| Sleep-onset association disorder | Child associates falling asleep with a person or object (eg, television) and is unable to fall asleep without its presence |
Adult fading (ie, graduated extinction) using ‘camping out’—gradual withdrawal of parental presence from the child's bedroom over 7–10 days ‘Checking method’—parent checks on the child at regular time intervals (2, 5 or 10 min, with intervals increasing over time)
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| Delayed sleep phase | Shift in the child's sleep–wake cycle, in which the child cannot fall asleep until late and then wakes late in the morning |
Bedtime fading—child's bedtime is temporarily set later to when they are usually falling asleep and gradually brought forward. The child is then woken at a preset time in the morning Early morning light exposure
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| Limit setting sleep disorder | Child refusal to go to bed and general non-compliant behaviour at bedtime. Parent struggles to set appropriate and consistent bedtime limits |
Parent management strategies—ignoring child protests, rewarding compliance with bedtime routines. A ‘bedtime pass’, whereby the child can only leave the bedroom one time before sleep, can be used to promote compliant behaviour Consideration of bedtime fading or the checking method
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| Primary insomnia | Child has substantial difficulty initiating and/or maintaining sleep even if they go to bed at a later time |
Visual imagery and relaxation Basic cognitive restructuring Restricting time in bed (eg, temporarily setting the bedtime later as per delayed sleep phase or getting out of bed and doing a relaxing activity if the child cannot sleep)
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| Night-time anxiety | Specific night-time fears including fear of the dark and/or child worrying about other things while in bed |
Visual imagery and relaxation training Discussing fears during the day rather than just before bedtime Rewarding brave behaviour Other—use of a security object, avoiding scary television shows, use of a book to record worries
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