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Helping Our Children to "Sleep Like Babies" |
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Sleep-related issues are the biggest complaint parents bring to their children’s pediatricians, according to sleep medicine specialists with Gaylord Hospital.
The sleep issues don’t fade once bleary-eyed parents graduate from their child’s infancy. More pediatricians are seeing older children with sleep issues and teens who show signs and symptoms of sleep disorders. When it comes to sleep, the pediatrician isn’t just treating the child, but the family as well. A child’s sleep problems can affect parents and other siblings. In fact, according to the National Sleep Foundation’s 2001 Sleep in America poll, adults with children get less sleep and report more sleep problems than their counterparts without children. The first thing to understand is that sleep is not an equal opportunity employer. Sleep needs and issues differ among children and may change at various ages. A good sleep history is key. Parents should keep a diary of their child’s sleep habits, hour by hour, and then review it with a health care provider to uncover the specific issues. Remember, too, that not every sleep complaint is a disorder. A good sleep history will help the health care provider distinguish between a disorder and a complaint. When sleep complaints are behavior problems, the health care provider should also consider the family’s level of tolerance. What may be acceptable for some families may not be acceptable for others. Rock-a-Bye Baby For example, in infants and toddlers, the question of what is the appropriate amount of sleep is always an issue: “How long should my baby sleep?” “How many naps should my child take?” “When should my baby sleep through the night. A parent may want her toddler in bed by 7 p.m., and then become frustrated when the child refuses to cooperate with the bedtime routine. The parent and the health care professional need to look at sleep patterns throughout the day and night to assess the child’s sleep needs. “How much sleep is the child getting?” “Does the child sleep in the car or in the stroller? If so, how long and how often?” How many daytime naps does the child take?” “How long does the child nap?” “How often does the child eat?” Based on the information gleaned from the history, the child’s nap schedule or feedings may need to be adjusted. Acceptable sleep behavior can be established as early as infancy. Many new parents will rock their babies to sleep instead of allowing them to fall asleep on their own. Infants then learn to associate sleep with the movement. When they awaken, they find themselves alone and can’t transition back to sleep. “I compare this to an adult who goes to sleep in bed then wakes up in the kitchen,” says Rochelle Turesky, M.D., a pediatrician who is working on a fellowship in sleep medicine at Gaylord. “You can imagine how startled and unsettling that would be for an adult. Imagine how a baby would react after falling asleep in the comfort of his mother’s arms only to awaken in a crib with no mother in sight.” Sleep association is, therefore, a behavioral issue that can be addressed through various methods. Parents should take solace in knowing that babies and children can learn to fall asleep naturally. (For more information on sleep behavior and sleep problems in children, visit the American Academy of Sleep Medicine at www.aasmnet.org or National Sleep Foundation at www.sleepfoundation.org.) I’m a Big Kid Now For toddlers, the big sleep issue is the transition into the child’s own bed. Parents may have trouble setting limits for the child in various settings—and sleep is just one. Sleep, however, is frequently the trigger that brings limit setting to the forefront. When a child refuses to go to bed, stalls for time, or makes it difficult for a parent to leave the bedside, limit-setting problems may be at work. Limit-setting problems (which tend to show up after two years of age) can occur at bedtime, napping, or during nighttime awakenings. Parents must keep a firm bedtime routine despite a child’s pleas. As seasoned parents know, children can come up with an endless stream of delay tactics. Parents need to set limits and be consistent to reinforce these behaviors. Off to School In older children, the symptoms of sleep deprivation are often overlooked or erroneously attributed to attention deficit disorder and behavioral issues. During well-child check-ups, health care providers still need to ask parents about their child’s sleep. Children, for example, should not snore. Loud snoring could be a sign of sleep apnea, restless sleep, or irregular sleeping. |
Spotting sleep problems in older children is more difficult. Remember, children don’t complain about not sleeping. Children also don’t yawn or rub their eyes the way an adult would when sleepy or overtired. They may, however, be more irritable, lack concentration or exhibit behavioral problems. The lack of adequate sleep can also result in decreased performance in the classroom or extracurricular activities. Other sleep disorders that are seen in older children include night terrors, sleepwalking and sleep talking. Teenagers Rule According to a study conducted by the National Sleep Foundation, teenagers are more likely to complain of being tired during the day than are younger children. “Our research has shown that biological changes during puberty affect an adolescent’s internal sleep-wake clock. Many adolescents are physiologically not ready to fall asleep until 11 p.m. or later,” explains Mary A. Carskadon, Ph.D., Sleep Research Lab Director at Bradley Hospital/Brown University and National Sleep Foundation Pediatric Council Chair. While the average teen needs about nine hours of sleep each night, many get less than seven, according to the study. A frightening figure provided by the National Sleep Foundation and the National Traffic Safety Board shows that 60% of parents who have children old enough to drive say that they have not discussed the dangers of falling asleep at the wheel with their children. Drowsy driving causes at least half of all teen crashes in the United States each year. Given teenagers’ sense of invincibility, many are not aware of the impact their drowsiness plays on driving ability. “Teens, especially young males, are pushing the envelope when it comes to dangerous, drowsy driving,” Dr. Turesky says. Pediatricians need to continue to ask their adolescent patients about their sleep habits, and to include the topic of late-night driving in their pre-college talk about drinking, drugs and safe sex. The TV Connection Parents concerned about their childrens’ sleep habits also may consider how much the television is on in the household. A survey of third- through eighth-graders revealed that as the number of hours of television viewing increased each day so did the prevalence of symptoms such as anxiety, depression and post-traumatic stress (Singer MI, et al. J Am Acad Child Adolesc Psychiatry. 1998; 37:1041-1048). The amount of television viewing—especially at bedtime—and having a television set in the child’s bedroom were factors significantly related to the frequency of sleep disturbances found in children in grades K-4, according to a survey reported by Pediatrics (Owens J., et al. Pediatrics. 1999; 104:e27). Nine percent of the parents surveyed reported that their child experienced nightmares related to television viewing at least once a week. While children are sensitive to and frightened by different things at different ages, media images can produce very real, lingering fears and anxieties in toddlers, teens and young adults. The American Academy of Pediatrics reports that children need reassurance when frightened and the encouragement to choose media that will promote rather than disturb their physical and emotional well-being. The bottom line for all those who care for children is that sleep is a requirement of good health. Every child deserves a good night’s sleep.
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