Helping your child understand feelings and find calm, including at bedtime

What is co-regulation, and why does it come first?

Co-regulation is when a calm adult helps a child's body and feelings settle. Children borrow that calm, again and again, and slowly build self-regulation: the ability to calm themselves.

A 2026 review calls parent-child co-regulation "a key mechanism" in how children learn to manage emotions, both "moment-by-moment" and over the long term (Northrup et al. 2026). Autism can make this harder: triggers can be everywhere and hard to predict, your child may not notice feelings building, and their signals can be hard to read. Research in young autistic children "remains limited", the authors add.

Co-regulation in practice:

• Calm yourself first. Slow your breathing, lower your voice and relax your face.
• Get close and on your child's level, if they want you near.
• Use very few words, and name what you see: "Big feelings. I'm here."
• Rock, hum or breathe slowly alongside your child, if they like that.
• Offer a calm tool you have practiced together, without insisting.

Your own stress matters too: it is hard to lend calm you don't have.

Why can feelings be hard for autistic children to notice and name?

Many autistic children find it hard to notice, understand and name their own feelings. This is a real difference, not stubbornness, and misreading goes both ways: autistic and non-autistic people can misread each other (Milton 2012), so learn your child's signals too.

• Alexithymia means difficulty identifying and describing your own emotions. A review of 15 studies, mostly in adults, found it in about half of autistic people (49.93%) compared with about 5% (4.89%) of non-autistic people, and called it "common, rather than universal" (Kinnaird et al. 2019). The first study in children found it "substantially elevated", though children's and parents' answers did not agree (Griffin et al. 2016).
• Interoception is the sense of what is happening inside your body, such as hunger, thirst, needing the bathroom, pain or a racing heart. Feelings often show up first as body signals, like a tight tummy or fast breathing, so a child who doesn't notice these signals may miss a feeling until it is very big.

How can I teach my child about feelings?

Teach feelings in small, everyday moments, using your child's way of communicating: speech, signing, pictures or AAC. These ideas come from emotion coaching research, not a tested program.

1. Name feelings in the moment. Keep it short: "Your body looks tight. I think you feel worried."
2. Link feelings to body clues. "Your heart is fast. Your hands are squeezing." Point to where on the body.
3. Use pictures. Photos of real faces, simple drawings or other visual supports give your child something to point to.
4. Use a simple feelings scale. Three levels suit most younger children; older children may manage five. Always include "I don't know", and body energy choices such as "my body feels fast" or "slow".
5. Show you understand. "It's hard when plans change."
6. Talk it over later. When everyone is calm, look back at what your child felt and what helped.
7. Use the same words and pictures at home, daycare or preschool, and school.

If your child is non-speaking or minimally speaking (some services say "nonverbal"), use even fewer words, offer pictures to point to, and point to feelings and calm words on their AAC as you talk.

This is called emotion coaching. In a general-population trial with 128 parents of 4 and 5 year olds, parents who learned it coached more and reported bigger falls in behavior problems (Wilson et al. 2012), but no trial in autistic children was found.

Which calm tools can we try?

Your child's choices matter most. Practice tools when your child is calm, so they are familiar when needed.

A one-minute animated video guiding four slow breaths raised heart-rate variability and lowered heart rate, which are body signs of calming, in a general sample of 342 children with an average age of 7.5 (Obradović et al. 2021). Autistic adults describe stimming as a way to self-regulate and object to efforts to remove it (Kapp et al. 2019), and the Autism Society encourages stimming because it aids emotional regulation (Autism Society). None of these tools has been shown to reduce anxiety in autistic children, so notice what helps yours.

A calm space and calm choices

For a calm space, use the Autism Society's advice for overwhelming moments: dim the lights, reduce noise and offer headphones (Autism Society). Add what soothes your child, such as a blanket or cushions, visit it together on good days, and stay nearby if they want you.

Our free calm choices board, a choice board that prints on US Letter paper, lets your child point to a calm option instead of talking. Start with 3 or 4 options they already like, such as jumping, slow breathing, headphones or a hug, plus a "break" picture.

How can I help my child calm down at bedtime?

Keep bedtime short, dim and the same every night. Sleep problems are common in autistic children, and a 2020 American Academy of Neurology guideline puts sleep habits and behavioral strategies first, along with checking for medicines and conditions that disturb sleep (AAN 2020).

1. Use the same short routine. Pick 4 to 6 calm steps, such as bath, pajamas, teeth, bathroom, story and lights out, shown as pictures on a visual schedule.
2. Turn screens off at least an hour before bed, as the American Academy of Pediatrics recommends (AAP).
3. Make the last hour calm and dim, using calm tools your child knows, and show tomorrow's pictures if worries come at night.
4. Check the bedroom through your child's senses: light, noise, scratchy pajamas or bedding, heat and cold.
5. Move more earlier in the day. A meta-analysis of 8 controlled studies found physical activity programs had a large positive effect on parent-reported sleep problems in autistic children and teenagers (Liang et al. 2024).
6. Change one thing at a time, and keep a 2-week sleep diary for the pediatrician.

Training parents in behavioral sleep strategies was "generally effective and valued by parents" in a review of 11 studies with 416 autistic children or children with an intellectual disability (Kirkpatrick et al. 2019). A weighted blanket did not help autistic children sleep longer in a trial, though families preferred it (Gringras et al. 2014). Ask the pediatrician to check for reflux, seizures, anxiety or breathing problems during sleep (AAN 2020).

What can I give my autistic child to calm down?

For a child upset right now, the answer is not a pill: your calm, a quiet space and their own calm tools come first. Before giving any medicine or supplement, ask your child's pediatrician or a pharmacist and tell them what your child already takes. Never give adult medicines or someone else's prescription.

• Medicine for specific problems. A 2016 parents' guide from the American Academy of Child and Adolescent Psychiatry (AACAP) says medicine is mostly used for problems that can come with autism, such as anxiety, sleep problems, hyperactivity or aggression, and that it "would be rare" for medicine to completely replace other support (AACAP 2016).
• Melatonin. In the US, melatonin is sold as a dietary supplement, not approved by the FDA as a sleep medicine, and the American Academy of Pediatrics says to use it only after talking with your pediatrician and setting up healthy sleep habits (AAP).
• Store medicines safely. Keep all medicines, vitamins and supplements away from children (AAP).

How can I tell if my child is anxious?

Watch for changes in behavior and body, since a child who speaks little often can't say they are worried. The National Institute of Mental Health lists signs that a younger child might benefit from a mental health evaluation, such as often seeming fearful or worried, frequent stomachaches or headaches with no known medical cause, sleep changes or nightmares, and frequent tantrums (NIMH). From practice, not a tested checklist, also watch for:

• more stimming, or the same question asked again and again
• clinginess, or avoiding places and people
• going very still or quiet
• more meltdowns, or new hitting or self-injury

The same changes can mean pain or illness, so ask your pediatrician to check for a medical cause (AACAP 2016).

Anxiety is common in autistic children, although estimates vary. A 2011 review of 31 studies, covering 2,121 autistic children and teenagers, found that 39.6% had at least one anxiety disorder (van Steensel et al. 2011). A 2019 review covering all ages found a lower figure, 20%, and higher estimates in clinic samples than in whole-population samples (Lai et al. 2019). Anxiety can start young: in a study of 82 autistic children aged 3 to 6 in Spain, 30.48% had significant anxiety on a parent questionnaire, worry about uncertainty was the most common kind, and more repetitive behavior went with higher anxiety (Durán-Bouza et al. 2025).

Intolerance of uncertainty is a tendency to react negatively, in feelings, thoughts and behavior, to uncertain situations and events (Rodgers et al. 2019). In one study, it appeared to link autism and anxiety in children and teenagers, although that kind of study cannot prove cause (Boulter et al. 2014).

What helps an anxious autistic child?

Make the unknown smaller and easier to see, and practice small changes when your child is calm.

• Make it visible. Show what is happening with a first-then board, a visual schedule or a calendar, and use a "change" picture when plans change. See our guides to first-then boards and visual schedules.
• Practice small surprises. When your child is calm, plan tiny changes, starting with good ones (a new snack), then neutral ones, then harder ones. Praise coping, not just calm. This echoes the program below but is not the program itself.
• Don't avoid everything. The 2026 review warned that avoidance used as a "quick fix" may hinder how children learn to manage feelings over time (Northrup et al. 2026).

Parent-led programs: the only anxiety trial found for this guide in children aged 4 to 7 worked through parents. In the CUES-Junior trial in Western Australia, parents of 64 autistic children with worries about uncertainty joined an 8-week parent group or a waiting list. More children in the group improved in how they handled uncertainty, family life was less affected, and the gains were still there 2 months later (Ong et al. 2026). But it was one small trial with very uncertain results, compared only with a waiting list, and we could not confirm whether the program is offered in the US.

Talk therapy: most research on cognitive behavioral therapy (CBT) for anxiety in autistic children is in older children who talk well (Sukhodolsky et al. 2013), so ask whether a therapist adapts it.

Where can I get help in the US?

Seek help if your child's behavior or emotions last for weeks or longer, cause distress for your child or family, or get in the way of home, school or friendships. Start with your child's pediatrician and ask for a referral to a mental health professional experienced with children (NIMH).

For early intervention, "a doctor's referral is not necessary": contact your state program yourself (CDC).