Lack of sleep can turn even the best of parents mad. But fear no more, Mandy Gurney from the Millpond Sleep Clinic is here to help

Q: Our adopted daughter is now almost four years old. I am a stay-at-home Mum and she is our only little child. She does not sleep at night. We have reached the desperation stage! We have tried all the standard things.

She gets up at least three to four times a night after we follow a bedtime routine and know that she is really tired. When we calmly tell her to go back to her bed, she cries so hard that she makes herself throw up. We do keep her closet light on as she wants it on. We have a sound machine that plays ocean waves which we have tried. She has a special animal that she sleeps with.

We give her warm milk. We read to her before bed. She gets a bath most of the time, sometimes not. I stand at the door till she falls sound asleep. We've tried putting her to bed a bit earlier and also a bit later, neither works.

About every two hours or so, she wakes and comes crashing into our bedroom, crying. If we tell her to go back to, or take her back to, bed, the crying is so intense, she vomits.

We are desperate for answers. I can tell you that with me being home all day with her,  she is very attached to me and hardly lets me leave a room or go to the potty without  following me and staying by my side. She does attend pre-school on Mondays, Wednesdays and Fridays and does just fine. She also is in Sunday School for two hours each week and does fine with that.

Mandy says

It sounds as if your daughter has got separation anxiety syndrome, and that does need to be dealt with. I would suggest that you talk to your doctor about it, as I don’t think this is only a sleep problem.

To try to sort out the sleep issue, I have taken the approach which has the least amount of anxiety. I think it’s vital to try to get the anxiety and heat out of this, and to teach your daughter that she can go happily to sleep.

It sounds as if she has a real dependency on needing to know where you are. My suggestion would be to try a Gradual Retreat Programme which I explained in a previous sleep clinic. Here you slowly increase her confidence in her ability to go back to sleep during the night, when she stirs into her light sleep phase.

To briefly recap the programme

You will need to identify and name a “sleepy cushion”. Use this at bedtime and in the night as a symbol of where you will sit as your daughter goes to sleep.

Explain the rules to your daughter:
Mummy will sit on the “sleepy cushion” until you fall asleep at bedtime and during the night.
The Sleep Fairy (who I talk about below) will leave a special treat in the fairy pot if she settles to sleep without a fuss with Mummy or Daddy on the cushion.

(Wait ten minutes before you leave so that she is in a deeper sleep and you don’t get caught tip-toeing out of the room).

Over the next three weeks, gradually move the cushion along the landing and back to your room.

Using a reward system at this age will not make the programme happen, only you can do this, but it will help your daughter view the changes you make in a more positive light. In order for this system to be effective you must clearly explain the rules about what she has to do to receive a reward (i.e. that she must go back to bed without a fuss or she won’t get a treat from the Sleep Fairy).

It is vital that you start with an easily achievable goal; once you have engaged your daughter you can then gradually increase the requirements for getting the reward. Small changes will be more realistic rather than asking her to sleep through the night in her own bed straight away.

The Sleep Fairy

The aim of the Sleep Fairy is to instigate a reward system to encourage a child to sleep through the night. We suggest that the Sleep Fairy is a magical friend of the Tooth Fairy, and visits every child at night. If they sleep well, she leaves a treat for the child to find in the morning.

Tell your child that the Sleep Fairy will leave her a reward in a little pot. You could make a pretty pot together, or even decorate a shoebox, as long as there is something to look into in the morning. However, don’t leave the pot in your child’s room, as you don’t want them to hear you putting a treat in during the night. Having it in their room makes it hard to control. Instead put it in your room, or in the kitchen.

Small children don’t always react well to star charts, as stickers and stars don’t necessarily mean anything to them. A treat is something far more immediate and real, and can make a real difference to their behaviour. The Sleep Fairy also fires up a child’s imagination.

It’s also important to note that any reward has to outweigh the benefits of the negative behaviour for the child. The reward has to be significant enough to make them want to change.

In the night, if your daughter does make a fuss, make it clear that there will be no reward from the Fairy.
Guide her back to her room with minimal interference and talking, so as not to inadvertently reward her behaviour.

Do keep the night light on if that makes it easier for her.

If she vomits, don’t make a fuss. Clean it all up quickly and basically ignore it as much as you can. Still take her back to her room and put her back to bed. Then clean up when she is asleep. You could make sure she gets a sad note from the Sleep Fairy in the morning.

Best of luck.