What does your child associate with falling asleep? Depending on the age of the child it could be a binky, a blankie, a bottle, a stuffed animal, watching TV or even Mom or Dad laying down next to him. A sleep association is anything a child has linked to falling asleep and needs in order to fall asleep (at bedtime or during the night after a nightwaking).
A positive sleep association would be one that a child can re-create on his own without adult assistance. This would include such things as a binky, blankie, stuffed animal, white noise machine, etc. If a child wakes in the middle of the night (like we all do naturally), he would be able to recreate the situation he needs to go back to sleep independently. The object associated with sleep should also be limited to sleep as it will trigger to the child’s body it is time to sleep. A good recommendation is to leave it in bed during the day.
A negative sleep association would be one that a child requires adult assistance to re-create in order to fall back asleep. This would include being rocked to sleep, watching TV, needing Mom or Dad to lay down next to him, a bottle/breastfeeding, etc. When children with negative sleep associations wake in the middle of the night, they are unable to recreate the situation they need to fall asleep and therefore, require adult assistance.
Negative sleep associations are the basis for a very common sleep disorder found in about 25% of children: Behavioral Insomnia of Childhood: Sleep Onset Association Type. These children are unable to self-soothe and require parental intervention after a brief arousal that normally occurs at the end of a 60-90 minute sleep cycle. One way to prevent this problem is to put an infant in bed while he is still awake, but drowsy. Thus, preventing the creation of an association between being held or rocked and falling asleep. For a child that has already developed a negative sleep association, it is important to replace the negative association with a positive one – this may involve a lot of coaching with the child (talking them through it/preparing them for it) and possibly some crying from the child as he learns to self-soothe (a critical developmental milestone).
It is important to create positive sleep associations from an early age and there are a variety of options to select from. Just be sure not to use blankies, stuffed animals, etc. until your child is old enough (see American Academy of Pediatrics recent recommendations for Safe Sleep).