There are numerous methods proposed by child psychologists and experts to help parents cope with these bedtime problems. Deciding on the best method isn’t easy.

A survey of 2,000 parents in the Omaha area shows they overwhelmingly prefer three "cry it out" strategies for their children at bedtime.

The survey contradicts results of previous studies that report parents do not like their children to "cry it out."

Brett Kuhn, Ph.D., assistant professor, pediatrics, and licensed psychologist at the Munroe-Meyer Institute, conducted the survey on the belief that the lack of acceptability in previous studies was population specific.

"The studies had been conducted on the parents who visited physicians and sleep clinics, not the general population. Parents presenting to sleep clinics are more likely to have unsuccessfully tried the "cry it out" approach. It was my hunch that many parents in the general population use this approach successfully and find it a reasonable method for their children," he said.

In his survey, Dr. Kuhn gave parents a scenario in which a 2½-year-old child never slept through the night, cries when put to bed, frequently awakens and has difficulty settling after each episode.

• Extinction — This is planned ignoring or "let em’ cry it out." The child is put in bed and the parents ignore any crying until the child falls asleep.

• Extinction with quick check — Similar to the straight extinction procedure, except that parents may enter the child’s bedroom at preplanned intervals (every 10 minutes) to briefly check on the child’s well being.

• Graduated extinction — Referred to graduated ignoring or progressive delay responding, made popular by psychiatrist Richard Ferber’s 1985 best-selling book on children’s sleep disorders. It is similar to the quick check method, except the time interval between parental checks is gradually increased, by five-minute intervals, for example.

• Extinction with parental presence — This is no different from straight extinction, except that the parent pretends to be asleep (ignores child) while remaining in the same room with the child — gradually working way out of bedroom over time.

• Faded bedtime with response-cost — This procedure involves setting the initial bedtime when the child is likely to fall asleep, then adjusting the bedtime by 30 minutes (earlier or later) each subsequent night based on how quickly the child falls asleep. If the child does not fall asleep within a reasonable amount of time, 15 to 30 minutes, the child is removed from the bedroom for 30 minutes before given another opportunity to fall asleep.

• Scheduled awakenings — After the parent has kept track of the child’s awakening pattern for one week, the parent wakes the child 15 to 30 minutes prior to an expected awakening. The parent then does what he or she normally does, rub the child’s back or give a bottle, for example, if the child awakens. The duration between scheduled awakenings is gradually increased until they can be eliminated altogether.

• Bed-sharing — Referred to as the "family bed," or co-sleeping, this strategy involves the child sleeping with the parents in the same bed. For his study, Dr. Kuhn defined bed-sharing as parent and child sleeping together on a regular basis (every night), for the entire night.

• Sedative medication — This treatment involves giving the child a prescription "sleeping pill" at bedtime to make the child drowsy. No specific medication was named in the survey.

Dr. Kuhn used the Treatment Evaluation Inventory-Short Form to assess parental judgements of treatment acceptability and perceived efficacy. The highest score any method could receive on the survey was 45 and the lowest was nine.

The three methods of "cry it out" were preferred among the participants in the study. The most preferred was the graduated extinction, with a score of 32.86 acceptability. The quick-check method received a score of 31.31 acceptability and straight extinction received 27.48.

Scheduled awakenings received a score of 28.39 acceptability. The other methods and their scores are: faded bedtime, 26.78; parental presence, 25.87; and co-sleeping, 21.77. The least preferred method was medication, which received 18.64 acceptability.

Dr. Kuhn will present the results of his study at the Association of Professional Sleep Societies conference in Orlando next June. Data for future sleep disturbance studies are now being collected on all the children being seen in the pediatric sleep clinic at MMI. He also is gathering information on how these sleep disturbances affect the stress level of parents and what treatment methods they find acceptable.