Module 4: Promoting Mental Health in Early Childhood


Fostering Healthy Patterns

By the end of the first year, most children should be able to sustain or return to sleep throughout the night. Inadequate sleep often leads to behavior problems. Parents need to establish bedtime routines and set limits to help their child develop good sleep patterns and get enough rest.

Questions to Ask

  • Tell me about your child’s sleeping habits.
  • Does she sleep through the night?
  • What is your bedtime routine? What time is bedtime?
  • How do you handle naps?
  • How many hours a day and night does your child sleep?

Provider Tips

  • For some families and cultures, the “family bed” or co-sleeping is the norm. If the family is co-sleeping:
    • Counsel parents on safety issues related to co-sleeping and identify hazards
    • Evaluate co-sleeping families to ensure that it is not done for sexual gratification
    • Assess whether co-sleeping is the result of parents’ inability to control child’s bedtime behavior
  • Using the guidance listed below, discuss the importance of bedtime routines and healthy sleep habits with the parents.

Guidance for Parents

  • Nightly bedtime routines help your child “wind down” at the end of the day and prepare her for sleep. Put her to bed at the same time each night and spend quiet time together that includes any or all of the following:
    • Rocking and cuddling with her
    • Reading and singing to her
    • Talking about the events of the day
    • Giving her a favorite toy to snuggle with
    • Putting on a night-light if she wants one
  • It is best for your child to fall asleep on her own after bedtime routines. Tuck her in bed when she is drowsy, but still awake.
  • Your child may go through a short period of waking at night. If she wakes up:
    • Briefly visit her room to reassure her, but don’t give her enjoyable attention
    • Help her use a stuffed animal, blanket, or favorite toy to console herself
    • Don’t bring her into your bed to get her back to sleep
  • From the ages of 1 to 2 years, your child will probably need to take two naps a day. As she gets older, one nap during the day should be enough to keep her well rested. Develop regular naptime routines for her and space her nap so that she will be tired at bedtime.
Resources for Providers and Families

For the Provider

Area of Concern: Bedtime Struggles more information

When a child refuses to go to or stay in bed, consider the following:

  • The child may not be tired because of irregular schedules (going to bed at inconsistent times, napping in the afternoon, or sleeping late in the morning). A sleep diary can help parents determine the reason for and solve their child’s sleep problem.
  • Parents may believe that their child needs more sleep than is necessary.
  • The child may need more adult assistance in going to bed.
  • Consistent behavioral limits are not being maintained during the day.
  • Fears may be causing the child to resist going to bed.
  • Parents may be having trouble separating from their child at bedtime, creating a sleep problem. This is most common if:
    • parent-child relationship involves a lot of struggles
    • parents feel guilty because of limited time spent with their child
    • parents are experiencing depression or marital conflict
  • Parents may need to become aware of how they are signaling their own ambivalence about separating from their child at bedtime. They may need to spend special time with the child daily and set appropriate limits. (Guidelines for Special Time)
  • Referral to a mental health professional may also be needed.

For the Family

A sleep diary can help parents determine the reason for and solve their child’s sleep problem. PDF

A Lullaby for Good Health

Sleep Challenges

Nightmares and Night Terrors

Principles of Limit Setting PDF

Fears in Early Childhood PDF

Berenstain S, Berenstain J. 1982. The Berenstain Bears in the Dark. New York, NY: Random House.

Emberley E. 1992. Go Away, Big Green Monster! Boston, MA: Little Brown.

It’s Sleepy Time. 2002 (VHS). Dallas, TX: Learning Through Entertainment. (Part of The Duke Family Series, available from Learning Through Entertainment.)

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