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Fussy eating, sleep, tantrums and more!

Why do they happen?

Tantrums occur because young children are not able to express themselves easily. Toddlers can also want independence and become frustrated when this can't or doesn't happen. Tantrums tend to decrease and/or stop after four years of age as children are better able to understand the world around them and communicate their needs and wants. 

What are tantrums?

Tantrums tend to start between two and three years old, although they can start earlier. During a tantrum, a child will often shout, scream and cry. They may also kick, hit or bite. Tantrums are very common and almost all young children have them - some more than others. This is a normal phase of your child's development. 

What can I do when my child is having a tantrum?

when you child is having a tantrum:

  • Try to be calm and consistent - speak slowly and quietly, don't worry about what other people may think if you are in public and if at all possible don't give in to the tantrum as your child may then see this as a way of getting what they want.
  • Ignore the tantrum - ensure that your child is safe and explain that you will be there for them when they have calmed down, then carry on with what you were doing.
  • Reassure - after the tantrum, once your child is calmer, reassure your child, talk to them about their emotions and if they are old enough, talk about how they might deal with those emotions differently. Once the episode is over don't continue to talk about it as this may make your child feel bad. 
  • Positive reinforcement - try to make a point of noticing and commenting on good behaviours (such as "you are playing very nicely with your brother") so that your child gets attention for acting in the way you would like them to.

What can I do if I need more help?

If you are struggling to cope with your child's behaviour, talk to your health visitor or GP.

Further information:

What is it?

Separation anxiety in children is common and very normal. It tends to occur between the ages of six months and three years although it can crop up at other times in response to stress and change. Your child may not like being held by other people or may get upset when you leave the room. They may also cry and protest when you go to new places or leave them with other people, for example, at nursery.

Why does it happen?

Separation anxiety begins when a child starts to understand that they are dependent on their caregiver but this person/people are separate to them and can leave. This can make the child feel worried and insecure.

What can I do to help?

It is important to understand that this is a normal phase for your child. Although some children struggle with this phase more than others, it will almost certainly get better in time. Here are a few things you can try:

  • Practice separation - try leaving your child for short periods of time, let them know what is happening and when you will be back.
  • Say goodbye and go - have a short and predictable goodbye routine, make sure you leave after you have said goodbye.
  • Use a comforter - some children like to have a familiar item (cuddly toy or blanket) when they are apart from their main caregiver.

What if I need more help?

If your child is extremely distressed and this does not improve over time, contact your health visitor to discuss your concerns.

For further help please this video from the NHS: My child wants to be with me all the time - what can I do? (6 - 18 months)

How much sleep should my child be getting?

Below are approximate guidelines that are suitable for most children to feel rested:

Age & Sleep Requirement:

0-3 months - 14-17 hours

4-11 months - 12-15 hours

1-2 years - 11-14 hours

3-5 years - 10-13 hours

6-13 years - 9-11 hours

14-17 years - 8-10 hours

18-25 years - 7-9 hours

 

Why is my child not sleeping?

There are many reasons why young children may have difficulty sleeping including:

  • Sleep association (something or someone your child needs to fall asleep e.g. needing to be fed to sleep or held/rocked)
  • Separation anxiety
  • Being overtired
  • Bedtime fears (being scared of the dark)
  • Nightmares
  • Night terrors

For older children, bad sleep habits, too much caffeine, too much screen time, worries, stress and mental health problems can all contribute towards poor sleep.

 

What can I do to help?

  • Try to understand and address the underlying problem.
  • Having a bedtime routine - a warm bath, dim lights and a story can all be relaxing and help to signal sleeping times.
  • Have a consistent bedtime and wake time, adapting this to your child's sleep needs as they get older.
  • A comforter may help a young child settle at bedtime and if they wake during the night.
  • Avoid screen time in the hour before bed.
  • Make sure your child has a cool, quiet, dark and comfortable place to sleep.

What if I need more help?

If you need further help and support, speak with your health visitor and/or GP.

For more information:

What is fussy eating?

Many pre-school aged children can be fussy about what or how they eat. It is not uncommon for children to refuse to eat certain foods, eat a very limited range of food or refuse to eat at all.

What can I do to help?

The following things may help:

  • Try not to worry or focus too much on food - if there are no problems with your child's growth and development it's best to wait for your child to outgrow this phase.
  • Try to eat together as a family and eat the same meal, ensuring that your child has an appropriately sized portion and that their food does not have any added salt.
  • Keep trying with new foods and offer them in different ways (e.g. offering carrot cooked, uncooked, grated, mixed in a sauce etc.).
  • Get your child involved in preparing and cooking meals.
  • Praise your child when they try something new.
  • Aim for no more than two snacks a day.
  • Don't cook to order, if food is uneaten at the end of the meal, just take it away without comment.
  • Focus on minimising distractions (phones, toys, pets) during mealtimes so your child can really concentrate on the food. 

What if I need more help?

If you need further help and support, speak your health visitor and/or GP.

Further information:

When to start?

Most children are ready to start potty training between 18 months and 3 years of age. However, all children are different and it is important to wait until your child is ready. You might feel your child is ready to start potty training when you notice the following:

  • Your child can get on and off of the potty
  • Your child can pull their clothes and underwear down
  • Your child can follow instructions
  • Your child knows when they have a wet or dirty nappy and they tell you this
  • Your child can stay dry for an hour or two
  • Your child knows when they are doing a wee and they tell you this
  • Your child knows when they need to do a wee or a poo and they may tell you this in advance

How to start?

  • Choose a time when there are a few other big changes such as house moving or a new sibling arriving
  • Keep a potty next to the toilet
  • Once you have chosen a time to start, swap nappies or pull-ups for pants
  • Encourage your child to sit on the potty regularly, particularly after meals and at any time you know your child normally does a poo
  • Encourage boys to sit down to wee - this helps them to empty their bladder properly and makes sure they can poo as well if they need to
  • Don't make a fuss if they have an accident but do praise them when they succeed

Night-time potty training

Night-time potty training might take longer than daytime potty training. If your child's nappy is dry or very nearly dry in the morning, they may be ready for night-time potty training. Make sure that your child uses the potty just before bed and then make sure it is nearby in case they need to use it overnight. Use a waterproof sheet and have clean bedding and pyjamas to hand. If things aren't going well, stick with nappies for a little longer and try again later.

What to do when there are problems?

If after you start potty training, it appears that your child was not quite ready, go back to nappies/pull-ups and try again in a few weeks. If you have any other concerns about potty training, talk to your health visitor and/or GP.

Further information:

Up to the age of 5 years, wetting the bed is normal. It usually stops happening as your child gets older without the need for any treatment:

  • up to 1 in 5 5-year-olds wet the bed
  • 1 in 20 10-year-olds wet the bed
  • about 1 in 50 teenagers wet the bed
  • about 1 in 100 teenagers continue to wet the bed into adulthood

Bedwetting happens when your child makes more pee at night than their bladder can hold; unfortunately, young children often don't wake to the feeling of a full bladder, which means that they wet their bed whilst they are sleeping. It can run in families, and boys are more likely to wet the bed than girls.

The good news is you don't need to wait until children grow out of bedwetting - treatment is now available and recommended from the age of 5 years.

What should you do?

If your child is under 5, you don't need to see your GP about their bedwetting unless:

  • it happens a lot and is upsetting them
  • they're constipated despite you changing their diet
  • they have also started wetting themselves during the day, but had been dry most days for a while
  • they go to the toilet a lot during the day (for example, every hour), they can't hold on for even a few seconds or minutes, peeing is painful, or they're peeing less than 4 times a day

Other practical tips include giving them their last drink of the day no later than 90 minutes before they go to sleep and encouraging them encourage them to pee as the last thing they do before they go to sleep. Ask you health visitor or school nurse for advice if you are worried.

For commonly asked questions and excellent practical information about the treatment of bedwetting, click here.

There are many sensory issues associated with sleep including:

  • Sensitivity to sound, touch, and visual stimuli which can be distracting and distressing and can affect the process of falling asleep.
  • Interoception difficulties, particularly recognising when hungry, full or thirsty or when the person is tired. 
  • Some children are more sensitive to foods like sugar, caffeine and additives which keep people awake.

Look at the bedroom environment to see what may be affecting their ability to go to sleep and stay asleep. Do their pyjamas and bedclothes feel comfortable, are they too hot or cold?  Is it too light or too dark, too noisy or too quiet? Perhaps it is too cluttered and stimulating. Think about your child’s diet. Are they eating too early or not having enough to eat? Are they eating food that can stimulate them close to bedtime. There can be added difficulties where children have restrictive diets but some simple adjustments of what is eaten and when can make a big difference. 

Click here for more information on sensory issues.
 

Sticking to the same routine helps your child to know what to expect at bedtime and helps them feel secure. It also helps to support your child’s internal body clock and keep it on track. The age related sleep advice and information on this website can help with establishing routines. Some children will benefit from using picture timetables, timers or social stories to help them understand their bed-time routine. More information about visual supports can be found on these websites

Visual Resources | Autism West Midlands 
Visual Supports | Autism Toolbox Autism Toolbox

Your child may be feeling overstimulated after a busy day and needs help to wind down, or their environment may be overstimulating with lots of toys, TVs and computers within reach. Avoiding TV and computers or hand-held devices an hour before bedtime can help your child to wind down. Activities that are good for the wind down period are jigsaws and colouring. Having a relaxing bath and milky drink can help some children, but for some children having a bath can over-excite them so they may need to have their bath earlier in the day.

Children who wake to use the toilet, wet the bed, or who wear nappies or pull-ups at night that need changing may have disturbed sleep. Eric, the children’s bowel and bladder charity are a good source of advice on this topic.

 

What might help 

Keeping a sleep diary 

A sleep diary can help you understand what may be causing difficulties with sleep. Fill it out every evening and record as much as you can. You can use it to spot patterns and make changes that may help. 

The Sleep Charity have templates you can download; one for teenagers and one for younger children. 

Seeking advice and help from sleep services 

There are organisations that can help you if you are having difficulties with your child’s sleep. There are many national organisations, including those who specialise in sleep for SEND families, and there are also community-based services in Shropshire, Telford and Wrekin. Click the link at the bottom of page to visit our support services page. 

Understanding sleep cycles 

The circadian sleep cycle is a 24-hour cycle that helps govern essential bodily functions especially the sleep-wake cycle. It plays a vital role in a person’s ability to sleep in one consolidated block of time at night and to stay awake during the day. As the sun sets in the evening, the brain begins producing melatonin, a hormone that induces sleepiness. Core body temperature also drops.

As melatonin and tryptophan (an amino acid which helps produce melatonin) are naturally produced in the body, there are things you can do to help their production.  Darkness helps to promote the production of melatonin which is why it is a good idea to put your child to sleep in a darkened room, and light emitting devices such as tablets and phones also can destroy Melatonin so should not be used for at least an hour before bed. New research shows that limiting exposure to screens and increasing physical activity levels during the day has a positive effect on children's overall physical, mental health and wellbeing, including sleep.

Setting a waking time consistently even in holiday times, called ‘anchoring’ the wake time, can help to reset the body clock over time. This should be accompanied with exposure to lots of light on waking to support circadian rhythm. 

Melatonin and tryptophan occur naturally in some foods and drinks such as milky drinks and cereals which is why having a milky drink before bed can help settling to sleep. For more information visit Diet & Sleep - The Sleep Charity

Prescriptions of melatonin

Behavioural strategies and practical solutions are the best way to address sleep difficulties, but if they are having a significant impact on your child’s ability to function, a drug form of melatonin is sometimes prescribed for neurodivergent children. As the drug’s function is to re-set sleep and wake cycles, it works best combined with good sleep hygiene practices. It is important that is it taken under medical supervision and not purchased on-line so that it is closely monitored for dosage and side effects. It should be prescribed for the shortest period necessary as the long-term effects of the drug on children’s development are not yet known. 
In Shropshire, Telford and Wrekin the Community Paediatric Service and the BeeU Service (CAMHS) can prescribe Melatonin for children and young people who meet ALL of the following criteria.

  1. the child/young person must be open to and being treated by the service due to a neurodevelopmental/mental health need (diagnosis not required)
  2. sleep issues are causing significant impact on the child/ young person, for example due to daytime sleeping or behavioural problems that are impacting daily functioning or educational attendance
  3. behavioural approaches have been tried and failed. These may have been offered by the service (where available) or by community sleep support services.

GPs are unable to prescribe Melatonin although they sometimes issue repeat prescriptions when prescribing has been started by a specialist (such as a paediatrician or child psychiatrist). 

Further support 

Click on the link below to visit a page with information about

  • national websites and sleep organisations
  • local community services in Shropshire, Telford and Wrekin.