In my September 2003 column ("Bed-time I Don't Thinkâ€¦") I responded to a question about a 6-year-old girl who was refusing to go to bed in her own room even though she had gone to bed peacefully for years. I wrote "If you have made sure there is no fear involved, and the bedtime is appropriate, then you can assume the problem is just one of wanting your attention. In that case, the most effective approach is deliberate, studious ignoring. Perhaps your daughter knows she is getting to you, so she escalates the problem. In this case it might be wiser to lock her door, but reassure her that you are awake and would unlock the door if there were any danger." In this column I have included suggestions made by the reader, and also responses suggested to me by my colleague Allison Rees, who presently teaches the LIFE seminars we have developed together.A reader wrote to me as follows: "I am quite concerned about parents forcibly confining a child to her room. I am worried that if this route is chosen by the parents, the situation could escalate and the child may experience emotional or physical harm. The fine line between confinement and abuse could easily be crossed (such as extended or day-long confinements or confining even though the child may get hurt through resisting the confinement)."Now, let's get clear here. Confinement is forcing a child to stay in her room at a time when she would normally have the freedom to move around the house and do what she wants. Expecting a child to go to bed at bedtime is not the same thing. It is setting boundaries or limits, telling the child that parents have needs too and that she is not to interrupt them at the time when they need to be alone and she needs sleep. Very small children don't understand these limits. A child of six is old enough to be expected to learn them. This child is not tied to her bed or forced to have the light out; she is only asked to stay in her room. It is important that children learn to respect adults' needs.But my reader is concerned that something may be wrong in the child's life, and that's a valid point. What's causing the problem? I was trying to keep the original article short, so I didn't elaborate on all the possible worries the child might have. This reader wanted to get more specific. She wrote : "There can be reasons other than fear for a child to resist sleep or to need the presence of a loving adult at bedtime. Perhaps she is feeling anxious about a situation in her life (anticipation of starting school, peer relationships, a move, a new sibling, a parent returning to work). Perhaps she has become aware of her parents' mortality because of the death of a beloved grandparent, a more distant family member, a pet, or a celebrity. Children may sense parental concern about world events and may feel stressed as a result. I find myself very curious about this child. I wonder what was going on for the child at the onset of this situation. Why did this child, who cooperatively followed a bedtime routine faithfully for several years, suddenly change her behaviour? Has she experienced a negative event at bedtime or in a bedroom, either at home or elsewhere? What may be different at home, daycare or school? What is happening in the world? Is there a hidden medical issue that needs to be addressed? " I couldn't agree more. We parents are prone to react to kids' behaviours with consequences before we know the causes of the behaviour. Causes should be thoroughly explored first.And how do we explore the causes? The reader goes on to write : "I suspect that it may be asking a lot of a child of six to identify all her possible fears and concerns. Young children often have difficulty articulating their feelings verbally, which is why therapists use expressive or play therapies with children. Even adults sometimes have trouble identifying stressors or sources of anxiety in their lives. It may help the parents to realize that their child is telling them that something is wrong, in the best way she knows how, even if the only issue is that she is feeling more needy than usual." This may indeed be the case. And it's important that the little girl's parents spend relaxed time with her so that she can express what's bothering her. Some kids try to stay up at night because it's the only time their parents are around them.However, the problem still exists, and the child's mother wrote to me: "She wants us to lie down with her and she refuses to stay in her room. We refuse to do this and she throws a temper tantrumâ€¦ This tantrum usually goes on until about ten o'clock every night. I feel that she is trying to manipulate us and I get very resentful. I have also explained to her that we need time to ourselves, all to no avail. Please help. We are getting to the point where we dread every evening."The reader wrote : "Even if there seems to be no clear reason for the child's distress, giving her extra attention for a little while will not spoil or ruin her. Instead, it can only solidify a compassionate and caring relationship between the little girl and her parents. I understand that it may be temporarily frustrating for the parents if they do not have the freedom they are used to having in the evenings (although, I have a hunch that if they were to give a little, they would gain a lot). However, it will not be many years before they wish their child would communicate with them more, come out of her bedroom to talk sometimes, and, perhaps, spend a few evenings at home. Investing in their child now and staying on her "side" will only ease transitions in their relationship down the road."My reader gives the following suggestions : "The parents could have their child participate in a problem-solving session in which the child assists in generating a list of alternatives such as the parents altering the routine to include more time with the child after "lights out" or the child being allowed to fall asleep in the parents' bed. Together, the family can choose which alternative they wish to try first. This will help the child to feel powerful and effective... which in turn will help her become more self-confident and improve her sense of self-control. I am concerned that confinement may extinguish her will and teach her to feel helpless." Yes, but giving in to her can make her feel it is her right to be all-powerful and override other people's wills. This will not serve her well in adolescence or adulthood. Sleeping with the parents as an alternative speaks to a child having power not only over herself but over her parents and their needs and personal boundaries. These parents have already given more than a little.Remember that we are talking about a six-year-old, not a toddler, here, and she needs to learn that her parents have needs too. Six-year-olds are not mature enough to understand this fully, but they're old enough that their parents have to keep making this point. Values teaching is about teaching a child to respect other people's needs and feelings. This child needs to have her needs and feelings respected, but she also needs to learn to do this for others. A problem-solving session generating lists of alternatives can be helpful, provided the parents as well as the child have the right to veto some of the alternatives.It's true, children can cut themselves off in adolescence. And you know what? They're more likely to do that if their parents are over-involved with them, because they need space to be alone and work out their own decisions. Introducing a child to the independence and responsibility of sleeping alone is an important step towards the maturity she needs to develop.And, yes, children can be spoiled. A spoiled child is one whose parents give in to her every whim, rather than asserting the importance of their and other people's personal boundaries. Giving extra attention is fine in the daytime. In the evening when a child needs sleep and the parents need time alone for their own relationship and to recuperate from the day's work is not the time for extra attention. A nice bedtime routine with time to talk, then a firm insistence that the child stay in her room, is a good way of asserting those important limits.With regard to sleeping there are two different approaches among professionals. Richard Ferber's book "Solve Your Child's Sleep Problems" suggests that a child becomes used to falling asleep in the presence of a parent and then feels she needs the parent to be there, just as most of us need a pillow to fall asleep. The author suggests that the child needs to go through a period of withdrawal, and there is no way around it. "The No-Cry Sleep Method" by Elizabeth Pantley (www.pantley.com/elizabeth) provides alternatives for parents who do not wish (or cannot bear) to let their child "cry it out". Look at these approaches and make your own choice.Many parents make the mistake of leaving a child in her room for a while, listening to her cry, and then resentfully allowing her to come out since she has been crying for a long time. This just teaches the child to cry for longer and longer periods of time, since she knows that her parents will eventually give in. Then she may very well find her parents resentful and cranky since she is taking up the only time they would normally have to themselves. If all the alternatives have been tried, and the parents do insist on the child staying in her room after a certain time, they need to grit their teeth and carry it through, not giving in at all. Usually in this situation the child persists for three or four nights, then adapts to being in her room and becomes content with it. There should still be a warm loving bedtime routine.Having clear boundaries around bedtime does not take away trust in a parent or their ability to communicate with them. That loving connection can be nurtured and attained within a framework of healthy boundaries. The parents can still check in with the child and agree to do that but if the child is continually coming out of her room even after negotiating a different routine, there is not other method other than completely giving in. If you want a long look into the future, you would see two burned out parents with a daughter who doesn't respect personal boundaries.More About Thumb-SuckingElizabeth Morch, a dental hygienist, would like to add some information about thumb-sucking. She writes : "Thumb sucking at 4 years old rarely creates problems for the teeth. However, thumbsucking once the permanent teeth begin to erupt (age 5-6) can create substantial problems. In severe cases, children can separate the premaxilla (anterior portion of the palate) from the posterior sections and can cause flaring of the anterior teeth. A four year old child that thumbsucks for a couple of hours at night is unlikely to cause damage, and this behaviour often stops by age 5-6 naturally. I would just like this parent to know that if the habit continues when the permanent teeth erupt, seeing a dentist for further advice would be strongly advisable. Timeframes (related to age) are very important for this type of information."