Case Study #2: Addressing Nighttime Sleep Anxiety
The Huggy Puppy and Bedtime Pass Methods for Handling Nighttime Anxiety
How the Huggy Puppy method helped 3 year old Nate’s nighttime anxiety.
Every child's sleep journey has its ups and downs, but for Nate's family, finding consistent, peaceful sleep had been a rollercoaster from the beginning. Things had been going well for Nate, but at almost age 3, his sleep went haywire again.
Nate's Sleep History: A Rocky Road
Nate's parents tried sleep training when he was a baby without much success. When they finally made progress at 16 months, it lasted only two months before they hit another roadblock—a whole month where Nate would only sleep while being held.
After another month of consistent work, they finally achieved independent bedtime sleep for almost a year. That's when everything changed again.
Several big life events happened in Nate's world:
A new sibling arrived about 7 months ago
The family moved to a new home 6 months ago
Nate witnessed his grandmother fall and hurt herself
Any one of these events could disrupt a child's sleep. For Nate, it created a perfect storm.
The TODDLER Sleep Crisis
What was once a simple bedtime routine—close the door and Nate would fall asleep independently—had transformed into a nightly battle:
Nate demanded the door remain open
He climbed out of his crib (prompting a transition to a toddler bed)
Even with added sleep supports like a red nightlight, he required a parent sitting by his door
Bedtime was taking 1-2 hours EVERY night
Parents tried limiting his daytime nap to one hour, but to no avail
Uncovering Nate's 24-Hour Sleep Needs
When I analyzed Nate's sleep patterns, I discovered something crucial: he only needed about 10-11 hours of sleep in a 24-hour period. This was an important insight because Nate was battling for so long at bedtime, it appeared he may no longer need his nap given that his sleep needs had shifted a bit.
Despite implementing a reward chart and offering a "treasure chest" for good sleep behavior, Nate continued struggling. As I always remind parents—you can't bribe biology! A child who has met their sleep needs simply won't sleep more, no matter what reward is offered.
I recommended cutting his nap entirely to see what would happen. Coincidentally, Nate skipped his nap that day, and the results were immediate:
He went down quickly at bedtime
No night wakings
No protests
Slept soundly through the night
The pattern continued successfully for about a week, confirming my theory about his total sleep needs, which worked out to be closer to 10 hours.
When Life Gets in the Way OF SLEEP
Just as things were stabilizing, a weekend family event required a later bedtime. His parents, wanting to help him make it to the later hour without becoming tired, offered a nap.
This worked in the short term for the special occasion, but once regular life resumed, everything fell apart again:
Nap days led to bedtime battles
Bad nights led to offering naps to "catch up"
This created a cycle that perpetuated the problem
I reminded Nate’s parents about the importance of consistency, even after a rough night. They agreed to get back on track with no naps.
WHEN SLEEP SCHEDULE TWEAKS ARE NOT ENOUGH
Despite their consistency with no naps, Nate's sleep problems evolved:
Bedtime battles returned
Long night wakings occurred
Early morning wakings emerged, sometimes as early as 2 or 3AM without falling back asleep
Parents noticed increasing separation anxiety
Dad had been working late frequently, reducing quality time with Nate
We had already tried traditional methods:
Check-ins
Camping out
Reward chart
Appropriate schedule based on 24-hour sleep needs
But sometimes, sleep issues aren't just about schedule and methods—they're about emotional needs.
Addressing the Real Issue: Nighttime Anxiety
For children experiencing separation anxiety or insecurity at night, I often recommend two specific approaches:
The Huggy Puppy INTERVENTION (HPI)
What it is: This evidence-based method developed by Professor Avi Sadeh uses a special stuffed animal as a transitional object to help children feel secure when parents aren't present.
How to implement:
Select a new stuffed animal - Choose something soft and huggable that your child hasn't seen before
Build a backstory - “This is my friend Huggy. Huggy is usually a very happy puppy. Right now, he looks a little sad and scared. Can you guess why he might be sad? [After your child replies, the story continues.] He is sad because he is very far away from his home and he does not have any good friends. He likes to be hugged a lot but he has no one to take care of him. Do you think you can be his good buddy, take care of him, hug him a lot, and take him to bed with you when you go to sleep?”
Establish a connection - Most children are excited about a new stuffed animal and want to help Huggy and are happy to hug him and take him to bed when they go to sleep. They are welcome to take care of Huggy during the day, too!
Caregiving and Transfer of Fears - Huggy helps children feel less worried about their own fears and anxieties and instead focus on caring for Huggy to ensure HE feels safe and secure.
The Bedtime Pass Method
What it is: Another evidence-based technique that gives children limited control over night-time interactions while setting clear boundaries.
How to implement:
Create a physical pass - This can be a special card, token, or small object
Explain the rules clearly - Tell your child they get one pass (or two, depending on your situation) each night
Define how it works - When they use the pass, they can call you for one brief visit, a drink of water, or a hug
Set boundaries - Explain that once the pass is used, it's gone until morning
Provide positive reinforcement - If they make it through the night without using the pass, offer praise!
Be consistent - Don't give in to requests after the pass is used. In the beginning, it may be helpful to create two passes for children who are really struggling, then graduate them to one pass.
Combining Methods for Maximum Effect
For Nate, I also offered the option of combining Huggy Puppy with the Bedtime Pass, which can be helpful for some children. Ultimately, Huggy Puppy (or “bunny” in Nate’s case) was enough to help him with his nighttime separation anxiety.
One thing we knew about Nate, however, was that he was missing out on time with dad. Often, when a parent travels frequently or needs to be out until after bedtime, I will recommend offering a parent comfort item. In Nate’s case, Huggy Puppy + Parent Comfort Item was the magic bullet.
The Parent Comfort Item
Select something with your scent - A t-shirt or sweatshirt that dad had worn
Explain its purpose - Tell your child this is a special piece of you they can keep close all night
Pair it with the huggy animal - The stuffed animal can "watch over" the clothing item or even wear the clothing item
Refresh as needed - Every few days, wear the item again to renew your scent
This combination addresses both the child's need for comfort and their desire to have a parent present, while still promoting independent sleep skills.
The Breakthrough
Nate's parents implemented these strategies, using a "Huggy bunny" (what they had on hand for Easter) instead of a puppy. The results were immediate and dramatic:
Nate slept through the entire night
Despite waking early, he lay comfortably in bed resting until 7AM
No protesting
No crying
No anxiety
But the real test came on night two with the Huggy bunny. Would the solution stick, or was it just a one-night success?
Mom's report tells the story: "So good!! Fell asleep at 7:30 with some protesting but not awful. Woke up at 5:30. Went in and told him it was still night night time and he listened and went back to sleep! And I had to wake him up!!!! I woke him up at 7:20 (I was a little late to the 7 am… because I was enjoying getting ready in silence and lost track of time)."
That's right—not only did Nate go back to sleep after an early waking (a skill many toddlers struggle with), but mom actually had to wake him up because she was enjoying her peaceful morning so much she lost track of time! For parents who have struggled with sleep issues, this kind of report is nothing short of miraculous.
The Real Lesson: Sleep Is About More Than Just Hours
Nate's case teaches us something important: understanding a child's 24-hour sleep needs is crucial, but it's just the beginning. For Nate, his troubled sleep wasn't only about biology—it was about emotional security.
When big life changes happen (new siblings, moves, witnessing scary events), or when routines are disrupted (a parent working late), children often express their anxiety through sleep behaviors.
The solutions that finally worked for Nate addressed both his biological sleep needs AND his emotional needs:
No nap and respecting his 10-11 hour total sleep requirement
A comfort object given special meaning by his parents
A physical reminder of his dad's presence when dad couldn't be there
Finding the right sleep approach sometimes takes trial and error, but addressing both the physical AND emotional aspects of sleep can make all the difference for your child.
