Category Archives: Children & Teens

For Better Sleep, Teach Your Kids Good Habits

It is becoming quite apparent to those of us in sleep medicine that children and adolescents are not getting enough sleep. I believe there are two major reasons for this, the first being that some parents really don’t have a clue as to how much sleep their children need. However, the second and more extensive is the proliferation of electronics in the bedroom and the failure of parents to take charge and set limits.

In a recent study published in the International Journal of Mental Health and Addiction, 1,200 Australian high school students were studied. They completed a questionnaire assessing electronics use and sleep duration. Sleep duration on schooldays was reported to be less than optimal by 71% and by 53% on weekends. In one out of five, the major cause for a delayed bedtime was use of electronics. In fact, 10% were deemed pathologically addicted to electronic devices.

We know that lack of sleep in children and adolescents has severe consequences. Among these are irritability, problems with impulse control, inattentiveness, and depression. Additionally, childhood obesity and early onset diabetes can be linked to insufficient sleep.

The good news is that you as a parent can make a big difference. In the 2014 National Sleep Foundation (NSF) Sleep in America poll it was clear that parents can make a big difference. When parents enforced such things as bedtimes, caffeine drinks, and how late electronics could be used, their children slept on average almost one hour more than those who did not. In addition, roll modeling is important. Children of parents who have interactive electronics in their bedrooms are far more likely to have them as well.

What is the take-home message? First, educate yourselves about how much sleep your children require. A school-aged child of six to twelve should be getting 10 to 11 hours while a high school student needs 9 to 10. Second, don’t be afraid to set some rules. All interactive electronics and televisions should be off a minimum of one hour before bedtime, and if possible, they should not be part of the bedroom environment. In the end, once you get through the moaning and groaning you will be rewarded with a much happier and healthier kid. After all, isn’t that a parent’s responsibility?


10 Signs Your Child’s Snoring Is a Problem

We know that anywhere from 8% to 12% of children snore most nights. This is called habitual snoring. We also know that 3% to 5% of children have sleep apnea. Pediatric sleep apnea is a serious condition that can adversely affect your child’s growth, emotional and cognitive development, and cardiovascular health. Here are 10 tips that should help you decide whether your child’s snoring might need further medical evaluation.

1. Frequent nighttime sweating. This is due to overactivity of the sympathetic (fight or flight) nervous system during sleep, triggered by low oxygen and efforts to breathe against a closed airway.

2. Paradoxical inward movement of the rib cage and sternum (breastbone) while breathing in. Again caused by vigorous efforts to breathe in against a closed airway.

3. Assuming unusual positions while asleep. Hyperactive extension of the neck is common in children with sleep apnea. It tends to help keep the airway open.

4. Morning headaches. These are due to low oxygen and elevated blood pressure while asleep.

5. Chronic bedwetting. Several studies have shown a high incidence of sleep apnea in bedwetters. In one recent study, 42% of a group of children treated for sleep apnea were bedwetters. After treatment, 66% showed significant improvement.

6. Hyperactivity and inattentiveness in school. Children with sleep apnea are frequently misdiagnosed as having ADHD. Careful screening such as inquiring about snoring can in some cases avoid unnecessary medications used for ADHD.

7. Frequent sleepwalking and night terrors. Sleep apnea can cause this. In fact, in a study done at Stanford several years ago, a majority of sleepwalking children with sleep apnea stopped sleepwalking after treatment of their sleep apnea.

8. Pediatric hypertension. All children with hypertension should be screened thoroughly for the presence of sleep apnea.

9. Down syndrome. The incidence of sleep apnea has been reported to be anywhere from 40% to 70% of all children with Down syndrome. Untreated, it can severely affect their health and mental development.

10. Obesity. Recent studies have shown that as many as 30% of obese children may have sleep apnea. Untreated, associated sleep apnea increases their already high chances of developing hypertension, insulin resistance, and associated metabolic disorders. It also hinders the child’s ability to lose weight.

Therefore, the take home message is that sleep apnea is becoming even more common but it can be easily treated in most children. Untreated, it may have numerous undesirable effects on health and development. Consequently, if your child snores chronically or has any of the other aforementioned signs or symptoms, be sure to bring it to the attention of your health care provider.

What Every Parent Should Know About Sleep

As parents, you should know that 25% of all children experience some type of sleep problem during childhood, the most common being bedtime difficulties and night awakenings. If untreated, these can lead to mood disturbances, impaired attention, and poor impulse control. In fact, in a recent British study, children with irregular sleep/wake schedules demonstrated long-term deficits in math and language skills. The following are some behavioral tips on how to deal with the child who is a problem sleeper.

1. Extinction: The parent is advised to put the child to bed and ignore the child’s response. It is very effective and has not been shown to cause harm. However, many parents find it difficult.

2. Graduated extinction: This is extinction with periodic parental checks. The interval between checking-in and the duration of each check-in are increased nightly.

3. Self-soothing: The idea here is to put the child to bed when groggy, not after they have fallen asleep in your arms or on the couch. By doing this, it helps the child to develop techniques for falling asleep. It also discourages the very bad habit of associating the parents’ presence with falling asleep.

4. Positive bedtime routines: The intent is to make bedtime a positive, enjoyable time for the child. Such things as taking a bath, brushing teeth, and putting on pajamas, followed by a bedtime story can work wonders.

5. Develop a regular sleep/wake schedule: Children and adolescents should have a consistent schedule. I urge parents to learn how many hours of sleep your child needs at that age and work backwards from wake time. Try to avoid no more than one hour’s difference on non-school nights.

6. Avoid caffeine: Children should avoid any caffeine-containing product after noon. Soda, coffee, chocolate, and iced tea are prime examples.

7. Sleep environment: Most studies show children sleep better in cool environments. Temperatures of 65° to 70° are recommended. Televisions and video games should be eliminated. Most studies show increased sleep problems and lighter sleep in children with televisions in the bedroom.

8. Naps: Make sure that the number and duration of naps is appropriate for your child’s age. Note that after the age of five most children do not require naps. However, each child is different, so there is no hard and fast rule here. We do know that naps too close to bedtime can interfere with the ability to fall asleep.

9. Avoid pre-bedtime roughhousing. This serves to increase the production of stress hormones, as well as increase the core body temperature. Both of these can inhibit the ability to fall sleep.

10. Avoid bedtime snacks, especially those high in sweets. These snacks can cause a sudden burst in energy–the last thing you want when your child is trying to go to sleep.