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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.

Daily Dose

New Sleep Guidelines for Your Baby

1:30 to read

I am sure that many of you heard about the latest recommendations on infant sleep that the American Academy of Pediatrics has released. The latest policy statement from the AAP recommends that all infants sleep in their parents room, but not in the parents bed,  for at least the first 6 months of life and preferably for the first year!!  This is big news and quite a change from the previous sleep recommendations which were published in 2011.

 

All of the latest recommendations regarding sleep are intended to help to reduce the incidence of SIDS (Sudden Infant Death Syndrome), which is the leading cause of death for children under the age of 1 year. SIDS in one of the greatest fears of all parents. While “the back to sleep” campaign has reduced the incidence of SIDS, there are still over 3,500 babies in the U.S. who die suddenly and unexpectedly every year while sleeping. (this includes some from suffocation and strangulation and not SIDS).

 

In addition, the recommendations re-iterate that the baby should not co-sleep with their parents, but should be in a crib or bassinet with a firm sleep surface, in the parents’ room. These new recommendations, may be driven by the reality that breast feeding mothers are exhausted and often fall asleep while nursing their baby. If the mother is sitting in a chair or on the couch and falls asleep the baby may be at risk of suffocation if they roll into a cushion or fall down between pillows. If the mother is in bed breast feeding and accidentally falls asleep at least the baby is on a firm surface - make sure when you do breast feed your baby in bed to remove all loose blankets and pillows in the area around your baby prior to feeding - just in case.

 

Although it has been a long ago, I always put our infants in their own cribs to sleep -  you might say I was obsessed. One night, shortly after the birth of our 3rd child I found myself on my hands and knees looking under the bed. When my husband was awakened and asked me “what are you doing?” I replied…”looking for the baby!” He then reminded me that I had put the baby in his crib in the nursery right after I had finished breastfeeding him.  I truly had no memory and thought he had fallen under our bed!! This, from someone who had previously stayed up for 36 hours during residency working in the hospital and thought I could handle sleep deprivation- clearly not true!! I just remember the feeling of being frantic! 

 

The AAP continues to recommend that the crib be essentially bare - in other words, no bumpers, no blankets, no stuffed toys, just the fitted crib sheet. The baby should always be placed on their back to sleep…once your baby learns to roll from back to front ( which typically happens after they have learned to roll tummy to back), they may be left to sleep on their tummy. Even with a baby in your room you cannot get up all night to keep trying to keep them from rolling over!  

 

The AAP does recommend using a pacifier for sleep times ( I am a huge pacifier fan as you know). The only problem with a pacifier is convincing The Parents that it is time to “get rid of the paci” once their baby is over a year old….. sometimes hard to sell that concept.

 

Lastly, the APP reiterated that they do not support the use of any of the devices sold to new parents to help “prevent”  SIDS. In other words, all of the technology being marketed including  “anti-SIDS mattresses, home cardiorespiratory monitors, and even fancy video monitors.  While many a well intentioned parent will invest a lot of unnecessary money and time trying to make the baby safe during sleep, the mantra “less is more” is now the best way to ensure safe sleep for your baby. I remind parents that there will be plenty of ways to spend that money  - start the college savings!

 

 

 

 

Your Toddler

Toddlers Lack of Sleep Tied to Behavior Problems

2:00

Sleep is vital to survival and while we may appear to be doing nothing, our brains are very active. Sleep deprivation can make us grumpy and unable to make good decisions or concentrate. Not only do adults need sufficient amounts of sleep- so do children.

 A new study looks at the affects not enough sleep can have on toddlers and found that those little ones that slept less than 10 hours a night or woke up frequently were more inclined to have emotional and behavioral problems at age five.

Researchers were surprised that the “risks were so strong and consistent” said lead author Borge Sivertsen of Uni Research Health and the Norwegian Institute of Public Health in Bergen.

“While only an experimental study can determine causality, our study does suggest that there is an increased risk of developing such problems, also after accounting for a range of other possible factors,” Sivertsen told Reuters Health by email.

The results were from a long-term study of 32,662 pairs of mothers and children in Norway. The mothers filled out questionnaires when they were 17 weeks pregnant, when the child was 18 months old and again when the child was five years old.

Mothers rated 99 child behaviors on a scale from “not true” to “very true” and reported how long the child slept in a 24-hour period and how often he or she woke up during the night.

At 18 months, almost 60 percent of toddlers were sleeping for 13 to 14 hours per night and about two percent were sleeping for less than ten hours per night. About 3 percent of toddlers woke three or more times per night. Most kids woke a few times per week or less.

Toddlers who slept less than 13 hours per night often had emotional or behavioral problems at the same age, the authors write in JAMA Pediatrics.

They also had a higher risk of internalizing problems such as being emotionally mercurial, anxious and depressed.

While the study doesn’t prove causation, it does lend a lot of credibility to there being a link between too little sleep in toddlers and later emotional and social problems.

“Although it is difficult to tease out causality from observational studies, this longitudinal study does suggest that inadequate sleep in early childhood increases the risks for later emotional and behavioral problems,” said Michelle M. Garrison of Seattle Children’s Research Institute in Washington, who wrote an editorial about the research.

Not all of these children will necessarily develop mental health problems later in life. Other factors also play important roles like the child’s temperament and his or her parent’s emotional health.

If your child seems to have difficulty sleeping well or getting to sleep, talk with your pediatrician about tips to help your little one get the rest he or she needs. 

Source: Kathryn Doyle, http://www.reuters.com/article/2015/04/13/us-toddlers-sleep-behavior-idUSKBN0N41U920150413

 

Your Child

Good Sleep Habits Help Kids Succeed in School

1:30

If you’ve ever been sleep deprived, you know how difficult it can be to focus and get through the demands of the day.

So it’s not surprising that a new study says that children, who have good sleeping habits by the age of five, do better when they start school.

However, what may surprise you is that according to the National Sleep Foundation, a 2004 poll revealed that 69 percent of children 10 and under experience some type of sleep problem such as insomnia, nightmares, restless legs syndrome, sleep terrors, sleepwalking and sleep apnea.

For this study, researchers reviewed the sleep behavior of nearly 2,900 children in Australia from birth until they were 6 or 7. They found that one-third had mounting sleep problems in their first five years that put them at added risk for attention disorders and emotional and behavioral problems in school.

"The overwhelming finding is it's vital to get children's sleep behaviors right by the time they turn five," researcher Kate Williams said in a Queensland University of Technology news release. Williams is on the faculty in its School of Early Childhood.

For many families, today’s social and home environment is a roller coaster ride; creating solid routines, winding down and focusing on good sleep habits has almost become a lost art.

Williams and her team found that children with increasing sleep problems in early childhood were apt to be more hyperactive and to have more emotional outbursts in the classroom.

"If these sleep issues aren't resolved by the time children are 5 years old, then they are at risk of poorer adjustment to school," she noted.

There are lots of online tips for helping children develop good sleeping habits. These are usually in every list:

·      No video games, TV or electronic gadgets for at least an hour before bed.

·      Set a bedtime and stick to it that allows for plenty of sleep.

·      Follow a routine – brush teeth, wash hands and face and settle in for sleep. Reading a book to your little one can help relax them.

·      Make sure their room is dark and cool when it’s time for light’s out.. If your child needs a night light, place it in the hallway or bathroom and leave the door ajar. Turn it off once they are asleep.

·      Avoid giving your child candy or food right before bedtime. Certain foods can be stimulating and creating the habit of eating before bed or during the night is a hard one to break.

·      Make sure your child is comfortable. Pajamas should not restrict movement. Blankets shouldn’t be so heavy as to cause them to be hot or too warm.

Story sources: Robert Preidt, http://consumer.healthday.com/kids-health-information-23/education-news-745/children-sleep-school-qut-release-batch-2570-708848.html

https://sleepfoundation.org/sleep-topics/children-and-sleep

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?

 

Your Baby

Should You Let Your Baby Cry Itself to Sleep?

1:30

As any parent of an infant will tell you- sleep is a precious thing. So, what’s the best way to get your baby to sleep through the night? There are many ways to help baby drop off to dreamland, but two of the most common had researchers wondering if there might be long-term harm resulting from these techniques.

Turns out, they was nothing to worry about.

The study tested two methods; graduated extinction and bedtime fading.

Graduated extinction is more commonly known as controlled-crying or letting baby cry his or herself to sleep while learning how to self-soothe without parental involvement

Bedtime fading is keeping baby awake longer to help them drop of more quickly.

Researchers discovered that both techniques work and neither had any long-term negative effects.

The graduated extinction approach also showed babies waking up fewer times during the night.

Parents worry about the controlled-crying method, in particular, according to study leader Michael Gradisar, a clinical psychologist at Flinders University, in Adelaide, Australia.

With that technique, parents resist the urge to immediately respond to their baby’s nighttime cries, so he or she can learn to self-soothe. Some parents worry that will damage their baby emotionally, and possibly cause "attachment" problems or other issues in the long run, Gradisar explained.

But, he said, his team found no evidence that was the case.

For the study, the researchers randomly assigned parents of 43 babies to one of three groups: one that started practicing controlled crying; one that took up bedtime fading; and a third, "control" group that was just given information on healthy sleep.

The babies ranged in age from 6 months to 16 months. All had a "sleep problem," according to their parents.

Parents in the controlled-crying group were given a basic plan: When their baby woke up crying during the night, they had to wait a couple of minutes before responding. They could then go comfort, but not pick up, the baby.

Over time, parents gradually let their baby cry for longer periods before responding.

Bedtime fading is a "gentler" approach, according to Gradisar: The aim is to help babies fall asleep more quickly by putting them down later.

Parents in that study group were told to delay their baby's bedtime for a few nights -- to 7:15 p.m. instead of 7 p.m., for instance. If the baby was still having trouble falling asleep, bedtime could be pushed back another 15 minutes.

After three months, the researchers found, babies in both sleep-training groups were falling asleep faster when their parents put them down -- between 10 and 13 minutes faster, on average. On the other hand, there was little change in the control group.

A year after the study's start, children in the three groups had similar rates of behavioral and emotional issues. They were also similar in their "attachment" to their parents -- which was gauged during standard tests at the research center.

Experts say that infants are usually able to sleep longer through the night, as they get a little older. By the age of 6 months, 80 percent of infants sleep all night. By 9 months, about 90 percent do.

If your baby doesn’t seem to be able to sleep through the night by those ages, contact your pediatrician to see if your little one may have a problem that needs checking out.

Story source: Amy Norton, http://www.webmd.com/parenting/baby/news/20160524/what-really-works-to-help-baby-sleep

 

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.      

Your Child

Melatonin May Help Kids with Eczema Sleep Better

2:00

Eczema is a common skin disease that affects as many as 30 percent of all kids.  It’s an itchy red rash that often causes continuous scratching. Numerous children with eczema have trouble sleeping through the night. A new study suggests that over-the-counter melatonin may help them sleep longer and better.

These sleep problems can be difficult to treat in these children, said Dr. Yung-Sen Chang, an attending physician in pediatrics at Taipei City Hospital Renai Branch in Taiwan. Antihistamines can stop working after a few days, and tranquilizers have potentially serious side effects, Chang said.

But giving children melatonin, his study found, "is safe and effective for helping children with atopic dermatitis fall asleep faster."

The link between the skin condition and insufficient sleep "has an impact on people with eczema at all ages," said Dr. Lawrence Eichenfield, chief of pediatric and adolescent dermatology at the University of California, San Diego and Rady Children's Hospital.

According to Eichenfield, it's generally established that it’s the itching that keeps people with eczema from getting enough sleep. However, Chang said that may not be the case.

Chang and colleagues discovered that patients with eczema, that had difficulty sleeping, had low levels of nocturnal melatonin. That intrigued Chang and inspired the new study.

"Melatonin is a natural human hormone with minimal adverse effects," Chang said, "so it seemed like a good choice for children."

The study was small and involved 48 children, about 22 months to 18 years old, who had eczema. The children received treatment with either an inactive placebo or a 3-milligram daily dose of melatonin at bedtime for four weeks. Thirty-eight participants then took the alternate treatment (melatonin or placebo) for another four weeks.

When the children took melatonin, the severity of eczema dipped slightly, possibly because melatonin's anti-inflammatory effect improved the skin condition, Chang said.

Also, kids taking melatonin fell asleep about 21 minutes sooner than kids taking the placebo, the findings showed.

Total nightly sleep rose by 10 minutes on average (from 380 to 390 minutes, or 6.5 hours total) in the melatonin group, while it fell by 20 minutes among those who took a placebo, according to the report.

The participants did not report any side effects. Melatonin supplements are inexpensive in the U.S.- typically under 9 cents a pill from one major supplier.

Eichenfield, who wasn't involved in the research, said the study appears to be well-designed. Melatonin hasn't been studied much as a sleep treatment for kids, he cautioned.

While Eichenfield said melatonin may turn out to be helpful, he said there are a broad set of other tools available to treat eczema and minimize its effect on children. He suggested tackling the skin condition first to try to mitigate the sleep issues.

Chang recommended that parents talk to their child's doctor before starting melatonin. As for adults, melatonin may help them, too. But more studies are needed, Chang said.

The study was published in a November online edition of the journal JAMA Pediatrics.

Source: Randy Dotinga, http://www.webmd.com/children/news/20151124/melatonin-might-help-sleepless-kids-with-eczema-study-finds

 

Daily Dose

Moving to the "Big Bed"

1.15 to read

I received an email and phone call as I was leaving work the other day from a “frantic” young mother whose son had crawled out of the crib and had injured his arm.  This was not a 12-15 month old toddler but a 2 ½ year old, who loved his crib, and therefore had not been moved to a “big boy bed”.

There are many reports of injuries from “toddlers” crawling out of their crib, although most of the time the child who falls out of their crib is not injured. But, there are reports of injuries such as fractures of the forearm, or the clavicle or even of the humerus from children who climb out of their cribs.

Of course toddlers and 2 year olds think they are invincible and that they can fly just like a super hero. Many children are more than content to stay in a crib and never venture out until parents just decide that it is ultimately time to get their child out of the crib. Sometimes it may be out of necessity, as a new baby is due. I am not a big believer of buying more than one crib unless you are having twins etc.  (My frugal side I guess).  Although it is nice to have your child “behind bars” in their cribs, many a child can easily be moved to a “big bed” and never dream of getting out of that bed either.

That was the case with one of my boys, when we moved him to the “big boy bed” we were convinced he was the type of child who would get up and come walking down the hall for a visit. Quite to the contrary, he would awaken in the morning and call out to us, “Mommy, I am up, come get me!”  I swear, it was as if he had a moat with sharks circling his bed, he just never realized that he could just put his cute little 2 year old feet on the floor and head out!!  He was inquisitive about everything else, so go figure. 

Children will always surprise you. I like to move a child out of their crib several months before a new baby is due so that the transition is easy and complete before the new sibling arrives.  That way the big brother or sister does not feel as if their new baby sibling has displaced them and they are proud of being the big kid in their own big bed.

The bedtime routine should not change as you move a child from crib to bed either. When I moved our sons to a big bed I just pushed the bed up against the wall and used one of the railings that fits under the mattress to keep them from rolling out. If your child does pitter pat down the hall after they have been put to bed, just walk them right back to bed, tuck them back in and re-iterate that they need to stay in their bed. That works for the majority of kids, but for those that persist in getting up, you may need to be a little more creative in ways to reward them for staying in bed.

Once you have moved the older child out of the crib (in anticipation of new sibling), I would close the door to the nursery, or move the crib out of sight (and mind) for several months before beginning preparations for the newest arrival. Now, the older child will be excited to help get ready for the baby, and at the same time they do not feel like they were moved right out of the crib and the new baby plops right down in “their crib”.  This helps make the entire transition to bringing home a new baby easier for everyone. The cute toddler who fell out of the bed, did succeed in breaking both bones in his wrist, but happily only required a splint.  The funniest thing is, he is back in his crib, with a crib tent on top!! I think he is ready for a big bed, but……..we will leave that up to his Mom. That's your daily dose for today.  We'll chat again tomorrow.

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