The number of parents told by a health visitor or GP that their child "should" be sleeping through the night by 12 months, and the number of parents of 18-month-olds or two-year-olds who are still waking multiple times, suggests a fairly wide gap between expectation and reality.
The reality is that a large proportion of toddlers continue waking during the night. A 2020 survey-based study found that around 27 per cent of two-year-olds were still waking at least once a night. Night waking in toddlers is biologically normal, even if it is exhausting.
None of this means nothing can be done. Sleep consolidation can be supported and encouraged, and for families where night waking is significantly affecting wellbeing, there are approaches with a reasonable evidence base. What matters is matching the approach to both the child and the family.
Healthbooq (healthbooq.com) covers sleep development across infancy and toddlerhood, including sleep associations, nap transitions, and approaches to improving sleep for the whole family.
Why Toddlers Wake at Night
Understanding the mechanism helps. Sleep occurs in cycles of roughly 45 to 90 minutes in toddlers, transitioning through light sleep, deep sleep, and REM sleep. At the end of each cycle, there is a brief partial arousal. Whether the child goes back to sleep independently or fully wakes depends largely on whether the conditions at the moment of arousal match the conditions at sleep onset.
A child who fell asleep being fed, rocked, or in a parent's bed expects those same conditions at the end of each sleep cycle. Finding them absent, the child fully wakes and calls for the parent to recreate them. This is sleep association: associating sleep onset with a particular external condition and being unable to return to sleep without it.
This is the most common mechanism for habitual night waking in toddlers who were previously good sleepers. The infant who fed to sleep through the first year often reaches toddlerhood still requiring a feed to return to sleep at each cycle.
It is not the only mechanism. Illness, teething, developmental leaps, separation anxiety (which peaks around 9 to 12 months and again around 18 months to 2 years), and major changes to routine all cause temporary waking that resolves without intervention once the underlying cause resolves.
The Role of Daytime Sleep
Total sleep in a 24-hour period is regulated. A toddler who naps extensively during the day has less homeostatic sleep pressure (the biological drive to sleep) at bedtime and overnight. Long naps or late naps can reduce the depth and continuity of night sleep.
The nap transition from two naps to one happens typically between 15 and 18 months. A toddler who is still on two naps but is developmentally ready for one may be overtired at the short-nap transition stage, or undertired at night if the combined nap duration is too long.
Nap timing matters as well as duration. A nap that ends too close to bedtime (within about 3 to 4 hours) may make it harder to fall asleep at bedtime, creating a later start to the night and disrupted early-night sleep.
Sleep Environment
The sleep environment should be consistent: the same room, the same temperature (16 to 20 degrees Celsius), darkness (blackout blinds are worth considering if light waking is an issue), and a quiet or consistent background sound.
White noise at a volume below 50 decibels (roughly the level of a shower) can help some children maintain sleep through household noises and can be used at the source of noise (a machine in the room) rather than played through a phone or speaker at close range to the child.
A consistent, calm bedtime routine that ends with the child in their sleep space is the most reliably supported environmental strategy. The routine signals to the brain that sleep is coming.
Approaches to Night Waking
For families where night waking is significantly affecting functioning, and where the waking is habitual rather than caused by illness or developmental change, a planned approach to sleep associations can help.
Gradual approaches involve progressively reducing the parental input required at sleep onset and at night wakings, over a period of days or weeks. The Ferber method (graduated extinction) involves waiting for progressively longer intervals before responding, with brief parental visits to reassure. Fading methods involve the parent remaining present but progressively less involved. Chair methods involve the parent sitting in the room but not engaging, then progressively moving the chair further away.
Extinction (controlled crying in its full form, where the child is not responded to until morning) is faster but requires more parental tolerance. The 2016 Gradisar randomised controlled trial found no difference in cortisol, attachment security, or emotional and behavioural outcomes at 12-month follow-up between graduated extinction, bedtime fading, and control groups.
All of these approaches require consistency to work. Inconsistent application, where the approach is used some nights and not others, typically produces worse sleep than the original situation because the child learns that persistence eventually produces the old response.
A conversation with your health visitor or GP before starting a sleep programme, to rule out medical causes of waking and to get local support, is worthwhile.
Key Takeaways
Most toddlers still wake during the night at some point and this is biologically normal, though the frequency and degree of parental involvement required varies considerably. Sleep consolidation (longer, less-interrupted nights) develops progressively through the toddler years and is influenced by sleep associations, total daytime sleep, timing of naps, the sleep environment, and illness. Approaches to night waking vary in how much parental presence they involve; research supports that graduated approaches are not harmful to attachment when implemented after six months. The aim is manageable sleep for the whole family, not an arbitrary standard of perfection.
