Paediatric Nurses Take on Routines and Regulation

I'm a paediatric nurse and a mum of two. I’ve seen how creating predictability supports children through everyday moments. I've also seen that no routine survives every day fully intact, and it doesn't need to.

Routines aren’t just about getting through the morning or making it to bedtime. For children, knowing what comes next can bring a sense of security and calm.

Here are a few things I've noticed, at work and at home with my own kids.

Routines help children feel safe

Knowing what is happening now and what comes next can reduce uncertainty and make everyday situations feel more predictable.

I've noticed in my work, in paediatric nursing, that children sometimes need regular procedures they have no real choice over, such as caring for a feeding tube or a port. Keeping the process familiar can make it feel a little less frightening. We explain what will happen, follow a similar order each time and then give the child choices where possible like where they sit or what they are distracted by. They cannot always choose whether something needs to happen or not, but they can still be given some control over how they experience it and build confidence in the task at hand.

 

Regulation often comes before cooperation

Following instructions can be much harder when a child is overwhelmed, overstimulated, tired or anxious. Supporting them to regulate first can make it easier to move through the routine.

Since children can't always express themselves and tell us that they're feeling anxious, it's up to us to notice the signs. Often, it is a change in how that child would normally respond. They might become upset, irritable or unusually restless. They may cover their ears, try to leave, become clingy or repeatedly say no. 

What looks like refusal is not always a child choosing to be difficult. Sometimes it's their way of showing us that they do not have the capacity for that task right now. 

When that happens, my advice would be to slow everything down. When a child is already overwhelmed, adding more instructions of trying to reason with them usually does not help. Reduce the noise and activity around them. Keep your words simple and give them time.

What helps will look different for every child. One child may want you close, while another might need more space. They might benefit from moving to a quiet environment, receiving a hug, holding something familiar, getting a drink or simply having a break with no more demands placed on them. 

The task can wait for a moment. Once the child feels safer and calmer, we can reconnect and work out what comes next. Regulation needs to come before expectation. 

 

Visual aids can reduce repeated reminders

Showing children what needs to happen gives them something to refer back to, and can help break the cycle of “brush your teeth”, “get dressed” and “where are your shoes”.

One example from a recent win in our household is hanging up the bath towel. It used to be something I'd remind the kids about every day. We added it to their Tick & Track boards. Over time they started doing it without being asked. It seems like such a small thing, but that is exactly what we want a routine to do, take something that requires constant prompting and gradually turn it into a habit. 

This is a big part of why Ash and I made MagMates. The reminders are on the fridge, not coming from you every time.

 

Keep routines simple and achievable

Too many steps can quickly become overwhelming. Breaking the routine into a few clear tasks makes it feel more manageable and gives children more opportunities to experience success.

We noticed this with the "Tidy Up" task and our then 4 year old. To an adult, that sounds simple. But when we first introduced it to our son, he was unsure of what that actually meant.

What needs tidying up? Where does he start? How much needs to be done before it is finished?

It was far less successful than when we introduced "Hang up your towel", which is one clear action with an obvious endpoint. It wasn't that "Tidy Up" was a bad task, but it was difficult for a 4 year old to comprehend without further break down and understanding what that actually means.

Currently, it means a tidy bedroom that would be accessible if I was to vacuum the carpet. We will work to develop this skill further as he grows to understand more. 

If a routine has too many steps or the tasks are too broad, children lose interest before they have even started. They also end up seeing all the things they have not completed rather than feeling proud of what they have achieved.

A routine does not need to include every part of their day. It should make the next few steps easier to understand. If it is creating more stress than it solves, that is usually a sign to simplify it.

 

Independence builds gradually

Routines can help children take more responsibility for everyday tasks over time. Some days they may manage with very little help while on other days they may need more support, and that’s ok.

In raising our kids, we've learnt that consistency matters. We tried swapping around who would feed the dog and who filled up his water bowl thinking it would be more fair that way. But it mostly led to arguments. Giving each child their own regular task worked much better because they understood their task and knew what was expected of them.

Owning a task will help the child build independence.

 

Routines don’t need to be long or complicated. A few simple, achievable steps can help children understand what’s expected, reduce the repeated reminders and gradually build independence.

 

When a Routine Isn't Enough

Though they can be incredibly helpful, routines are only one support. They cannot fix every reason a child might be struggling. 

If a child is regularly distressed, their behaviour has changed significantly or the difficulties are affecting sleep, eating, school, friendships or everyday family life, it is worth speaking with someone.

A GP could be a good starting point in this instance. They can look at the whole picture and help work out whether another professional, such as a paediatrician, psychologist, occupational therapist or speech therapist, might be helpful. 

I would also seek advice if there were concerns around development, communication, anxiety, sensory needs or a child losing skills they previously had. 

You don't have to wait until things become unmanageable. As a parent, you know your child, and you are their biggest advocate. If something does not feel right or everyday life is becoming increasingly difficult, it is ok to ask for support.

There are some fantastic Australian online resources available for families. The Raising Children Network is often a great place to start for practical, evidence-based information about children of all ages. Emerging Minds has helpful resources focused on children's mental health and emotional wellbeing. And Healthdirect provides trusted health information and advice about when to seek further care. 

A routine might make a situation easier to navigate, but it is not a replacement for individual assessment or professional care when a child and family unit needs more help. 

 

Remember that a routine should support the child and family, not become another expectation that must be met perfectly.