Pearls of Wisdom: Sleep Deprived Parents

Martha, a 36-year-old sleep deprived mother of 2, visits for a routine vaccination. The children are happy and healthy, but she jokingly mentions that her life would be a lot better if the little ones didn’t repeatedly pop out of bed for hours past their bedtime—with excuses ranging from being hungry, thirsty, needing to go to the bathroom, or simply wanting a hug.

Assuming that the children and parents are in a healthy environment (eg, no excessive noises, danger, or impaired parent-child relationship), such behaviors do not represent any pathology and will ultimately resolve over time. However, the repeated excursions out of bed are costing parents loss of what precious little sleep they may already be getting.

For small children who habitually get out of bed after bedtime, what would be an appropriate suggestion?

A. Try the “bedtime pass” technique
B. Place a glass of water in the bedroom, so the child doesn’t have to bother the parents in the middle of the night
C. Speak to the child through an intercom system to reassure them
D. Explain to the child that adults don’t wake up for these reasons, so it’s time they don’t either


What is the correct answer?
(Answer and discussion on next page)

Louis Kuritzky, MD, has been involved in medical education since the 1970s. Drawing upon years of clinical experience, he has crafted each year for almost 3 decades a collection of items that are often underappreciated by clinicians, yet important for patients. His “Pearls of Wisdom” as we like to call them, have been shared with primary care physicians annually in an educational presentation entitled 5TIWIKLY (“5 Things I Wish I Knew Last Year”…. or the grammatically correct, “5 Things I Wish I’d Known Last Year”).

Now, for the first time, Dr Kuritzky is sharing with the Consultant360 audience. Sign up today to receive new advice each week.



Answer: Try the “bedtime pass” technique.

We know that the adult and young adult populations are already sleep-deprived, so it is important that the baseline sleep deprivation of harried mothers or fathers is not worsened by children who provide a variety of excuses for why they are always out of bed.

Assuming that the parent–child relationship is healthy and that there are no environmental or medical reasons why the children should be getting up, what might remediate the situation?

Sleep Disruptions and Insomnia in Older Adults
Toward a Good Night's Sleep: An Approach to Insomnia

The Research

An interesting report on the subject was written by 2 psychologists who were trying to deal with the repeated out-of-bed excursions of their own little ones.1 Having tried the obvious gambits to get the little ones to stay in bed, the 2 parents devised a scheme called “The Bedtime Pass.”

The Bedtime Pass1


The methodology of “The Bedtime Pass” is simple and straightforward: At bedtime, the children are each issued a pass with their name on it, which is good for 1 out-of-bed excursion. When the pass was used, it was surrendered to the parent.

The Results

In this clinical trial of 2 participants, the parents followed the behavior of their 2 children (ages 3 and 10) for 50 days. The 10-year-old child responded after a single session of bedtime pass use and the 3-year-old eliminated out of bed excursions within 3 weeks.

The Bedtime Pass: Results1


What’s the “Take Home”?

Children outgrow unnecessary out-of-bed after bedtime excursions spontaneously. In the meantime, simple measures like “The Bedtime Pass” may speed up the process


1. Friman PC, Hoff KE, Schnoes C, et al. The bedtime pass. Arch Pediatr Adolesc Med. 1999;153(10):1027-1029.