There are many reasons for children not going to sleep at bedtime. These can be the result of disruption of the child's normal routine or environment, or the child having fear of darkness or being alone, or poor sleep habit all along. Changes in daily activities such as sleeping too much or being too excited in the daytime can make children have difficulty falling asleep. These problems can be dealt with by trying to adjust the daily routines and allowing time for children to adapt to them. There may be times when there are changes of environment such as starting school or hospitalization. Children may feel anxious towards the new environment or even separation with parents. They may be upset and become clingy. The resulting bedtime problems are usually temporary.

So there are different reasons behind children's problem of not going to sleep. What shall we do to help if children are anxious?

In general, we can manipulate the physical environment to help children go to sleep easier. Keep the bedtime mood by keeping the noises down and avoiding the child to get too excited. You may dim the light in the room and put the child's favourite blanket, hanky or rag doll in his bed. It will be important to stay with him for a while just to have a light chat with him, tell him a story or hum him a lullaby before leaving him to fall asleep on his own. When children are anxious, you may have to strengthen their sense of security through giving more attention to them in addition to manipulating the physical environment. If he gets fearful, try to understand how he feels. Preschoolers have their own way of thinking which adults sometimes may feel it absurd. When you listen to him, try to understand his anxiety and answer his question with simple words, his anxiety may be relieved. It may help him to fall asleep. If his anxiety lingers on and you feel disturbed, you may need to seek help from the professionals.

I see. But my child has been clingy at bedtime since he was small. There seems to be nothing to do with environmental change or fear.

In that case, he may have developed a poor sleep habit. If we yield to children's crying or whining by staying with them or allowing them to stay up in bed, we would have accidentally rewarded their poor sleep habit. They would ask your company every time at bedtime. If you want your child to fall asleep independently, you have to re-establish a bedtime routine with him, helping him learn to associate particular activities such as brushing his teeth, getting into bed, telling him a story, drinking water and tucking in, etc with going to sleep. After kissing him goodnight, it will be the time to fall asleep on his own. You will have to leave the room immediately, not paying attention to any of his requests. At first, you may ask him to lie down quietly and not to call out. Promise him that if he can do it you will go back to check on him. After two minutes, if he can stay quiet, you may go back to praise him, but don't stay more than 30 seconds. If your child hasn't got used to the routine, you may repeat the steps of going back to check, but wait longer before you check each time, until he falls asleep on his own. If your child is over two years old, you may consider using a star chart to help him establish the bedtime routine. When he can fall asleep quietly on his own, award him a star or sticker the next morning.

What about if he refuses to go to sleep quietly or get out of his bed to look for me?

If you are determined to establish a bedtime routine to help him fall asleep independently, you have to be firm with him. Take him back to his bed. Tell him, 'Now you have to go to bed.' Then leave immediately and don't talk or play with him. If he still shouts out, you may choose one of the following strategies which you feel most comfortable and which best suits the temperament of you child.

• The first strategy is to give no response to his protests at all and do not even go to check. This will not harm him but helps him learn quickly how to fall asleep by himself.
• On the other hand, if you feel that you have to go back to check, you can do so but don't respond straight away. He may quiet down and fall asleep by himself after a few minutes. If he is still protesting after 5 minutes, you may return to console him by stroking him and reminding him that he should go to sleep. Going back to check may comfort him as well as yourself. Leave after a minute even if he is still crying. If he keeps crying, you have to wait longer than 5 minutes before you go back to check. Remember don't stay longer than a minute and gradually lengthen the time in between your checkups each time. He will gradually learn to comfort himself and fall asleep on his own.
• The final approach is more gentle, and it can be used for children who still sleep in a cot. When your child refuses to lie down when you put him into the cot or wake up and cry in the middle of the night, lie down on another bed in the same room and pretend to be asleep until he falls back to sleep. Do not attend to his cries unless he is ill or in danger.