A parent emailed me with this story, “Over the past week and a half, we have been having serious issues getting our 2-year-old to go to bed, both for naps and for nighttime. We go through her usual routine of brushing teeth, prayers and reading a story, then put her in her bed with her doll/blanket. As soon as we put her in her bed, she starts screaming, jumps up and runs for the door (we have a baby gate on it so we can keep the door open). We leave the room and she keeps screaming bloodcurdling screams wanting to go downstairs and snuggle with us. At a minimum this lasts for half an hour, usually an hour and a half to two hours. For naps we have given in sometimes and she doesn’t take a nap, and for night we take her downstairs until she conks out.”

I get this question all the time, but I’m a bit afraid to answer it. There is no right answer, no one way, no trick that works for every child. And someone somewhere will accuse you of being a bad parent, no matter how you handle your sleep-avoiding toddler.

There are many, many philosophies about what to do with 2-year-olds who don’t want to go to bed. I have 5 children under age 10, and I often work the night shift as a pediatric hospitalist. I’m tired. I think I’ve tried every toddler sleep philosophy out there. I’ve read mountains of pediatric sleep research. Here are my honest conclusions.

Sleep is a need, not a want. You need to do what works for you and your family, so that everyone gets a good rest.

Some parents, especially those who follow attachment parenting philosophies, say just let your toddler sleep with you until she wants to sleep alone. Personally, I need my kids to sleep in their own beds so that I can sleep. It’s especially hard to sleep with a toddler when I have an infant in a bedside co-sleeper. The toddler generally wakes up the infant and no one gets enough sleep. Yet I still have at least 1-2 children in bed with me each morning when I wake up. Usually they come down in the night and I just let them stay. It is rare that I let them start a night of sleep in my bed.

There are many methods to get toddlers to stay in bed, including variations on the Ferber method and the camping-out method. Although usually used for infants, you can use variations on these methods with toddlers, too. Read more on these methods of sleep training, and my response to the criticism that these methods may psychologically harm infants and toddlers here.

When teaching a toddler to stay in bed, I usually start with what I call the “100 walks” method. In this method you let the toddler come out of his or her room and then walk them back to bed a zillion times, as many times as it takes. When they get out of bed you don’t get angry or show emotion. Simply say, “It’s time for bed,” take their hand or pick them up, and walk them back to bed. After several nights of 30+ immediate trips back to bed, the toddlers get the point and quit. Many people combine this with a positive reward system, such as a sticker chart for every night that a child stays in bed. Another good reward is a special breakfast for kids who stayed in bed all night.

When I’m just too tired for the “100 walks” method, I use what I call the “open door reward” method. I tell my toddlers that if they stay in their bed they can have the door open. If they get out of bed I will have to close the door so they will stay in their room. If they play in their room (which is lit with a nightlight) I don’t do anything about it—they will fall asleep on the floor quickly. If they cry I go back in every few minutes and briefly say that I love them, and it’s time for bed, and that the door can stay open if they get back in bed. Then I close the door again (unless they get in bed). I stretch out the intervals of these reassuring check-ins, similar to the Ferber method mentioned above. After a few nights of this they generally stay in bed. This method allows the child to have some control over the situation, so it’s not just a battle of the wills.

Then there’s the Bedtime with the iPad method—or what I call my “Total Mom Fail.” It doesn’t work. (Sadly, I tried it). The blue light from the touch-screen inhibits melatonin release and can keep toddlers up for hours. Even if your child does fall asleep with a touch screen, you are establishing bad sleep habits that can last for life. Resist the temptation and keep touch screens out of your child’s bed.

I don’t recommend the cry-it-out method. I do feel it is just too stressful for toddlers and may interfere with attachment.

Pick a toddler sleep method for your family, and stick to it for a while. Don’t be afraid to make exceptions for unique circumstances. For example, I usually don’t lay down with children until they fall asleep (although they ask all the time). I have 5 children and it’s simply impossible to do this for multiple children each night. But there are times when I make exceptions. For example, if a child is overtired and very upset, it is often best to just lie beside them for less than 10 minutes, not talk, and let the child calm down and go to sleep. Overtired children often lack the self-control to calm themselves down for sleep, especially if they are off-schedule, missed a nap, or had an unusually hard day.

Occasionally, when a child is really off schedule, I use melatonin. Melatonin is a naturally occurring hormone that our bodies make that triggers sleep. You can buy it over-the-counter at any drug store, but there is very little research on melatonin use in children, and the side effects can be significant. I think it is fine to use low-dose melatonin supplements for children on a short-term basis (1-5 days) to help re-program their body’s clock if they’ve gotten off their regular sleep schedule. I would only do this in consultation with your own pediatrician, and after trying these suggestions to get a child’s sleep schedule back on track.

I always make sure children know that they can come to us if they are sick or very scared, no matter what. (Nightmares and night terrors are a different issue, which my colleague has written about here.) Rarely, children can have medical conditions that impair sleep, such as sleep apnea or narcolepsy. Our sleep center at St. Louis Children’s Hospital can help you determine if your child is suffering from these conditions.

If your child is sick, gets off schedule, or goes through a life transition, you may have to go through a sleep-training period all-over again. You’ve done it before, you can do it again. Teaching kids to get to sleep is a life skill, something they will have to re-visit many times, even though teen and adult years. The benefits of a good night sleep are incredible! Kids who sleep well do better academically and socially, and are less likely to be obese or sick. (Read more about the benefits of sleep for kids here.)

Are you tired? Here’s the truth about sleep-deprived parenting.