Diploma in Early Childhood Care & Education
PHASE 1: 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.
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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 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:
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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
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.
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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 indicates
that they are paying more attention. This is believed by some to be an evolutionary
response to danger.
Toddlers:
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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 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 selfsatisfaction, 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."
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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 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
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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 makebelieve. 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 even more
familiar to the newborn, therefore they will prefer or expect to hear it regularly for
prolonged periods.
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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.
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Food
Importance of Healthy Food in Early Childhood Development
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.
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
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. 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
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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.
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
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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 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
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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.
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.
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• 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
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
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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.
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
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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 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
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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.
Breads, cereals, rice, pasta and noodles
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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 adultsized 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.
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
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.

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
Newborn to 6 months:
Sleep Required
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
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(spaced between two or three naps).
6 months to 12 months:
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.
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.
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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.
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.
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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.

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 912 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
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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.

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
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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.
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
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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 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,
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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
Arousal Disorders in Children
Arousal disorders are common in children. Arousal does not
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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
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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.
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 selfsoothe if given the chance. The concept of sleep-onset associations is an important one.
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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
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‛.
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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
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.
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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.

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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