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Daily Dose

Kids Who Snore

1.30 to read

Does your child snore?  If so, have you discussed their snoring with your pediatrician.  A recent study published in Pediatrics supported the routine screening and tracking of snoring among preschoolers.  Pediatricians should routinely be inquiring about your child’s sleep habits, as well as any snoring that occurs on a regular basis, during your child’s routine visits.  

Snoring may be a sign of obstructive sleep apnea and/or sleep disordered breathing (SDB), and habitual snoring has been associated with both learning and behavioral problems in older children. But this study was the first to look at preschool children between the ages of 2-3 years.

The study looked at 249 children from birth until 3 years of age, and parents were asked report how often their child snored on a weekly basis at both 2 and 3 years of age.  Persistent snorers were defined as those children who snored more than 2x/week at both ages 2 and 3.  Persistent loud snoring occurred in 9% of the children who were studied.

The study then looked at behavior and as had been expected persistent snorers had significantly worse overall behavioral scores.  This was noted as hyperactivity, depression and attentional difficulties.  Motor development did not seem to be impacted by snoring.

So, intermittent snoring is  common in the 2 to 3 year old set and does not seem to be associated with any long term behavioral issues. It is quite common for a young child to snore during an upper respiratory illness as well .  But persistent snoring needs to be evaluated and may need to be treated with the removal of a child’s adenoids and tonsils.

If you are worried about snoring, talk to your doctor. More studies are being done on this subject as well, so stay tuned.

Your Child

Study: Bedtime Routine Offers Kids Many Benefits

1:45

If your child doesn’t have a nightly bedtime routine, he or she is missing out on a tremendous amount of health and behavioral benefits according to a new study. And you’re not alone.

A multinational study consisting of over 10,000 mothers from 14 counties reported that less than 50 percent of their infants, toddlers and preschoolers had a regular bedtime routine every night.

Researchers determined that the participant’s children who did have a regular bedtime routine benefitted on many levels. The study found that children with a consistent bedtime routine had better sleep outcomes, including earlier bedtimes, shorter amount of time in bed before falling asleep, reduced night waking, and increased sleep duration. Children with a bedtime routine every night slept for an average of more than an hour longer per night than children who never had a bedtime routine. Institution of a regular bedtime routine also was associated with decreased sleep problems and daytime behavior problems, as perceived by mothers.


“Creating a bedtime routine for a child is a simple step that every family can do,” said principal investigator and lead author Jodi Mindell, PhD, professor of psychology at Saint Joseph’s University and associate director of the Sleep Center at Children’s Hospital of Philadelphia. “It can pay off to not only make bedtime easier, but also that a child is likely to sleep better throughout the entire night.”

According to the American Academy of Sleep Medicine, positive bedtime routines involve the institution of a set sequence of pleasurable and calming activities preceding a child’s bedtime. The goal is to establish a behavioral chain leading up to sleep onset. Activities may include giving your child a soothing bath, brushing teeth and reading a bedtime story.

“It’s important that parents create a consistent sleep schedule, relaxing bedtime routine and soothing sleep environment to help their child achieve healthy sleep,” said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler.


Researchers found that consistency was an important factor in helping children sleep well

“For each additional night that a family is able to institute a bedtime routine, and the younger that the routine is started, the better their child is likely to sleep,” said Mindell. “It’s like other healthy practices:  Doing something just one day a week is good, doing it for three days a week is better, and doing it every day is best.”

Mothers participated in the study by completing a validated, online questionnaire that included specific questions about their child’s daytime and nighttime sleep patterns, bedtime routines and behavior. The questionnaire was translated into each language and back-translated to check for accuracy.

“The other surprising finding is that we found that this effect was universal,” said Mindell.  “It doesn’t matter if you are a parent of a young child in the United States, India, or China, having a bedtime routine makes a difference.”

Sleep deprivation is becoming an all too common problem with today’s children and adults. The earlier a good sleep routine can be established and practiced, the better for a child in the long run.

Study results are published in the May issue of the journal Sleep.

Source: http://www.healthcanal.com/disorders-conditions/sleep/63298-study-shows-that-children-sleep-better-when-they-have-a-nightly-bedtime-routine.html

Your Child

New Guidelines for How Much Sleep Kids Really Need

2:00

As adults, we all know that without a good night’s sleep, we’re going to be struggling to get through the day’s activities. When we’re not running on all rested cylinders, small troubles seem like mountains, being able to focus and complete a project is difficult and nodding off while driving is more likely to happen.

Restful sleep is a wonderful thing and unfortunately, many of us just aren’t getting enough.

Most adults know about how much sleep they need the night before to feel their best the next day. Children, on the hand, need a certain amount of sleep depending on their age.

For the first time, a new set of sleep guidelines specially tailored to children, have been released from the American Academy of Sleep Medicine. The new recommendations give a precise number of hours for each age range, spanning from infancy up until 18 years old.

"Sleep is essential for a healthy life, and it is important to promote healthy sleep habits in early childhood," said Dr. Shalini Paruthi, fellow of the American Academy of Sleep Medicine, in a statement. "It is especially important as children reach adolescence to continue to ensure that teens are able to get sufficient sleep."

A team of 13 top sleep experts conducted a 10-month research project to find out how much sleep children actually need. The team reviewed 864 published scientific articles that revealed the link between sleep duration and the health of children across all age categories.

Here’s what they found:

·      Infants between 4-12 months of age should get 12 to 16 hours of sleep for any 24-hour period. This includes naps.

·      Children between 1 and 2 years of age need 11 to 13 hours for every 24-hour period.

·      Children between 3 and 5 years old need a little less at 10 to 13 hours per 24-hour period.

·      Children between 6 and 12 years old need 9 to 12 hours of sleep – not including naps- in a 24-hour period.

·      Teens between 13 and 18 years old need 8 to 10 hours per 24-hour period.

All told, babies, kids, and teens spend roughly 40 percent of their childhood asleep, according to the National Sleep Foundation.

The panel points out that the right amount of shut-eye is critical for a child’s developing brain and body and overall mental and physical health.

Researchers also noted that when children do not get enough sleep, their behavior is affected and their long-term health can be negatively impacted.

"Adequate sleep duration for age on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health," the American Academy of Pediatrics (AAP) wrote. "Not getting enough sleep each night is associated with an increase in injuries, hypertension, obesity and depression, especially for teens who may experience increased risk of self-harm or suicidal thoughts."

According to Dr. Nathaniel Watson, the president of the American Academy of Sleep Medicine, making sure that their child gets enough sleep is one of the best ways parents can lay a foundation of healthy habits that children can take with them into adulthood. With more than one third of the adult population sleep deprived, sleep becomes paramount for children to avoid the slew of consequences that come with a lifetime of sleep problems.

"The AAP endorses the guidelines and encourages pediatricians to discuss these recommendations and healthy sleep habits with parents and teens during clinical visits," they announced. "For infants and young children, establishing a bedtime routine is important to ensuring children get adequate sleep each night.”

Story source: Samantha Olson, http://www.medicaldaily.com/how-much-sleep-do-kids-need-sleeping-baby-constantly-tired-389448

Daily Dose

New Baby Questions!

1:30 to read

Lots of new baby questions this week in my office, so I that I thought I would cover a few of the most frequently asked by parents within days of bringing that precious newborn home from the hospital. So, here we go:

My baby has blue hands and feet…should I go to the ER?  The medical term for this is acrocyanosis.   It is not uncommon for a baby to have a bluish/purple discoloration to their hands and feet. This often occurs if the baby gets chilled or cold, whether that is after a bath or sometimes even after they are unswaddled to wake them up a bit to get them to eat.  If your baby has pink lips and tongue and seems otherwise fine this is the normal adjustment of a baby’s circulation and may last for a few weeks to months.  When parents are concerned about this and make a trip to the ER where they are discharged with the diagnosis of “worried well”.

What temperature do I need to have my thermostat set?  This question always makes me laugh a bit because some of it is truly dependent on the climate where you live. Many parents think they need to “crank up the heat” for a newborn, but actually a cooler room temperature has been shown to correlate with a reduction in sudden infant death (SIDS).  The “ideal” temperature that has been recommended is around 68 - 70 degrees, but for those of us who live in the south during the dead of summer, it is almost impossible to keep your house this cool and very expensive. At the same time, some parents are uncomfortable during the winter with the thermostat at 68 degrees…so I would recommend keeping your house comfortable and on the cooler side rather than too warm. You also do not need to bundle your baby when it is blazing hot outside, less is more if the house is hot.

What about a pacifier?  Mother’s come in and say, “I was told that I shouldn’t use a pacifier because it will cause “nipple confusion”.  While I am a huge proponent of breast feeding I think that a pacifier is also helpful for a breast feeding mother so that she does not use her own breast as a “human pacifier”. Many new moms come in to see me at the 2 week check up crying, exhausted and with bleeding nipples. They are putting their baby on the breast for hours at a time as “it seems the only way my baby is content”.  Although they were told that they could put their finger in their baby’s mouth as a way to help console their baby, that too does not provide much of a distance from the baby…even to go to the bathroom, take a shower or eat!! A baby has the reflex to suck which is termed, “non-nutritive sucking”.  This is one way that your baby will calm themselves.  So, once your baby is getting on the breast, I would buy a pacifier and “teach” your partner how to hold your baby in the position as if they were going to be fed,  but with a pacifier to suck on rather than the breast. Once situated you can try walking around, gentle bouncing or swaying while your baby is happily sucking on their pacifier. Mother gets a bit of a rest between feedings and infant is happy with a pacifier ( rather than a finger). We will discuss taking away a pacifier at another time! 

 

Daily Dose

How To Prevents SIDS

1:15 to read

A new study on swaddling and sudden infant death (SIDS) was just published this week in the journal Pediatrics. Not surprisingly, it found that infants who were swaddled and placed on their sides or stomach had a higher incidence of SIDS. It has been routinely recommended for more than 15 years that all babies sleep on their backs and since that time the incidence of SIDS has been dramatically reduced.  Unfortunately not everyone follows the AAP recommendation. 

While it has been known that tummy sleeping has been associated with SIDS this meta analysis looked at data which was gathered over two decades and from 3 different global sites. The review found that infants who were swaddled and placed on their sides were almost twice as likely to experience SIDS and the risk of SIDS did double in those babies who were swaddled and placed on their stomachs.  

I discuss swaddling with all of my patients as there are so many different swaddle blankets available.  Actually, one of the first things a newborn nurse seems to teach a new parent is how to swaddle their baby.  While swaddling has been promoted to aid in calming a newborn as well as to help their sleep, the recommendation that the baby be placed on their back in their crib continues..  Many a baby looks like a little burrito….. rolled up in the swaddle and then being placed on their back in the crib.

But is seems from this study that some babies were being swaddled and then placed on their side to sleep. Unfortunately, even a newborn may squirm enough that they then move from their side into the prone position.  Older infants who are swaddled may actually roll from their back to their tummies, even while swaddled. While the association between swaddling and SIDS remains unclear, I think this is a good reason to start getting a baby out of a swaddle once they are rolling. So around the 3 month mark I start having parents loosen the swaddle and try to just lay the baby on their back without being swaddled.

Let me re-iterate, this article does not confirm an association between swaddling and SIDS.  I do think it is a good reminder for putting a baby, “back to sleep” and once they are rolling “ditching” the swaddle seems to make even more sense. Once less thing to worry about, right?

 

Daily Dose

New Sleep Recommendations

1:30 to read

SLEEP! Who can get enough of it?  More and more studies point to the need for a good night’s sleep. But, as a new parent, you are sleep deprived, and then when your children get older they may sleep through the night,  but they want to wake up at the crack of dawn.  Once your children are adolescents their days and nights are totally up side down,  they often want to stay up too late and sleep half the day away.

Sleep is an important way to rest our brains and reset our bodies for another day.  Circadian rhythm helps to regulate sleep/wake cycles.  But trying to make sure that your children get enough sleep seems to be a never ending battle (at least in many houses). It is also one of the most frequent concerns of many of my patient’s parents.  

A recent study which was undertaken by the National Sleep Foundation reviewed over 300 articles published in peer reviewed journals between 2004-2014. Based upon their review here are the updated sleep recommendations:

Newborns (0- 3 months) 14 - 17 hours

Infants (4 -11 months) 12 - 15 hour

Toddlers (1- 2- years) 11 - 14 hours

Preschoolers (3 - 5) 10 - 13 hours

School aged children ( 6 - 13) 9 - 11 hours

Teens (14- 17)  8 - 10 hours

Young adults (18 - 25) 7 - 9 hours

So, how do your children stack up with their sleep?  Parents with newborns complain that their children may sleep 15 hours/ day, but not in the increments that they would like, while parents with children over the age of 13 rarely report that their children are getting  8 - 10 hours of sleep.

One mother recently was exasperated as her daughter age 7 would go to bed at 7:30 pm but woke up everyday at 6 am. I explained to her that her daughter was getting enough sleep, and that unfortunately her biological clock was set and that short of making her stay in her room until 6:45 when she wanted her to get up, there was not much to do.  The problem is that many parents cannot go to bed when their children do, (dishes, laundry, work emails, etc to get done while the children sleep.) So while their children may be getting enough sleep the parents are often sleep deprived!

While a good night’s sleep is important for mood and focus there is a lot of data suggesting that children who get enough sleep are less obese, are less likely to get into trouble and are certainly more pleasant to be around.

So, have a good nighttime routine beginning with a regular bedtime for your children. Commit to no electronics in their bedrooms and turn off any electronics at least an hour before bed.  We parents need to do the same!

Daily Dose

A Better Night's Sleep

1:15 to read

What is it about sleep and parenting? Babies never sleep enough and teenagers sleep too much!! Why can’t “we” get this right? While sleep patterns definitely do change with the age of the child, good sleep habits can begin in infancy and continue throughout adolescence.

Even from the beginning,  you should try to teach your child to fall asleep on their own and to self-console by either sucking on their fingers or a pacifier. But remember, this sleep thing is new and babies really do have to learn how to do this.  Think of it as if you were teaching your child to read, it doesn’t happen overnight, but evolves with practice, patience and repetition. Sleep is the same way.

After the early years of teaching your child to fall asleep on their own, the toddler, preschool, and elementary years are usually fairly easy to establish good sleep patterns if you follow a routine, with a set bedtime, reading to your child before bed and hugs and kisses and lights out. This is the age for occasional nightmares, or fears, but also for regular nights of uninterrupted sleep.

With the tweens and teens and hormone changes of adolescence comes a new sleep clock that is set to stay up too late and not wake up in the morning. Even teens need a good nights rest, so a bedtime should be encouraged and enforced unless there is a test of special event. There is not a reason I can think of for teens to be up past 11 pm on a school night, homework should be finished, and all of the accessories such as cell phone, computer and all other electronic gear put up before bed. The older you get the more you understand a good night’s sleep , but someone has to teach the basics along the way and before you know it the whole house will be on that schedule too. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue now!

Daily Dose

Bedtime!

1:30 to read

Bedtime….an important word for parents and for children. A new study in Pediatrics just reinforces how important bedtimes for children may be.  The research shows that preschool children who had an earlier bedtime were less likely to become obese in their teenage years. 

The study involved nearly 1,000 children who were born in 1991 and whose parents recorded their bedtimes when they were 4.5 years old.  The researchers then looked at the growth data (height/weight) for these children when they were 15 years of age.

Interestingly, the pre-school children who were in bed by 8:00 p.m. had half the risk of becoming obese as a teenager compared to those children who went to bed after 9 pm. Specifically, of the children who went to bed by 8 pm, only 10 percent were obese as teens, while 16 percent of those who went to bed between 8 and 9 pm developed obesity, and 23 percent of those children   who had bedtimes after 9 pm developed teenage obesity. 

While there has been much research surrounding sleep and obesity (as well as behavior), this study provides even more evidence to the possible “protective effect” of early bedtime and bedtime routines for young children.  If getting to bed on time and earlier can in some way help stem the obesity tide, it would seem like an easy recommendation for many parents to follow.  

As a mother I was always a “fan” of schedules and bedtimes…and actually putting your child to bed at night is such a wonderful time of day. The routine of a bath, snuggles, some books ( with wishes for just one more) and more hugs and kisses is such a wonderful memory I have of my own 3 boys. It just seemed that everyone was happier (and I guess healthier) when we had early bedtimes. I remember I had a friend who always had her 3 young children fed, bathed and in bed by 7:00 p.m. every night..and in those pre cell phone days we did not dare call her house after that time!!  

I also think bedtime routines are important for younger children year round. While it is more difficult to have regular bedtimes for older children during the summer months, children under elementary school age (and maybe even older) really do benefit from continuing on the same bedtime schedule during the summer months.  I think if you told your middle school or teenager this “rule” there  might be mutiny….but I know as well as a working parent, it is much easier to have a routine even when the kids are out of school…they would totally disagree!

I am excited about this study and using it as another resource when discussing sleep habits and bedtime routines with my patients.  This is especially important as we get ready to discuss back to school sleep routines….summer does fly by!

Your Teen

Kid's Poor Sleep Habits and Depression

1.50 to read

A 2010 study of 392 boys and girls published online in the Journal of Psychiatric Research found that those who had trouble sleeping at 12 to 14 years old were more than two times as likely to have suicidal thoughts at ages 15 to 17 as those who didn't have sleep problems at the younger age.Scientists are discovering that children with chronic sleep problems are at increased risk for developing a mental illness later in life.

Recent studies show that children who have persistent sleep problems, such as difficulty falling asleep or staying asleep, or not getting enough night-time shut-eye, are more likely later to suffer from depression and anxiety disorders and to abuse alcohol and drugs than kids without sleep problems. The findings add to previous research that has linked children's sleep problems to a host of issues, including aggressive behavior, learning and memory problems and obesity. A 2010 study of 392 boys and girls published online in the Journal of Psychiatric Research found that those who had trouble sleeping at 12 to 14 years old were more than two times as likely to have suicidal thoughts at ages 15 to 17 as those who didn't have sleep problems at the younger age. In a study published last year in Alcoholism: Clinical and Experimental Research, involving 386 participants, children whose mothers reported that they were overtired when 3 to 8 years old were 2.8 times as likely to binge drink when they were 18 to 20 years old. And a study of 1,037 children revealed that 46% of those who were considered to have a persistent sleep difficulty at age 9 had an anxiety disorder at age 21 or 26. By comparison, of the children who didn't have sleep problems at age 9, 33% had an anxiety disorder as young adults, according to the research, which was published in 2005 in the Journal of Abnormal Child Psychology. Scientists caution that some study-sample sizes are small and research is still in its early stages. Psychiatrists and psychologists say they hope that by addressing sleep problems in childhood, some of the instances of later mental illness can be prevented. Clinicians also have developed effective treatments for poor sleep and are experimenting with some new approaches that teach kids how to reduce the frequency and strength of anxious thoughts that can crop up at night. In general, doctors do not recommend using medication to help kids sleep. "We think that healthy, optimal sleep may be a buffer against developing anxiety and depression in kids," says Ronald E. Dahl, a professor at the University of California, Berkeley and a leading researcher on pediatric sleep. Anxiety disorders and depression are the most common mental illnesses: 28.8% of the general population will have an anxiety disorder in their lifetime and 20.8% will have a mood disorder, according to a 2005 study published in the Archives of General Psychiatry. Anxiety disorders emerge early in life: The median age of onset is 11, according to the study. Rates of depression spike in adolescence, too. And those who develop depression young tend to have a more serious disease, with a higher risk of relapse. Scientists aren't certain as to why poor sleep in childhood increases the risk of anxiety disorders and depression. It could be that sleep problems lead to changes in the brain, which, in turn, contribute to the psychiatric illnesses, they say. Or some underlying issue, partly explained by genetics and early childhood experiences, could be a precursor to both poor sleep and the mental disorders. Researchers say that before puberty—between the ages of about 9 and 13—is a key time to tackle poor sleep. That's before the spike in rates of depression and the upheavals of adolescence and while the brain is still very responsive. "The brains of children are far more plastic and amenable to change," says Candice Alfano, assistant professor of psychology and pediatrics at Children's National Medical Center in Washington, D.C. Sleep changes dramatically after puberty: Circadian rhythms shift so kids naturally stay up later. With schools starting early, kids often don't get enough sleep. Academic and social pressures surge, too. A small study suggested healthy sleep may be able to help protect kids from depression—even those at high-risk because of genetics. (Both anxiety disorders and depression are believed to be partly inherited.) The study, published in 2007 in the journal Development and Psychopathology, found that children who fell asleep quicker and spent more time in the deepest stage of sleep were less likely to develop depression as young adults. A larger body of research shows that improving sleep in kids and adults who already have mental-health problems also leads to a stronger recovery. A Good Night Most parents underestimate the amount of sleep children should get a day. They need: Infants: 14 to 15 hours Toddlers: 12 to 14 hours Preschoolers: 11 to 13 hours School-age kids: 10 to 11 hours Teenagers: 9 to 10 hours Strategies to encourage healthy sleep in kids Set a regular bedtime and wake time, even on weekends. Make the bedroom a dark and quiet oasis for sleep. No homework in bed. Create a calming bedtime routine. For younger kids: a bath and story. For older kids: Reading or listening to mellow music. Limit caffeine consumption, especially after 4 p.m. Ban technology (TV, Web surfing, texting) in the half hour before bed. The activities are stimulating. The light from a computer can interfere with the production of the sleep-promoting hormone, melatonin. Don't send kids to bed as punishment or allow them to stay up late as a reward for good behavior. This delivers a negative message about sleep. Help kids review happy moments from the day. Have them imagine a TV with a 'savoring channel.' Relegate anxious thoughts to 'a worry channel.'

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