Introduction to Early Childhood Care

Childhood is not only the formative years but also the most
impressionable. Teaching children can often prove to be walking
into unchartered territory and especially for Early childhood
teachers. Early childhood is the foundation for most future
learning. There is growing awareness that the early years are the
most important learning years. Most brain development occurs before a child turns 5,
and research shows early educational experiences can set the course for all future
learning. Therefore the focus on early childhood teacher education becomes a
priority.
This course is relevant for anyone who would like to be associated with education of
early childhood learners. The course will provide valuable insight into the learning
and teaching of the early childhood years for teachers, parents, caregivers, childcare
center heads, educators, preschool directors and coordinators. For the career
changers it is an option to get away from the hectic corporate routine and find a job
that is enjoyable and fulfilling.

WHAT IS EARLY CHILDHOOD?

Early childhood is a crucial period for every child all over the world. This is the period
when the child needs the cooperation and the supervision of the parents and other
relatives the most.
Most of the learning of a child’s life begins in this period. Early childhood is usually
defined as before the age of normal schooling. The age is from birth to 5years.
During the first three months of a baby's life, he or she grows in length approximately
20 percent and weight increases by about 30 percent. The child also learns to

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recognize his/ her mother’s smell, becomes more aware of her own hands, and
responds to touches that she finds soothing. Between the ages of three to six
months, there is a rapid growth physically. In addition to doubling their weight at
birth, most children learn to roll from back to front, sit up with support, pass toys
from one hand to the other, make babbling noises, and follow object with the eyes.

From six to nine months, parents start noticing major increase in their infant's
eyesight, hearing, and mobility. Children can sit up without any support, reach for
toys in front of them, and even crawl at this age. As their dexterity improves, so does
their ability to grasp and play with toys. During this stage, a child's vision is almost as
clear as that of an adult. Parents also notice that their kids begin to show definite
taste preferences, showing their enjoyment of certain food, while expressing
displeasure with foods they do not like. In the last three months of the first year,
children weigh about three times more than they did at birth and grow about 10
inches in length. Some children learn to stand up without support and begin to take
their first steps around the house, often helped by adults or by holding tightly on to
nearby furniture.
Infancy:

The term infant is typically applied to young children between the ages of 1 month
and 12 months. Newborns can feel different kinds of sensations, but respond most

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enthusiastically to soft stroking, cuddling and caressing. Gentle rocking back and forth
often calms a crying infant, as do massages and warm baths. Newborns can be
comforted by nursing, or may need to comfort themselves by sucking their thumb or
given an alternate way to suck. Newborn infants have unremarkable vision, and can
focus on objects for about 18 inches (45 cm) directly in front of their face. When a
newborn is not sleeping, or feeding, or crying, he or she may spend a lot of time
staring at various objects around and nearby. Usually anything that is shiny, has sharp
contrasting colors, or has complex patterns attracts an infant's eye. However, the
newborn has a preference for looking at other human faces also.

Infants cry as a form of basic instinctive communication. A crying infant may be trying
to express a variety of feelings including hunger, discomfort, overstimulation,
boredom, wanting something, or loneliness. Adequate amount of food consumption at
an early age is important for an infant’s development. From birth to four months,
infants should consume breast milk or an unmodified milk substitute. As an infant’s
diet develops, finger foods may be introduced as well as fruit, vegetables and small
amounts of meat.

Experiments have been conducted with infants up to four months of age using both
positive touch (stroking or cuddling) and negative touch (poking, pinching or tickling).
The infants who received the positive touch cried less often and also vocalized and
smiled more than the infants who were touched negatively. Infants, who were
touched negatively, have been linked with emotional and behavioral problems later in
life. A less amount of physical violence in adults has been discovered in cultures with
greater levels of positive physical touching.

Infants respond to the hissing sound of snake, angry voices of adults, the crackling
sound of a fire, thunder, and the cries of other infants. They have a drop in heart
rate, their eyes start blinking, and they turn towards the speakers or parent, which
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indicates that they are paying more attention. This is believed by some to be an
evolutionary response to danger.

Toddlers:

Toddlers are the children between 1- and 3-years-old. At this stage, they are leaving
the immature infant stage, but not yet ready for the more preschool stage. Typical
toddler development includes a move forward in motor development, increase in
mental reasoning skills and the beginnings of social and emotional growth.

Child psychologist Erik Erikson described how the physical development of a child in
his second year of life serves as the foundation for cognitive, personality and social
development. As a result of the muscularization of the legs, the child at this stage is
able to walk and explore on his own. With the gross motor skill abilities to walk, run
and climb, as well as the fine motor skills of grasping and manipulating objects, a
toddler is less dependent on his parents and an increased sense of autonomy.

According to the Swiss child psychologist Jean Piaget, children between the ages of 1
and 3 are able to represent objects with words. Children of this age are able to think
symbolically and to refer to objects that are not immediately present; however they

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are unable to see from the point of view of others. A typical 3-year-old can only
describe what he sees.

With autonomy and the sense of self, the child is presented with the problem of social
interaction. As Erikson describes, the toddler manages his ability of both self-
satisfaction, such as walking to a desired toy, and social manipulation, such as getting
someone to bring him the toy. The social development for the child at this age
centres around achieving a sense of self while struggling with feelings of shame for his
individuation. It is a result of the parent who scolds the curious toddler in his "terrible
twos."
Preschooler:

The preschool years (ages 2-1/2 to 5) are an exciting time for young children. When
they were infants, they developed a trust for their parents. As toddlers, they began to
establish some independence. Now, as preschoolers, they use this trust and
independence to actively explore new forms of play (e.g., pretend play) and new
environments (e.g., school).

Preschoolers rely heavily on the appearance to understand the world around them.
For example, if a child breaks a toy into three pieces while her brother breaks his in
half, she thinks that she has more than her brother because she has three pieces and
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he has only two pieces. Similarly, a child may begin a friendship with another child
because of something appealing that the other child has, such as a pretty dress or a
new toy.

Adults play an important role in helping children take initiative and explore their
environments. Adults' behaviours, attitudes and styles of thinking make a great
contribution to preschoolers' development. Talking with children and including them
in conversations help to develop their language skills. It is important to give children
opportunities for make-believe play. This helps them to understand themselves and
others, and encourages their imaginations.

Preschool children love to play, especially when their play activities involve make-
believe. This special type of play, known as pretend play, is particularly important for
young children's development. As children's thinking skills improve during the
preschool years, they can remember and tell stories that follow a sequence of events
and make sense to others.

Early Childhood:
Early childhood development consists of different types of physical development like
walking, talking, eating, playing etc. and different types of mental development like
sharing and caring, growing values, morals and ethics, respecting others etc. At the
early stage, education starts from learning all these physical and mental activities;
then comes formal learning like identifying body parts, alphabets, digits, colours and
shapes. According to Piaget’s theory, early childhood learning starts with play. It is
believed that children learn more effectively and gain more knowledge through play.
All this ‘learning by playing’ starts from home. Family is thus the first agency that
teaches children these things. Newborns prefer sounds that were a regular feature of
their prenatal environment, for example, a particular tune of music their mother
heard regularly. Naturally, the rhythm of the mother's breathing and heartbeat are
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even more familiar to the newborn, therefore they will prefer or expect to hear it
regularly for prolonged periods.
Early childhood is the time of maximum growth and development. At this time
physical, social, emotional and intellectual development of a child takes place.
Physical development refers to the development of different body parts and different
psychomotor skills, social development refers to the ability of young children
to interact with others with manners and sustain relationships, emotional
development refers to the children’s feeling about themselves as well as others and
intellectual development is the ability to acquire and to apply specific knowledge like
reading, calculating and language. Good quality early life experiences, including
helping families meet children’s needs, can enhance children’s resiliency and promote
optimal child development at this period.
Early Childhood Care and Nutrition

The formative years of early childhood need special care and understanding, and
being an early childhood educator means one should be aware of not only the
academic significance but also understand the physical environment and nutrition
that children receive are so much part of the growth process. Early childhood is a
rapid growth stage therefore the right diet; physical comfort and nursing care that
they receive have lifelong impact on the overall development of the children. Early
childhood educators and care givers must be aware that the young learners entrusted
in their care do not have the linguistic ability to always express themselves, their
needs and discomfort. Teachers spend considerable amount of time wherein there
may be situations when emergencies may arise. It is imperative that teachers are able
to identify such situations and act appropriately.

Food

Importance of Healthy Food in Early Childhood Development

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Healthy food and a balanced diet have a crucial role to play in early childhood
development. Healthy diet of early childhood has a strong impact on a child’s health
which continues throughout adolescence and adulthood. Maintaining a healthy diet
supports healthy growth and provides with the energy they need to carry out the daily
activities. Eating healthy food has been proven to help children grow as healthy and
confident kids. Food is fundamental to developing a sense of well being and is
responsible for children’s achievement at all stages of education. Proper learning is
enhanced when the children are well nourished. It has been observed that food
choices affect the behaviour pattern and the performance level of children.

Healthy food is a must for children as it provides essential vitamins, minerals and
other nutritional goodies that kids need for healthy growth and development.
Vitamins and minerals are vital for the body to function properly and each one has a
specific function for the body. Young children need energy (in the form of calories
from food) and nutrients such as calcium, protein, carbohydrate, vitamins and
minerals to make sure that their bodies work properly and grow. Your child has
different nutritional needs to your own and, as their bodies grow and develop, their
needs will change.

For example:

 Calcium is the most abundant mineral in the body and is essential for strong,
healthy bones and teeth. Good sources of calcium include dairy products (milk,
yoghurt and cheese), green leafy vegetables and bony fish.

 Protein is used by the body to build healthy muscle and tissue. Protein can be
found in lean meats, eggs, fish, poultry, beans and cheese.

 Vitamin C supports little immune systems and is also required to form collagen,
which is essential for the development of healthy bones, gums and blood vessels.

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Citrus fruits (lemons, limes and grapefruit), strawberries and broccoli are good
sources of vitamin C.

 Carbohydrates are used by the body for energy. Healthy carbohydrates are
essential for a child’s overall health. Child friendly fruits containing carbohydrates are
bananas, apples, pears and melons and among vegetables carrots, broccoli, corn, peas
and peppers are good sources of carbohydrates.

 B vitamins work together to help the body convert the food taken into energy
and provide the support children need to stay active. Good sources of B vitamins
include whole grains, poultry and eggs.

 Iodine is a mineral required for normal brain development, concentration and

learning ability, making it crucial to support growing children. Good sources of iodine
include seafood and fortified bread.

 Zinc is vital for normal growth and development in infants and supports healthy
immune function in children. Good sources of zinc include seafood, meat and beans.

Children should be encouraged to develop healthy eating habits from an early age
which will pave the way for a healthier adulthood. Healthy diet is extremely
important right from infancy as it is the most rapid period of growth in human life.
Moreover, early childhood is a crucial phase for cognitive, behavioural and physical
development and nutritious food is one of the important factors ensuring that the
child reaches its optimal level. During early childhood, the body is growing at a rapid
pace. This pace slows down after age 1, and may occur in spurts throughout
childhood, adolescence, and puberty. A child needs adequate dietary intake to
provide enough nutrients and energy for growth, without reducing his/her body's
ability to stay healthy. In addition, almost half of the adult skeletal mass is built
during adolescence. A healthy diet, rich in calcium and other essential vitamins and
minerals, enables optimal skeletal and physical growth.

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In order to get the required calcium, protein, carbohydrate, vitamins and other
minerals it is important that the children eat a wide variety of nutritious foods from
all the different food groups. As a general guide, children should eat lots of fruits and
vegetables, whole grains (such as brown rice , wholegrain bread and whole meal
pasta), beans and lentils, moderate amounts of lean meat, fish, nuts and dairy
products (cheese, yoghurt, milk) and only occasional consumption of biscuits, sweets
and chocolate.

Different colours of fruits and

vegetables usually contain different
combinations of nutrients. So
providing children with a colourful
palette of different kinds of food
(green, white, yellow, orange, blue,
purple and red) not only makes an
interesting whole some meal but also
increases the nutritional value of the meal. Healthy food helps to stabilize children’s
energy, makes them mentally nimble and balances their moods. Today’s peer
pressure and TV commercials for junk food have a strong influence on kids and deter
them from eating healthy therefore it is the responsibility of the parents to instil
healthy eating habits which will last a lifetime. Encouraging healthy eating habits
from early childhood make a huge impact on the children’s lifelong relationship with
food and give them the best opportunity to grow into healthy, confident adults.

But a lot depends on the choice of children who have a penchant to develop a natural
preference for the foods they enjoy eating, so the challenge for parents is to make
healthy food choices appealing to children. But it is easier said than done as it is
always going to be difficult to convince a four year old that an apple is as sweet a
treat as a cookie. Special care has to be taken to provide the children with a diet as

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nutritious and wholesome as possible, even while allowing for some of their favourite
treats.

Tips to promote healthy childhood eating to be communicated to parents

 Children should be made part of regular family meals. The entire family sitting
down together is a comforting feeling for a child and it helps in enhancing the
appetite. Breakfast is another bonding time for a family meal especially since children
who eat breakfast tend to do better in school.

 More meals should be cooked at home and children should be encouraged to

eat home cooked meals which is healthier for the entire family and sets a great
example for children about the importance of food. Restaurant meals tend to have
more fat, sugar, and salt. Dining out should be kept aside for special occasions.

 Getting children involved in choosing their own food can be a very good idea.
Children enjoy helping adults to shop for groceries, selecting what goes in their lunch
box, and preparing dinner. It's also a chance for you to teach them about different
foods and (for older children) their nutritional values.

 Children should be treated to a variety of healthy snacks available instead of

empty calorie snacks. Variety of fruits, vegetables, whole grain snacks and healthy
beverages (water, milk, pure fruit juice) should be
made easily accessible as this would make kids
become used to reaching for nutrition packed snacks.

 Food portion sizes should be limited and food

should never be used as a reward or bribe. Food
should never be forbidden in order to encourage
healthy eating habits in children as it just makes kids
want these foods more. Practicing moderation and setting limits are important.

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In school the teachers need to teach the children about food and nutrition and it is
the duty of the parents to turn the children’s learning in the classroom into action.
Moreover, eating together as a family is a healthy routine which provides children
with comfort and security about food.

Significance of family meals

• Nutrition – Family meals give the opportunity to children to eat more balanced
meals and a wider variety of foods especially when they are eating with their family.

• Tradition – Every family has a tradition with food and sharing meals with family
members makes children aware of family and cultural traditions about food.

• Comfort and security - Children who spend time together with their family at the
dining table bond over food and eating meals regularly with family provides them with
a satisfaction and security.

• Learning – Children can be involved while

preparing for a meal taking into account their
preference of food for the day which helps
children learn more about food and about how to
eat and make healthy food choices.

• Communication - Sharing meals gives children

and their parents the time to talk and share
information about their day.

Best Food for infants aged 0-12 months

A good investment in early childhood nutrition has a sweeping effect as it protects

health, promotes growth and saves lives. It is up to the parents to understand and
support the nutritional needs of a child from an early age. Optimal nutrition in early

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childhood not only supports the growth and development to the child’s full potential
but strengthens the lifelong eating habits.

Infant development begins at birth and during

their first year the babies grow at a rapid pace
tripling their birth weight and major infant
development takes place during the baby’s first
three months. Medical experts are of the
opinion breastfeeding is the best choice for the
newborns which has many advantages. The most
important being that breast milk is the perfect food for a human baby's digestive
system. It contains the vitamins and minerals that a newborn requires, and all of its
components — lactose, protein (whey and casein), and fat — are easily digested by a
newborn's immature system. Breast milk contains antibodies that help protect infants
from a wide variety of infectious diseases including diarrhoea. Studies suggest that
breastfed babies are less likely to develop certain medical problems, including
diabetes, high cholesterol, asthma, and allergies. Breastfeeding may also decrease
the chances of child obesity. But sometimes breastfeeding may not be possible or
preferable for all women. So in order to meet the nutritional needs of infants mothers
can switch to bottle feed using infant formula. Healthy newborns don’t need water,
juice or other fluids. Most newborns need eight to twelve feedings a day-about one
feeding every two to three hours.

After six months babies can start having semi-solid food like iron fortified infant
cereal and tiny portions of fruits and vegetables like banana, apple, peach, potato,
carrots, zucchini and pumpkin. Chicken and mutton can be fed after eight months but
in a pureed form. Fish can be started after nine months and dairy products like
yoghurt after eight months while cheese and cottage cheese after tenth month.

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Recommended food for toddlers aged 1-3 years

Compared to the growth rate of a baby in his/her first year,

a toddler grows at a much slower rate. It has been observed
that the growth rate slows down between a child’s second
and third birthdays. The toddler years are a time of
transition, especially between 1year to 2 years when they
are learning to eat table food and accepting new tastes and
textures. Breast milk and formula provide adequate nutrition for a child as an infant
but as toddlers they need to experience a variety of foods. They can start having
oatmeal with milk, homemade pancakes and mini omelettes with toast for breakfast.
Lunch could be rice or pasta with meat and vegetables, chicken with stir fried
vegetables or rice with lentils and fish, vegetable soup with whole grain bun. Toddlers
need dietary fat for healthy brain development and growth so milk should be offered
to children till they reach the age of two. Sometimes toddlers prefer to drink milk
rather than solid food but food is equally important for toddlers. Juice can also be
given to the toddlers but it should be restricted to ½ to ¾ cup per day although a
whole fruit is a better choice than juice. Toddlers should be offered water in between
meals.

Healthy food for preschoolers aged 3-5 years

Rapid growth and development occur in children aged 3 years to 5 years. A varied and
nutritious diet and opportunities to
play and be physically active are
required for a child to grow
properly and it is of vital
importance that they learn to enjoy
nutritious foods and pick up eating
habits for lifelong health. At this

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stage the children should eat and enjoy healthy meals with the rest of the family.
This is a critical stage for laying the foundation of healthy eating. Children’s
socialization with food begins at this juncture. They begin to understand the role food
play and get influenced by the different kinds of food they come across in
advertisements or in supermarkets as they step outside their homes. Emphasis should
be on the good nutrition which is an important part of a child’s healthy lifestyle. This
includes fresh vegetables and fruits, non-fat or low-fat dairy products (milk, yogurt,
and cheeses) lean meats (chicken, turkey and fish) and whole-grain cereals, bread
and rice.

Three-year-old children are frequently picky eaters and this kind of behaviour
sometimes continues in four year olds as well although the older the child becomes,
he/she gets more vocal about his/her preferences and more insistent about refusing
to eat certain foods. The children may have unpredictable emotional responses to the
foods during this period but it is up to the parents to put well-balanced meals on a
child’s plate and provide with the choices to meet his / her nutritional needs.

Children aged 3, 4 and 5 are curious, eager to learn and become better at doing
things on their own. They enjoy active learning using their senses (touch, taste, see,
smell and hear). They observe and imitate the behaviour of others especially adults
and this applies to their food preferences and eating habits as well.

Nutritional needs:

The quantity of food needed at this stage varies from child to child and from day to
day and depends on the growth and activity levels of the children. Children aged 3, 4
& 5 generally need about 1200 to 1400 calories a day, but those who are very active
may need as many as 1600 calories. They can meet their basic nutritional needs by
eating the types and amounts of foods listed below each day. The lower end of the
range provides 1200 calories, the higher end provides 1600 calories.

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Breads, cereals, rice, pasta and noodles

3 to 7 servings daily

(One serve = 2 slices of bread or 1 cup cereal or 1 cup cooked rice, pasta, noodles)

This includes all kinds of whole meal, wholegrain and white bread, cereal, rice, pasta
and noodles such as crackers, dry biscuits and fruit buns.

Vegetables and legumes

2 servings daily

(One serve = 1/2 cup cooked or 1 cup salad)

The children should be encouraged to taste and try a wide variety of both raw and
cooked vegetables. This is important in helping the child to develop healthy eating
habits. Fresh vegetables are best but frozen
and canned are good alternatives.

Fruit

1 serving daily

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(One serve = one medium piece e.g. an apple or banana or two small pieces, e.g.
pear)

Fresh fruit is best but frozen and canned are also good alternatives. But fruit juice is
not an alternative to fresh fruit.

Dairy products-Milk, yoghurt and cheese

2 servings daily

(One serve = two cups or 250ml of milk, custard or 200 gm yoghurt

or 40gm cheese or cheese slice).

Children do not need special yoghurts or custards. Reduced fat dairy

foods are suitable for this age group.

Meat, fish, poultry, eggs, nuts and legumes

2 servings daily

(1/2 serving = 1/2 cup mince or 35-50gm meat or 2 tablespoons kidney beans or other
legume, or 40-60gm fish or 1 egg)

Red meat is an excellent source of iron. But nuts are not

recommended for young children as they could cause
choking. Smooth nut pastes can be used though.

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Junk food should be limited or if possible be eliminated from children’s diet along
with sugared beverages. Since dairy is an important part of children’s diet, a child
could be served flavoured milk if it is the only way the child will drink milk. Further,
flavoured milks can help the child to meet the recommended daily dairy servings. To
improve bone health consuming low fat or fat free flavoured milks, cheeses and
yogurts containing modest amounts of added sugars help to meet calcium
recommendations in children. Desserts like ice cream and cake are fine once in a
while but certainly shouldn’t be an everyday indulgence. For overweight children,
attention should be paid to portion sizes and for four and five year olds, servings
should be less than the adult-sized portions.

To combat external influences it is the duty of the parents to keep the home as
healthy as possible by stocking up on low-sodium, low-sugar and low-fat products.
Children’s television viewing and exposure to advertisements need to be monitored.
Eventually the children will become accustomed to healthy foods, which may make
them less susceptible to the temptation of the more sugary, salty, or oily ones.

Safety tips during meal time in school

 An adult must always stay with children while they eat and drink.

 The children must be made to sit down while eating.

 Children can be taught to take small bites and chew the food well.

 Hard vegetables like carrots must be cooked or grated.

 Fruits should be chopped into small pieces and pits, seeds and tough skins
should be removed before serving.

 Bones should be removed from fish and fish should be rubbed between fingers
to find and remove bones.

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 Round foods like grapes, cherry tomatoes and hot dogs should be cut
lengthwise first and then into small pieces.

 Butter needs to be thinly spread on toast or crackers.

 Hard or sticky foods such as peanuts, nuts, seeds, popcorn, hard candy and gum
should not be served to children.

Importance of Sleep in Early Childhood Care

Sleep is extremely important for the well being of children because it is the primary
activity of the brain during early development.

Age Sleep Required

Newborn to 6 months:
6 months to 12 months:
Infants need about 16 to 20 total hours
of sleep per day (and usually wake
every two or three hours to chow
down). By about four months, most
babies sleep 10 to 12 hours at night
(with a feeding or two) and nap for
three to five hours of sleep a day
(spaced between two or three naps).
At this age, babies typically sleep
about 11 hours at night (many straight
through) and take two daily naps that
add up to 3 to 4 hours.

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1 year to 3 years: Most toddlers need 10 to 13 hours of
sleep, which includes an afternoon nap
of one to three hours.

Circadian rhythms or the sleep-wake cycle are regulated by light and dark and these
rhythms take time to develop, resulting in the irregular sleep patterns of newborns.
The rhythms begin to develop at about six weeks and by three to six months most
infants fall into a regular sleep-wake cycle. By the age of two, most children spend
more time sleeping than staying awake and approximately, a child spends 40 percent
of his or her childhood asleep. Sleep is especially important for children as it directly
impacts mental and physical development.

There are two alternating types or states of sleep.

They are as follows:-

1) Non-Rapid Eye Movement (NREM) or "quiet"

sleep- During the deep states of NREM sleep, blood
supply to the muscles is increased, energy is
restored, tissue growth and repair occur and
important hormones are released for growth and development.

2) Rapid Eye Movement (REM) or "active" sleep- During REM sleep, the brains are
active and dreaming occurs. Our bodies become immobile and breathing and heart
rates are found to be irregular.

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Infants spend 50 percent of their time in each of these states and the sleep cycle is
about 50 minutes. At about six months of age, REM
sleep comprises about 30 percent of sleep. By the
time children reach preschool age, the sleep cycle
is about every 90 minutes.

Sleep and Newborns (1-2 months)

For newborns, sleep during the early months occurs

around the clock and the sleep-wake cycle interacts
with the need to be fed, changed and nurtured.
Newborns sleep a total of 10.5 to 18 hours a day on
an irregular schedule with periods of one to three hours spent awake. The sleep
period may last a few minutes to several hours. During sleep, they are often active,
twitching their arms and legs, smiling, sucking and generally appearing restless.

Newborns express their need to sleep in different ways. Some fuss, cry, rub their eyes
or indicate this need with individual gestures. It is best to put babies to bed when
they are sleepy but not asleep. They are more likely to fall asleep quickly and
eventually learn how to get themselves to sleep. Newborns can be encouraged to
sleep less during the day by exposing them to light and noise and by playing more
with them during the daytime. As evening approaches, the environment can be
quieter and dimmer with less activity.

Sleep Tips for Newborns

 The sleep patterns of a baby needs to be observed and signs of sleepiness

identified.

 The baby should be put in the crib when drowsy, not asleep.

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 The baby has to be placed to sleep on his/her back with face and head clear of
blankets and other soft items.

 Sleep during the night should be encouraged.

Sleep and Infants (3-11 months)

By six months of age, night-time feedings

become less frequent and are usually not
necessary sometimes as many infants sleep
through the night; 70-80 percent will do so by
nine months of age. Infants typically sleep 9-
12 hours during the night and take 30 minute
to two-hour naps, one to four times a day –
fewer as they reach age one. When infants are put to bed drowsy but not asleep, they
are more likely to become "self- soothers" which enables them to fall asleep
independently at bedtime and put themselves back to sleep during the night. Those
who have become accustomed to parental assistance at bedtime often become
"signallers" and cry for their parents to help them return to sleep during the night.

Social and developmental issues can also affect sleep. Secure infants who are
attached to their parents may have less sleep problems, but some may also be
reluctant to give up this engagement for sleep. During the second half of the year,
infants may also experience separation anxiety. Illness and increased motor
development may also disrupt sleep.

Sleep Tips for Infants

 Regular daytime and bedtime schedules have to be developed.

 A consistent and enjoyable bedtime routine needs to be created.

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 A regular "sleep friendly" environment should be established.

 Infants should be encouraged to fall asleep independently and become a "self-

soother".

Sleep and Toddlers (1-3 years)

Toddlers need about 12-14 hours of sleep in a 24-

hour period. When they reach about 18 months of
age their naptimes will decrease to once a day
lasting about one to three hours. Naps should not
occur too close to bedtime as they may delay sleep
at night. Many toddlers experience sleep problems including resisting going to bed and
night-time awakenings. Night time fears and nightmares are also common.

Many factors can lead to sleep problems. Toddlers' drive for independence and an
increase in their motor, cognitive and social abilities can interfere with sleep. In
addition, their ability to get out of bed, separation anxiety, the need for autonomy
and the development of the child's imagination can lead to sleep problems. Daytime
sleepiness and behaviour problems may signal poor sleep or a sleep problem.

Sleep Tips for Toddlers

 A daily sleep schedule and consistent bedtime routine should be maintained.

 The bedroom environment should not be changed frequently and needs to be

consistent every night.

 Limits should be set that are consistent, communicated and enforced. The use
of a security object such as a blanket or stuffed animal can be encouraged.

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Sleep and Preschoolers (3-5 years)

Preschoolers typically sleep 11-13

hours each night and most do not
nap after five years of age. As with
toddlers, difficulty falling asleep
and waking up during the night are
common. With further development
of imagination, pre-schoolers
commonly experience night time fears and nightmares. In addition, sleepwalking and
sleep terrors peak during preschool years.

Sleep Tips for Preschoolers

 A regular and consistent sleep schedule should be maintained.

 A relaxing bedtime routine should be there that ends in the room where the
child sleeps.

 Child should sleep in the same sleeping environment every night, in a room
that is cool, quiet and dark – and without a TV.

(Information source-National Sleep Foundation)

Sleep Disorders in Children

Infants and toddlers are found to face

problems sleeping at night and could be at a
greater risk of developing a sleep disorder as
they get older. Sleep disorders are being seen
common in the age group of six months to
three years. The warning signs of a sleep

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disorder can vary widely. But some indicators of a potential problem in children are
loud snoring several nights a week, frequent bouts of getting up in the middle of the
night, nightmares or night terrors and routinely taking longer than 20 minutes to fall
asleep. Sleep disorders in children sometimes turn out to be serious problems which
might drag into adulthood. Poor sleep quality and/or quantity in children can result in
a host of problems including academic, behavioural, developmental and social
difficulties, weight abnormalities and other health issues. Sleep problems in children
not only affect their health but they can impact family dynamics and can disrupt
parental or sibling sleep.

In newborns, the quantity of sleep is divided fairly equally between night and day.
Night time sleep gradually becomes consolidated over the first year into a single
uninterrupted block of time and daytime sleep gradually decreases over the first
three years. By the age of four, most children no longer require a daytime nap. Night-
time sleep requirements also gradually decrease so that by adolescence they are
similar to the sleep needs of an adult.

Signs of Sleep Disorders

 Continued snoring could be an indication of an obstruction

 Breathing interruptions like heavy breathing and/or gasping for air during

sleep

 Children do not seem to be refreshed upon waking up

 Poor concentration or inability to focus during the

daytime

 Frequent night terrors that cannot be resolved on

their own

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Arousal Disorders in Children

Arousal disorders are common in children. Arousal does not mean that the child
wakes-up. The “arousal” is a partial arousal usually from “deep” sleep also called
“slow wave sleep”. Most commonly the child shifts from deep sleep to a mixture of
very light sleep and/or partial wakefulness. This stage shift commonly leads to a
confused state or a “confusional arousal”. During such an episode, the child remains
simultaneously awake and asleep. On one hand, the child may appear to be alert by
crying very loudly, moving or even running and can appear to be disoriented and
confused. They can be relatively unresponsive to solicitations from parents as well as
from other environmental challenges. There is usually little or no recall of the arousal
or any event that may have occurred during the episode the next morning or even 10
to 30 minutes later if the child remains awake.

Various behaviours can occur during sleep ranging from simple to complex activities.
Simple behaviours would include mumbling during sleep or sitting up in bed then
falling right back to sleep. However, more elaborate behaviours are also possible, for
example crying loudly in distress, inconsolable and ignoring the reassurance of the
parents seemingly “very far away.” The child may even exhibit aggressive behaviour
against parents who want to reassure the child and trying to escape an embrace.
Finally, very complex behaviours such as sleep walking are possible. The child may
quietly walk around the bedroom or rush around in highly agitated state hitting the
furniture. The complex behaviours may seem goal oriented or they may be poorly
directed. For example, a child may go into a closet looking for the bedroom door, or
may go into a closet and urinate before returning to bed. Usually only one episode
occurs during the night and often it is within the first 2 hours of falling asleep.
However, there are always exceptions to this rule. There may be periods where a
child has several episodes during a single night and then go several weeks without a
single episode.

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 Somnambulism and Somniloquy

In somnambulism (sleepwalking) and somniloquy

(sleep talking); a child sits up in bed with eyes open
but is “unseeing.” Sometimes the child experiences
purposeless restlessness in bed or sometimes he/she
actually starts walking through the house. Speech is
mumbled and slurred and is rarely comprehensible.

Sleepwalkers have the potential for physical harm and parents must take steps to
avoid unsafe situations such as falling from balconies or down stairs. Bedrooms for
sleepwalkers should be on the first floor of the home and windows and doors must be
firmly secured. When confronting a sleepwalking child, parents should keep
interventions to a minimum and refrain from shaking, slapping or shouting at the
child. These sleep behaviours are usually outgrown by adolescence and usually do not
require any intervention.

Nocturnal Enuresis

Nocturnal enuresis or bed-wetting is one of the most common and persistent sleep
problems in children. Enuresis is classed as primary when the child has never been
persistently dry through the night and as secondary when the child starts wetting the
bed after one year of continence. Primary enuresis is much more common and less
likely to have a pathologic cause.

A strong family history of enuresis may trigger this problem in children. Achieving
continence is also maturational and children who lag developmentally at one and
three years of age are more likely to be enuretic at age six. Enuretic children have
been found to have a lower functional bladder capacity (the volume of urine a
bladder can hold before starting to empty) than children without enuresis, although
their true bladder capacity is no different.

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Lastly, enuresis is widely regarded as a parasomnia by most sleep researchers because
it occurs only during NREM sleep. However, despite parental beliefs, enuretic children
are not more difficult to waken than their peers without enuresis.

Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is thought to affect 1 to 3 percent of

children. Symptoms include snoring, difficulty breathing during sleep or mouth
breathing during sleep. Infants with significant OSAS may have difficulty with feeding
as parents sometimes encounter. OSAS in children is frequently caused by
adenotonsillar hypertrophy as well as craniofacial abnormalities, obesity and
neuromuscular disease.

Secondary Sleep Disturbances

Secondary sleep disturbances are much more common than primary disorders and are
characterized by normal polysomnography. The disrupted sleep pattern is often
transient but it may cause distress in the family if it persists. The most frequently
encountered secondary sleep disturbances are night awakenings and bedtime
resistance which occur most commonly in toddlers and preschoolers. Although 95
percent of newborns cry after a night-time awakening and require parental response
before returning to sleep, by one year of age, 60 to 70 percent of infants will be able
to self-soothe if given the chance. The concept of sleep-onset associations is an
important one. A child who is put to bed still awake and learns to fall asleep using
self-comforting measures is often able to calm himself/herself and return to sleep
when he/she rouses in the middle of the night as most children and adults do.

On the other hand, a child who falls asleep accompanied by some parental behaviour
such as rocking or being physically present may sometimes have difficulty going back
to sleep when he or she wakes up alone in the middle of the night. For this reason,
parents may want to consider a trial of discontinuing rocking the child to sleep or stop

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allowing a child to fall asleep somewhere other than his or her crib (such as a swing,
or the parent's bed). They can try waiting a short while before responding to a child
who stirs or cries in the night to help train the child to self-soothe back to sleep.
Given the opportunity, many children will learn to settle themselves back to sleep
without intervention by their parents.

‘Colic’ and Sleep Problems

Colic is often the bane of a new parent's existence. While colic is not a sleep problem
per se, colicky infants appear to have a shorter duration of total sleep. Sleep
problems may sometimes persist after the child has outgrown colic because the
strategies that parents developed to decrease the crying spells (i.e., frequent
holding, car rides) interfere with the adoption of normal sleep patterns. An infant
older than four months who continues to wake up during the night is considered a
trained night crier. These infants calm quickly when picked up. Some people believe
that this pattern develops because parents provide secondary gain for continued
awakening. One approach that can be taken is to support parents in ignoring the
child's cries for progressively longer intervals; they may also choose to stop
responding to the crying child “cold turkey”. Either strategy can make for a few
difficult nights but may succeed in training the child to return to sleep on his or her
own.

Another technique that has been found to be effective and is more acceptable for
some parents is scheduled awakenings. Parents awaken the child at scheduled times,
shortly before anticipated awakenings. As the frequency of spontaneous awakenings
decreases, the length of intervals between scheduled awakenings can be increased.
Eventually, the spontaneous awakenings subside and the scheduled awakening can be
discontinued.

Disorders of Initiating and Maintaining Sleep

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Toddlers and preschoolers begin to have more problems with disorders of initiating
and maintaining sleep (DIMS). These children are dealing with significant development
issues of autonomy, separation and object permanence. Sometimes parents have
trouble setting firm limits and accede to the child's demands for one more drink of
water or one more story.

For children who have difficulty falling

asleep, a predictable bedtime routine
(e.g. three to four components lasting 20
to 30 minutes, such as a story, a song, a
drink and a back rub) can be developed
and use it on a continuous basis. The
onset of the routine can be gradually
moved earlier and earlier in the evening
until the child is going to bed at the desired time. The use of transitional objects such
as blankets or stuffed animals may also be helpful.

To encourage Better Sleep

With infants under six months, it is important to position them on their back for
sleep. Since sleep habits are learned behaviours for older infants they can be
improved both by changing habits and establishing a bedtime routine. Encouraging
better sleep habits depend on parents to a large extent and for children over age two
all they can do is:

 Set limits for the child.

 Eliminate TV viewing as much as possible.

 Restrict playing video games or using other electronics at least one hour prior

to bedtime.

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 Make sure to keep pets out of the bed.

 Try to develop a bedtime routine.

Other critical issues in early childhood care include safety, hygiene, play, physical
comfort, toilet training, common illnesses, first aid, helping them settle down in
social setups as well as formal settings like school and so on. Each of these issues may
be studied in depth depending on the requirement of the educator and the children in
her or his care. However, all educators dealing with this age group must have a good
knowledge and understanding of the responsibilities that come with managing young
children. Timely help and assistance given to those in need is the foremost priority of
early childhood specialists.

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