, super active, and very smart." She was an early talker but a late walker. She displays typical toddler stubbornness, particularly around bedtime, diaper changes, and taking vitamins—often expressing big emotions through tears and resistance.
She thrives on attention from her parents through physical affection, play time, reading, and storytelling. Her parents consistently praise her good behavior, and she enjoys trying new things and participating in her parents' activities. Independent play remains a work in progress.
An important health factor to note: Sophia struggles with constipation, which can impact her sleep at times.
SOPHIA’S SLEEP - BEFORE INTERVENTION
For the last 6 months or more, Sophia maintained a healthy sleep schedule and was able to fall asleep independently. Sophia always slept through the night.
Bedtime: 8:00-9:00 PM
Total overnight sleep: 10-11 hours
Daytime nap: 2-3 hours
Total 24-hour sleep: 13-14 hours
For a month or two leading up to her crib incident, her sleep drastically changed:
Bedtime routine started at 8:00 PM, but she wasn’t falling asleep until 10:00-11:00 PM
Multiple parent interventions were required (additional books, stories, etc.)
Middle-of-night wakings around 3:00-4:00 AM with 20+ minutes of parental involvement became more frequent; eventually this evolved into multiple night wakings with a similar parental intervention pattern
THE CRIB TO TODDLER BED TRANSITION
Generally, I like to keep children in their crib until age 3 as long as it can be achieved safely. Sophia was on the younger side for a crib to bed transition but we had no choice in this case. Sophia’s parents moved quickly to transition her out of the crib after their trip to the ER - there was little time to prepare.
Developmentally, two year olds can struggle with understanding why they need to stay in their bed or their room without physical boundaries (e.g. a crib). Cribs provide security through their four "walls," helping children feel safe and contained. Toddler beds are a new-found freedom that they may not be developmentally ready for.
When suddenly given freedom without the developmental readiness to handle it, toddlers often:
Feel insecure without the physical boundaries;
Test limits to understand new expectations
Struggle with self-regulation at bedtime and overnight;
Develop challenging sleep associations that require parental presence to fall asleep or back to sleep.
HOW I ADDRESSED SOPHIA’S SLEEP STRUGGLES
After thorough review, we determined two primary goals for Sophia:
Address bedtime battles and overnight wakings using age-appropriate methods
Adjust her schedule is necessary based on her changing 24-hour sleep needs
First, Sophia's behavior, while challenging, was developmentally normal. Toddlers naturally push boundaries to learn what is and isn't acceptable. Parents must consistently demonstrate acceptable behavior and avoid negotiating with terrorists, er toddlers, which can create a never ending power struggle.
Second, Sophia's schedule needed adjustment. She was struggling to fall asleep for both naps and nighttime, which suggested her sleep needs may have shifted. A completely normal part of growing up.
IMPLEMENTATION OF BEHAVIORAL SLEEP MODIFICATIONS
Our intervention plan included several components:
1. Progressive Sleep Training Methods - We began with "Camping Out" and "Be Right Back" techniques. However, Sophia became ill during this process, requiring a temporary pause in training. During her illness, her sleep habits spiraled even more (including 3 AM Peppa Pig viewing with mom, who is pregnant and in survival mode).
Once Sophia recovered, we implemented a more structured progressive check method. The first night, though Sophia slept by her door rather than in her bed, she required only three checks and slept through the night—a significant improvement. Our first goal was to get her sleeping IN her toddler proofed room knowing that eventually she would realize the floor really isn’t that comfortable.
2. Supportive Tools - We introduced some developmentally appropriate supportive sleep tools to help Sophia feel confident about sleeping in her own bed and room, and to help her visualize her success as her sleep improved.
Children's books about staying in bed and not fearing the dark
Visual bedtime routine chart to track successes
Consistent positive reinforcement for desired behaviors - studies show that positive reinforcement is far more beneficial to promoting behavior changes than any sort of tangible reward (though those can be motivating, too!).
3. Schedule Optimization Based on Sleep Analysis - Our behavioral modifications improved sleep disruptions but Sophia was still taking a long time to fall asleep. Without this critical piece in place, we would not have reached our goals. Through careful observation over several days, we determined:
Sophia's average 24-hour sleep need had shifted to approximately 12 hours.
She required about 7 hours of awake time to build sufficient sleep drive for her nap, otherwise she struggled to fall asleep quickly.
With 12 hours as her total sleep need, we planned for a 10-hour night.
Naps were capped at 2 hours to promote that long stretch overnight.
How did we calculate the 24-hour SLEEP schedule?
12 hours of total sleep needed = 12 hours of awake time needed
7 hours before nap meant we needed 5 hours after nap until bedtime, so we count backwards:
For a 6:30 AM wakeup and a 10 hour night, that puts bedtime (asleep) by 8:30 PM
If we know she needs 5 hours after her nap until bedtime, she needs to be awake from her nap at 3:30 PM
Her nap will last 2 hours, so that means her nap starts at 1:30 PM, which matches up perfectly with our 6:30 AM wakeup
RESULTS OF TODDLER SLEEP TRAINING PLAN
With the behavioral sleep modifications in place with Sophia’s updated sleep schedule based on her specific 24-hour sleep needs, we were able to achieve:
Quicker sleep onset at both naptime and bedtime
Consolidated, restorative sleep during both periods
Elimination of bedtime battles
Elimination of prolonged night wakings requiring parental intervention
Return to appropriate 24-hour sleep totals, which had shifted as she grew into toddlerhood
KEY TODDLER SLEEP TAKEAWAYS
Sophia's case highlights several important principles in toddler sleep:
Individual sleep needs vary. Understanding your child's total 24-hour sleep requirement is essential for creating an effective schedule.
Awake time builds appropriate sleep drive. Finding the optimal amount of awake time needed to support sleep drive and restorative sleep is essential to achieving total overall sleep needs and avoiding sleep time battles.
Consistency is crucial. Clear boundaries and consistent responses help toddlers understand expectations, even when they push back.
Visual aids and positive reinforcement are powerful tools for toddlers learning new sleep behaviors.
Personalization is key. The most effective sleep plans are tailored to a child's specific needs, temperament, and family situation.
For Sophia and her family, determining her 24-hour sleep needs and crafting an appropriate schedule based on her individual requirements were the critical factors that restored harmony to their household!
This case study represents one toddler's sleep journey. Every toddler has unique sleep needs and challenges. If you’re experiencing significant and persistent sleep disruption or challenges, let’s chat and create a plan that works for your toddler.
