The good news is that many babies simply need time, age-appropriate routines, and consistency as their sleep matures; however, some infants may be communicating that something deeper is affecting their ability to sleep. When challenges have been ongoing, one of the first things I tell parents is to trust their instincts and to look at the whole picture. [...]

Some helpful questions parents can begin asking include:

• Are feedings consistently difficult or stressful?

• Does my baby seem uncomfortable lying flat?

• Are they unusually sensitive to sound, light, touch, or movement?

• Do they only sleep when being held or moving, and seem unable to settle in any other environment?

• Are they incredibly difficult to soothe, even when all of their basic needs have been met?

• Are they spending very little time in calm, alert states because they're either constantly asleep, constantly crying, or frequently dysregulated?

• Do they seem uncomfortable during or after feeds, arch their back frequently, or have persistent digestive concerns?

None of these signs automatically mean something is wrong, and no single behavior tells the whole story. Many of these behaviors can also occur during typical development. What we're looking for are patterns—concerns that are persistent, occur together, or seem to interfere with a baby's ability to comfortably eat, play, connect, and sleep. [...]

Children with autism, ADHD, sensory processing differences, anxiety, communication differences, genetic conditions, or motor challenges often experience bedtime differently than their peers. [...] 

We still use the foundations of healthy sleep—consistent routines, age-appropriate schedules, and healthy sleep habits—but rather than parents asking "How do I stop this behavior?" I like to shift the conversation to "What might my child be trying to communicate?" Once we understand the "why," our toolbox expands far beyond traditional sleep strategies.

Those might include visual schedules, social stories, bedtime passes, sensory regulation activities, environmental modifications, communication supports, or teaching emotional regulation skills during the day rather than only expecting those skills at bedtime.

One powerful strategy that I love incorporating is pretend play and role-playing. As an occupational therapist, I know that children don't just learn through being told what to do—they learn through play. Play is a child's natural language, and it's often where they process experiences, build confidence, and practice new skills in a safe, low-pressure way.

The first thing I encourage parents to do is become curious about what helps their child regulate and to think beyond the bedtime routine. [...]

For many families, this means creating a bedtime routine that supports the nervous system, not just checks off tasks.

That might include dimming the lights, reducing household stimulation, slowing the pace of the evening, reading together, practicing deep breathing, gentle stretches, child massage, rocking, listening to calming music, or incorporating calming sensory activities that fit that particular child.

The goal isn't to add more to parents' evenings—it's to choose a few strategies that help that individual child feel safe, connected, and regulated.

I think this is such an important question because it's also an opportunity to talk about building the right team around a child. Sleep is influenced by so many different systems in the body, and sometimes supporting sleep means looking beyond sleep itself.

When I consider referring out to chiropractic care I’m often seeing underlying factors that may be contributing to their child's discomfort, movement, regulation, or overall well-being. If those concerns are present, chiropractic care may be one piece of a comprehensive care team for some families. [...]

As an occupational therapist, I often think about the nervous system as the foundation for everything we do. In some situations, families may choose to consult a pediatric chiropractor—particularly one with additional training in infant and pediatric care, neurodevelopment, or nervous system-focused approaches—as part of a broader evaluation.

This may be appropriate for children with persistent body tension, asymmetrical movement patterns, torticollis, positional preferences, musculoskeletal discomfort, feeding difficulties that occur alongside movement or postural concerns, or challenges with regulation that appear to be influenced by physical discomfort.

I know how isolating sleep struggles can feel. When you're up night after night, you're exhausted, you're questioning every decision you've made, and it can seem like everyone else has figured it out except you.

Add developmental differences into the picture, and it's easy to wonder if sleep will ever get easier. But I want parents to know that there is hope. [...]

I also remind families to celebrate progress instead of chasing perfection. Better sleep doesn't always happen overnight.

Sometimes success looks like a child falling asleep ten minutes faster, waking one less time during the night, tolerating a new bedtime routine, or needing a little less support than they did the week before. Those small victories matter because they add up to meaningful, lasting change.