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Daily Dose

Back to Sleep Ads

1:30 to read

I am concerned that I have been seeing on line ads promoting “new” baby products in which an infant is shown sleeping on their tummy. In other words….not following AAP guidelines that all infants are placed on their back to fall asleep.  Their should be a “law” that you cannot shoot a picture for any product being advertised for an infant in which the baby is shown sleeping in the prone position. Seeing this photo may only confuse parents about correct sleep position for their baby, especially when many of the advertisements are for sleep related products. 

 

The “back to sleep” campaign which started in 1994 has served to reduce the incidence of SIDS by over 50%. I have been fortunate in that I have not had a patient of mine die from SIDS since the recommendations for sleep position were changed. Unfortunately, when looking at data, 30% of SIDS cases report that the baby was found in the prone (tummy) position.  

 

So, if a sleep deprived new parent is surfing the net for products related to infant sleep, and then sees a baby on their tummy, they may think “maybe that is the trick “ to get my baby to sleep, never realizing the huge risk they are taking. Many a parent has come in to my office and said “ I think my baby sleeps better on their tummy”, which immediately puts a look of horror on my face!! “WHAT…I thought we had discussed that your baby must sleep on their back until they are rolling over on their own.” Some of the parents do reply, “my ……told me it was okay.” In this case do not listen to anyone about tummy sleeping!!! Discuss car seats, high chairs, pacifier options or whatever else instead….and choose which works for you. Sleep position is non negotiable. 

 

With that being said, I realize that between 4 - 7 months many babies will roll over during sleep even when placed on their backs. It is a developmental milestone for babies to roll and you cannot put a brick on them. I would “guesstimate” that about 25% of the babies I see will ultimately prefer to sleep on their tummies, but they are all out of their swaddle and then roll over after being put down on their back. I also get many videos showing me a baby in their crib who is in the act of rolling over, with a nervous parent running in turning them back over, only to have the child roll right back to their tummy. You could spend the entire night “flipping the baby” over!

 

Remember, back sleeping only, in a crib with just baby and no bumpers or toys….you will have plenty of time for other stuff in the crib when they are bigger.

Daily Dose

Good Sleep Habits For All Children

While we have been discussing infants sleep habits, a good night's sleep is equally important for children of all ages. It is important to focus on the sleeping half of children's lives, and the sleep habits of children have a direct impact on the adults who care for them. By starting off with good sleep habits in babies and teaching them how to sleep you will hopefully be blessed with a good sleeper, but many children will continue to have intermittent sleep issues.

Bedtime should be a pleasant part to the end of a busy day. As it gets dark your body secretes melatonin to signal the end of the day and the rest phase of our circadian rhythms. If you get overtired, your body secretes the hormone cortisol, to give you an energy burst, which may further contribute to bedtime problems. In other words, get your child to bed while still in the sleepy phase! Have a set bedtime and bedtime routine for children of all ages. Even teens require nine to 10 hours of sleep, so they should have a bedtime too. A good night's rest also contributes to your child's overall physical and emotional health. They will perform better in school, have less mood disturbances, and even experience less minor aches and pains like headaches and stomachaches. Wind down your evening with music, reading or a relaxing bath. Begin to dim the lights while getting your child to bed, as bright lights will signal the brain to stay alert so this will include turning off the TV and computer. Once every one gets into a good routine, maintain the habit. Good sleep habits are good for the entire family. That's your daily dose, we'll chat again soon.

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Daily Dose

Sleep

1:30 to read

Back to school bedtime routines are very important!  Now that kids are having to get up, (often before the sun comes up) going to bed on time makes everyone in the house wake up in a better frame of mind and mood for the day ahead.   

 

Bed time battles are typical for a toddler who has learned to ask for “one more book”, or for the elementary school child who swears “they are not tired” but who falls asleep during bath time.  But who knew there would be even more battles with teens and their electronics??

 

Numerous studies have shown that electronics disrupt sleep.  But, trying to convince your adolescent son or daughter that they need more sleep is a daily struggle. While the studies on sleep recommend that teens get between 8 to 9 hours of sleep, most teens are not even close to that!  (90% report less than 9 hours).

 

During the summer teens keep all sorts of crazy hours and many get the majority of their sleep during what we would consider to be “daytime” hours…as they go to bed at 2 or 3 am and sleep past noon.  So, the minute that school resumes after summer vacation they already have sleep issues trying to “re-adjust” their biological clocks…and then you throw in the use of electronics right before bed and you have the perfect storm for sleep deprivation and daytime fatigue.

 

The American Academy of Sleep Medicine found that “adequate sleep duration on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life and mental and physical health”.  There isn’t a parent around who doesn’t want happy, rested, studious and healthy kids…of all ages. If you throw in less moodiness for teens who get more sleep most parents would sign their teens up on the spot.

 

Why do we all need to disconnect from electronics in order to have better sleep?  That blue light from the electronic screen…of any shape for or fashion works against sleep. It signals the brain to suppress melatonin secretion, which is the hormone that makes us get sleepy at the end of the day. The light from the screen also confuses the brain of it being daytime and increases alertness which may delay sleep…even after turning off the screen.

 

Start the school year with the family rule, parents included, that all screens (phones, tablets, computers) will be off and docked outside of the bedroom at least 30-60 minutes prior to bedtime. While your teen may insist that they won’t use the phone, it is often too tempting to not “cheat” once you are in your own room and asleep. 

 

While this may initially be hard to enforce, once it is the family routine it becomes less of a battle. Everyone will have an easier time falling asleep and staying asleep, and maybe get a few more hours of “shut eye”.    

 

 

Daily Dose

Pregnancy & Sleep

1:15 to read

Why is it that as you get further into your pregnancy you sleep less?  I am sure that it is just a factor of being “bigger” and as one mother said to me, “having another human inhabit your body”. It is often hard to find a comfortable position to sleep in, and even if you do, the baby may not want to stop moving when it is your bedtime.

But, I also really think this is all in God’s plan to get a mother (and father who often says his wife keeps him up) ready to be new parents. It is just foreshadowing of the weeks to come when you bring that newborn home from the hospital.  You have already learned to “survive” with less sleep.

The first few weeks at home with that most precious baby is really just about survival. I don’t care what you read or how many classes you take...there really are no “rules” or “tricks” to get thru the first 6-8 weeks of being a new (or seasoned) parent.  

I tell my parents the only “rule” is that the baby MUST sleep on their BACK..other than that try to do the feed, play, sleep routine that you think will just happen, but know at times your baby just does not want to go to sleep when you want them to!! They are not abnormal and you are not a “bad” parent.....they are just newborns with developing brains and sleep cycles. I promise, this too shall pass and longer sleep cycles will come.

So, if you are awake one night toward the end of your pregnancy and reading this, look at the bright side.  Your body is just getting you even more prepared to be a “great” parent....you already know how to survive with interrupted and less sleep.      

Daily Dose

Bedtime!

1:30 to read

Bedtime….an important word for parents and for children. A recent 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.  

Your Baby

Babies Sleeping in Their Own Room, Sleep Longer

2:00

Many parents choose to have their newborn sleep in the same room as they do, so a common question is what is the right age to move baby into his or her own room? The answer may depend on who you ask. 

The American Academy of Pediatrics (APP) recommends that babies share their parents’ room – but not their bed- for at least 6 months and preferably, until their first birthday. The guidelines are meant to lower the risk of sudden infant death syndrome, or SIDS, which may occur while an infant is sleeping.

But if you are ready for your little one to sleep for longer periods of time, then a new study suggests moving your baby into his or her own room by 4 months of age.

For the study, Dr. Ian Paul, the chief of academic general pediatrics at Penn State College of Medicine. analyzed surveys from 230 first-time mothers. He found that babies slept for longer stretches if they didn't sleep in the same bedroom as their parents.

At 4 months, babies who slept alone had the longest stretches of uninterrupted sleep -- by about 45 minutes, on average -- though they slept about the same amount of time as babies who slept in their parents' rooms.

At 9 months, babies in their own rooms slept 40 minutes longer at night and over 20 minutes longer overall, compared with those who were still sharing a room with their parents. Those differences disappeared at 12 months but reappeared later. When the researchers followed up at 2½ years, toddlers who began sleeping alone by 9 months slept 45 minutes longer per night, though total sleep time was roughly the same.

As most parents can attest to, when a baby doesn’t sleep well it has an impact on the parents’ stress level and mental health. Paul notes that he believes the AAP recommendation is excessive and that most parents are ready for a room to themselves before 6 months to a year. "Most parents don't want their baby sleeping in their room until 1 year," Paul said. "I've got three of them myself."

Some experts also agree that moving an infant out of the parents' bedroom sooner could help babies sleep better before they develop separation anxiety, said Paul.

The difference in recommendations has led to tension between the two groups.

"This is important information," said Dr. Rachel Moon, a professor of pediatrics at the University of Virginia who co-authored the AAPs’ latest recommendation. "We don't have enough info about downstream effects about what we've recommended."

Moon, a SIDS researcher, cautioned in response to Paul's study that just because sleep is uninterrupted doesn't mean it's better. 

"We think that a lot of the problems with SIDS is that babies don't arouse," she said, adding that if babies sleep too deeply or for too long, some experts believe this could put them at risk.

Room sharing has been estimated to lower the risk of SIDS by as much as to 50%, according to the report Moon co-authored.

The researchers also found other differences between babies that slept in their own room and those that shared a room with their parents: Infants who slept in a room alone were also more likely to have a consistent bedtime routine, and they were more likely to go to bed by 8 p.m. Babies that shared a room were more likely to have something in their bed that shouldn’t be there, such as a blanket, pillow or stuffed animal, and were more likely to be brought into their parents’ bed sometime in the night. Both of which have been linked to sudden infant death, including by suffocation.

Instead of changing the guidelines, Moon said, doctors can use the new study to give better guidance to room-sharing parents who may be more likely to bring their baby into bed overnight, putting them at risk.

"If we know that this is happening, then we can do a better job of providing proactive guidance for families," she said.

If you’re still confused about when to move your little one into his or her room, talk with your pediatrician, for guidance, about any concerns or questions you have.

Story sources: Michael Nedelman, CNN http://www.cnn.com/2017/06/05/health/babies-room-sharing-study/index.html

 

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

Daily Dose

Prevent 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 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! 

 

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