Children's Sleep Issues and Emotional Concerns: When to Seek Help

Concerns about children's mental health?

Hello, doctor: My son is currently 6 years old and in the first grade.
He has been having restless sleep every night, sometimes sleepwalking or talking in his sleep.
Recently, for the past two weeks, he has been asking before bed if I would still see him if I died or if he died, and if I would be able to give birth to him again.
When I tell him that we might not see each other again, he becomes very sad and cries himself to sleep.
He is usually fine during the day, but this happens only at bedtime.
I'm not sure what the issue is.
Should I take him to see a doctor?

Cindy, 30~39 year old female. Ask Date: 2022/11/07

Dr. Li Jite reply Psychiatry

Hello, Mom.
Seeing your child suffer like this must be very painful and worrisome for you.
I believe this suffering can be viewed in two parts:
1.
The child experiences restless sleep every night, often accompanied by verbal or physical behaviors.
Medically, it is important to differentiate whether this is related to pediatric sleep disorders.
Furthermore, we need to clarify whether these conditions are triggered by physiological or psychological stressors.
Once we can distinguish and clarify these issues, it will provide a clearer direction for treatment or reveal that this is a normal developmental phase that can be observed, which may offer some reassurance.
2.
When the child asks us questions related to "death," it can often catch us off guard, especially since we may not have fully processed our own thoughts on death.
I appreciate how attentive you are as a mother, unwilling to deceive and instead choosing to answer your child's questions sincerely.
In fact, there are no standard answers to these questions! Simply trying to comfort the child may not provide them with peace of mind, as their concerns may relate to issues of "separation." Both death and falling asleep symbolize a disconnection from the waking world, leading to feelings of separation, and what children need most is to maintain a continuous connection with us.
This separation can sometimes evoke real fear in children.

At this time, we can try to focus on reassuring them by saying, "I am right here with you," while we strive to answer their questions (regardless of the answers).
We should let them know that no matter what happens, even in the face of unpredictable life and death situations, we will do our utmost to be by their side, providing them with a sense of security through our genuine presence.
Often, when children repeatedly confirm our commitment to being there for them, their situation improves.
However, we also need to delve into why the child is experiencing these worries and discuss some coping strategies.
In summary, I would recommend taking your child to speak with a child and adolescent psychiatrist.
In a limited time frame, you can listen to the doctor's thoughts, and if time is short, you can ask questions over several visits.
Visiting a doctor is not always about being sick; it can also be for consultation, so you can feel free to give it a try! You've been working hard, and everything will be alright.
Wishing you peace.

Reply Date: 2022/11/07

More Info

It sounds like you are experiencing a challenging situation with your 6-year-old son, who is dealing with sleep disturbances and emotional concerns. It’s understandable to feel worried as a parent when your child exhibits behaviors such as sleepwalking, talking in his sleep, and expressing fears about death and separation. These issues can be quite complex and may stem from various underlying factors, including psychological stressors, developmental stages, or even sleep disorders.

Firstly, let’s address the sleep disturbances. Sleepwalking and sleep talking are relatively common in children, particularly between the ages of 4 and 8. These behaviors can occur during deep sleep and are often not indicative of any serious underlying condition. However, they can be exacerbated by factors such as stress, anxiety, or changes in routine. It’s essential to ensure that your son has a consistent bedtime routine, a calming environment, and adequate sleep hygiene practices. This includes limiting screen time before bed, ensuring a comfortable sleep environment, and establishing a relaxing pre-sleep routine, such as reading a book or taking a warm bath.

Regarding your son’s questions about death and separation, it’s important to recognize that children at this age are beginning to grapple with complex concepts like mortality and loss. His inquiries may reflect a natural curiosity about these topics, but they can also indicate underlying anxiety. Children often express fears about separation, especially during transitions, such as starting school. It’s crucial to validate his feelings and provide reassurance. You might say something like, “I understand that you’re feeling scared about what happens when someone dies. It’s okay to feel that way, and I’m here with you.” This approach helps him feel supported and understood.

If these sleep issues and emotional concerns persist or worsen, it may be beneficial to consult a pediatrician or a child psychologist. Seeking professional help is not an indication that something is wrong with your child; rather, it is a proactive step to ensure that he receives the support he needs. A mental health professional can provide a safe space for your son to express his feelings and fears and can offer strategies to help him cope with anxiety. They may also assess whether there are any underlying sleep disorders that need to be addressed.

In addition to professional help, consider incorporating relaxation techniques into your son’s routine. Mindfulness exercises, deep breathing, or gentle yoga can help reduce anxiety and promote better sleep. Engaging in these activities together can also strengthen your bond and provide him with a sense of security.

In summary, while sleepwalking and sleep talking can be common in children, the emotional concerns your son is expressing warrant attention. Establishing a calming bedtime routine, validating his feelings, and seeking professional guidance if necessary are all important steps. Remember, you are not alone in this journey, and many parents face similar challenges. By addressing these issues early on, you can help your son develop healthy coping mechanisms and ensure his emotional well-being.

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