Q: We adopted our son at three years old. He had learned to soothe himself at night by rocking forward to hit his head into the mattress—and still does this four years later. What once served as a comfort to him now interferes with his sleep, causing him to awaken with sore muscles from the repetitive motion and feel tired and unable to focus at school. He is otherwise well adjusted and healthy. We tried using a weighted blanket, but it seemed to have no effect. What can we do to help him?

A: Many children living in institutional care develop rocking or other self-stimulatory behaviors as a means of entertainment and self-soothing, not only at bedtime, but throughout the day. Once they arrive in families, most children gradually decrease these behaviors during the daytime as they find new social relationship and play opportunities. Many children, however, continue to rock at bedtime for months or even years after adoption. Most of the time, this bedtime rocking is harmless, does not reflect a poor adjustment, and does not impair a child’s sleep. In your son’s case, though, it sounds like it needs some attention.

Does he also snore, wet the bed, or sleep walk? These may reflect other sleep disturbances, and should be reviewed with his pediatrician or a pediatric sleep medicine specialist.

Does he have lots of other sensory-seeking behaviors (such as loving to spin, jump, or crash into things, prefer very tight clothes or heavy blankets)? Occupational therapy may help here.

Does he have a hard time unwinding and getting ready to sleep? Melatonin, a substance that the brain makes naturally to regulate sleep and wake cycles, can be helpful. It can be purchased over the counter and given in conjunction with a soothing bedtime routine. You should discuss an appropriate dose with your child’s pediatrician.

Is he still struggling with past adversities? Sometimes this is hard to know, since you may now know what those adversities were, and they may be stored as pre-verbal memories. If he still has frequent tantrums or “meltdowns” for no apparent reason, struggles with separation from you, or has anxieties that seem out of proportion to circumstances, then working with a knowledgeable child psychologist may help to address those troubling memories, and in turn, help him to sleep more peacefully.