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Help! Toddler on the spectrum jumps all night

Jumping all nightI have a 2-year-old on the spectrum, and we’re having problems with him in his crib. He likes to jump in it, has caved in a mattress and broken the mattress springs twice. I'm worried that if I put him in a toddler bed, he’ll get out and bother his twin. I also know he can't stay in a crib forever. Any suggestions?

This week’s “Got Questions?” response is by pediatric psychologist Elizabeth Pulliam, of Arkansas Children’s Hospital and the University of Arkansas for Medical Sciences. The university and medical center are part of the Autism Speaks Autism Treatment Network (ATN)

Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.

When to transition from the crib to a “big bed” is a common question. But the issue can be particularly challenging for parents of children who have autism. Your child may be physically big enough to be in that toddler bed, but you’re wondering whether he’s developmentally ready. Then there’s concerns around your son getting out of bed in the middle of the night – also particularly common among children on the spectrum.

Your son’s crib jumping – a classic repetitive behavior – adds yet another dimension to your safety considerations. After all, the purpose of a crib is to keep your child safe while he sleeps. But jumping that’s vigorous enough to break a mattress and springs may mean the crib is no longer the safest place.

Clearly you feel it’s time to make some changes. I’d be glad to offer some general guidance that I encourage you to discuss with your son’s behavioral therapists and physician.

A better time and place to jump
Many children with autism love to jump and bounce. It’s a particularly enjoyable repetitive behavior that can provide both soothing and stimulating sensory input.

But jumping and bouncing in a crib can definitely become a problem. As in your case, the crib may not be able to hold up to all that jumping.  

In looking for a solution, the first thing to consider is why your child is jumping.

If it’s simply an enjoyable repetitive behavior, you might offer him alternative opportunities to jump and bounce during the day. One possibility is a mini trampoline with handles he can hold. You can make a few sessions on the trampoline a regular part of his day. One of these sessions might be part of his evening wind-down routine – but not immediately before bed as you don’t want to energize him.

Might the bouncing be a need for sensory input? This is a great issue to discuss with an occupational therapist as part of your son’s early intervention program (IEP). You and the OT can discuss other sensory techniques that can address your son’s sensory needs.

Examples include body brushing (the Wilbarger method), joint compression and deep pressure during the day and/or prior to bed. These techniques may give your son the sensory input he needs to fall asleep. Your son’s OT may be able to try these techniques with your son teach you how to perform them at home.

Is it time to leave the crib?
Before moving your son out of a crib and into a bed (or a mattress on the floor), it’s so crucial to childproof the room. This is true for any toddler. But it’s particularly crucial for kids on the spectrum who tend to wake up in the night. 

Toddler proofing the room includes making sure that all heavy furniture is secured to the wall and all electrical outlets have childproof covers, with a secure gate at the door to prevent roaming.

To prevent your son from bothering his twin at night, consider placing his crib mattress on the floor surrounded by a sturdy toddler play fence.

Or, you might place a twin-size mattress on the floor with one end against the wall, toddler bedrails on both sides, and perhaps a non-tippable chest on the other end. The bedrails won’t prevent your son from climbing out, but they will give him clear boundaries. So you’ll need to place him back in his bed each time with a calm but firm request to “stay in your bed” until he learns the new routine. (See the “behavioral approaches” section below.)

The sturdier crib option
Perhaps the above measures don’t work, or you’ve simply decided it’s not yet time for your son to leave the crib. Many medical supply stores – including online outlets – have extra-sturdy cribs and enclosed beds especially designed for children (and sometimes adults) with special needs. These cribs and beds are built to withstand considerable weight and movement. Some are built low to the ground for added safely.

Admittedly, they tend to be expensive. However, if it’s an autism-related medical necessity for your child’s safety, you may be able to get some insurance coverage with supporting letters from your son’s doctors and therapists.

The less-bouncy crib option
Another approach is to reduce the bounciness of the crib to help discourage nighttime jumping – while giving your son the alternative of bouncing during the day as described above.

One way to do this is to place a thick, sturdy piece of plywood under his crib mattress. For safety, it’s important to cut the plywood precisely to the crib’s dimensions, so the wood securely fits the crib frame.  Then, to further reduce bounce, consider replacing his current mattress with a thinner one on top of the plywood.

Another option – with some but not all cribs – is to remove the legs and bottom of the crib and place the frame directly on the floor. Make sure there are no hinges or other parts left on the frame that can pinch or otherwise hurt your child or catch his clothing. The mattress then goes directly on the floor. (Note: This option works only if the crib has a frame bar near the bottom, so there is little or no space between the floor and the frame. You can place one or more heavy pieces of cut plywood under the mattress to raise it off the floor if you need just a bit of lift to get a secure fit within the frame.) 

Behavioral training
Whichever approach you choose, it sounds like he would benefit from some behavioral intervention. This would be directed at either staying in his toddler bed or less bouncing if he’s still in the crib. I highly recommend involving your son’s behavioral therapist in personalizing how you approach this.

In general, you want to firmly and calmly state, “Stay in bed” or “No jumping,” as you lay him back down. Calmly repeat this each time he gets out of the bed or begins jumping in the crib. With consistency, this can reduce the unwanted behaviors over time.

But I want to emphasize again: If his bouncing is filling a need for repetitive movement and/or sensory input – and it sounds like it is – you want to give your son acceptable alternatives such as those described above.

Bottom line, your son’s safety is of utmost importance. If you feel he can no longer safely remain in his crib, take him out – even if it means inconveniencing his twin and some long nights for you as you teach him to stay in a big-boy bed.

I hope these strategies are helpful. Please let us know how you and your son are doing in the comment section below or by emailing us again at gotquestions@autismspeaks.org.