Nurseries and childminders have called for an overhaul of Ofsted as stressed-out staff said inspections were their main cause of anxiety.
A survey by the Early Years Alliance found the majority (77%) backed scrapping single-world Ofsted grading, such as 'outstanding' or 'requires improvement'.
Almost three in five (58%) said they ‘strongly’ supported the call, according to responses from more than 1,900 providers to a snapshot poll.
Almost half of respondents (45%) reported a negative experience with the watchdog - with a fifth (21%) filing a formal complaint, and more than half (52%) saying they felt their judgement was unfair.
Some eight in 10 (79%) nurseries, preschools and childminders said they worried about inspections “fairly” or “very often”.
It comes amid a growing backlash against Ofsted after headteacher Ruth Perry took her own life in January whilst awaiting an inspection judgement which downgraded her school.
The Caversham Primary School head's family blamed the "deeply harmful" pressure of the Ofsted inspection for her distress.
Childminders, and staff in nurseries and preschools, reported enduring sleepless nights and suffering from anxiety and stress due to the demands of their work.
More than eight in ten (81%) respondents said they were regularly stressed about a work-related issue in the past month, blaming inspections, pay and the Government's childcare expansion plans for their misery.
Most said this has had a knock-on impact on their physical health: in the past year, around two-thirds suffered with anxiety (67%), fatigue (65%) and loss of motivation (64%).
Some 14% said that they had experienced panic attacks, while 3% said they had had thoughts of taking their own life.
Neil Leitch, CEO of the Early Years Alliance, said: “The fact that working in the early years has left educators facing sleepless nights and suffering from anxiety and stress is not only deeply worrying; it’s completely unacceptable.
"It’s clear that the early years is in the midst of a mental health and wellbeing crisis, and that Ofsted inspections are a key source of this stress for many in the sector."
Mr Leitch said the Government's plan to announce an expansion to the 30-hours of free childcare provision was "heaping even more pressure on a sector that is already close to buckling.
"It’s no surprise that so many are struggling," he said.
An Ofsted spokesperson said: “Our inspections are first and foremost for children and their parents, to provide assurance about how well nurseries and childcare settings are run.
"Currently 96% of early years providers are judged good or outstanding, so the overwhelming majority are doing a good job for children. But we do sometimes have to take tough decisions when standards drop or children’s safety is compromised.
"We know that inspections can be challenging, so we talk regularly to early years providers to tackle some of the common misconceptions about our work. We want inspections to be as constructive as possible for nurseries and childminders.”
Chief Inspector Amanda Spielman previously said that she accepted single word grades could make people "uncomfortable" but insisted it plays an "integral part" in the system.
