Twitter Facebook RSS Feed Print
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

Why Is Your Baby Not Sleeping?

1.15 to read

I recently received an email from a mother who was beginning to have new sleep problems with her 6 month old. Whenever I get questions about a 6-9 month old and new sleep issues, most parents relate the problem to either teething and or not getting enough cereal/solids before bed time. 

In fact, new sleep issues often arise around this age as your baby is beginning to think and use those frontal lobes. Many babies had been sleeping for 6-10 hours a night by now and then suddenly begin to awake and they are crying.  This must be pain from teething, right?  So in response to that, many parents start giving their baby a pain reliever, such as acetaminophen nightly, but the sleep problems do not go away and still no teeth! 

At the same time, most babies are eating solid foods beginning around 6 months, and parents were convinced that starting solids would also cure the sleeping issues.  The baby is eating cereal and  waking up in the middle of the night. What gives? 

I think the most important milestone for this age baby to ensure good sleep:  the baby must put themselves to sleep. Many of the babies who are having awakenings are being rocked to sleep, or having the pacifier put back in their mouth all night long.  They are routinely rocked every night and then put down, so when they have arousals (as we all do all night long) they want to be rocked back to sleep, they are smart now and know what they want!   Similar to wanting a back rub every time you wake up, sounds good right? 

While all of this is going on in your baby’s mind your parent mind is telling you it has to be teething pain or lack of food or something worse, and not just a new phase of baby sleep!  Suddenly habits are started, the baby is getting fed in the middle of the night again, or you are giving acetaminophen every night, and typically the arousals continue.  

Sleep is precious for both baby and parent and a baby between 6-8 months of age should be able to not only put themselves to sleep at bedtime, but self console to go back to sleep in the middle of the night. Makes sense but takes a bit of work. This usually requires letting your baby cry for awhile. I am not a propionate of letting an infant cry it out or (CIO as this cute mom emailed), but I do see the need in this age baby. They have to learn to self-console and it is easier to break a bad habit sooner than later. Some babies have more stamina too, so each baby is going to be different in how long they can CIO. 

Practice putting the baby down awake and going back into the room to let them know you are present but not active in getting them to sleep.  Lengthen the time between each visit to their room. Repetition and consistency are the key.  It takes a while but most babies will then get back into even better and longer sleep at night, and you can stop all of that acetaminophen. They get teeth forever (well, at least for 12 years) and that is usually not the reason for waking up. Ask them when they are 5 and getting molars and sleeping well! 

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Breathing & Your Baby

1:30 to read

The first few weeks of a newborn’s life is usually a bit “cra-cra”, for both parents and the baby.  Once you leave the hospital with your newborn reality sets in pretty quickly, and you realize that your baby not only doesn’t sleep when you want them to but that at times they may seem to be noisy breathers when they are awake and/or asleep.  

 

As parents (and pediatricians) we play close attention to a baby’s breathing pattern and you may realize that they do some “weird” stuff.  For the first several months of life a newborn is an obligate nose breather.  Some of the noisiest breathing you may notice is when your baby is sucking and eating whether at the breast or from a bottle.  It is not always the quiet time you thought it would be. But, while they may be noisy, you need to look at their color and make sure that they are nice and pink.  Look at their lips and tongue if you are worried and both should be pink…never dusky or blue. 

 

Being a noisy breather does not necessarily mean there are problems. But, if a newborn has mucous in their nose or has refluxed some milk into the back of their throat you may hear some “congested” sounds which often cause parental concern. Again, look at the baby, open up their swaddle and lift up their gown and see what their chest looks like as they breathe.  A baby should look comfortable (even if noisy) and their ribs should not show as they breathe (which is called retracting), nor should you see their tummy (which may be full and protuberan) appear to be moving up and down with any effort.  Again, they should be  pink and well oxygenated.  Try to filter out the noise and watch the breathing!

 

Lastly, newborns have some “strange” immature breathing patterns as well. If you are watching closely you may see that they often seem to breathing normally and then pause before taking another breath. This is termed “periodic breathing of the newborn” and is perfectly normal…albeit a bit frightening. Your baby may pause for 5- 0 seconds before taking a breath which is then followed by several rapid shallow breathes. Sometimes this even occurs a few times in a row and then suddenly the normal breathing pattern returns. Again, your baby should not appear to have any change in color and their breathing pattern returns to “normal” without you doing anything at all. If you think that the pauses (apnea) are lasting longer than 10 seconds you need to call your pediatrician. With the advent of cell phone video I get many video clips of babies with periodic breathing.  The frequency of periodic breathing decreases as your baby gets older…and is usually gone by 2-3 months of age.

 

You will quickly get used to some “baby nuances” you never dreamed of and realize that even a tiny baby can be a noisy eater and sleeper!! 

 

 

 

Tags: 
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.

Tags: 
Daily Dose

Sleep

1:30 to read

Bedtime routines are very important!  Many kids are getting up earlier and earlier for some sort of practice (often before the sun comes up) so 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.

 

Try this new 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”.    

 

 

Your Teen

Is Technology Sabotaging Teen's Sleep?

2:30

For the first time in history, we have adolescents that have never known an age without cell phones, tablets and computers. These marvels of technology have been a part of their lives from birth and they spend an extraordinary amount of time engaged with them. 

All their texting, posting and web surfing is robbing teens of the much needed sleep they need to think and function clearly, according to a new study.

Experts say teenagers need at least nine hours of sleep a night to be engaged and productive during the day. Anything less can cause daytime sleepiness and interfere with school or daily activities.

How much sleep is today’s teen actually getting? Researchers analyzed a pair of long-term, national surveys of more than 360,000 eighth- through 12th-graders to find out.

One survey asked 8th-10th- and 12th-graders how often they got at least seven hours of sleep. The other asked high school students how long they slept on a typical school night.

In 2015, 4 out of 10 teens slept less than seven hours a night. That's up 58 percent since 1991 and 17 percent more than in 2009 when smartphone use started becoming more mainstream, the researchers said.

"Teens' sleep began to shorten just as the majority started using smartphones. It's a very suspicious pattern," said study leader Jean Twenge, a psychology professor at San Diego State University.

The more time students reported spending online, the less sleep they got, according to the recent study published in the journal Sleep Medicine.

Teens that were online more than five hours a day were 50 percent more likely to be sleep-deprived than classmates who limited their time online to about an hour.

Studies have shown that the light emitted by smartphones and tablets can interrupt the body’s natural sleep –wake cycle.  The bright light can make the brain think that it’s daylight and time to stop producing melatonin, a hormone that cues to the body to sleep. By disrupting melatonin production, smartphone light can disrupt your sleep cycle, almost like an artificially induced jet lag. That makes it harder to fall and stay asleep.

If smartphones, tablets and computers are one of the causes for teens’ sleep deprivation, experts agree that moderate use can help change that. Everyone -- young and old alike -- should limit use to two hours each day, the researchers advised in a San Diego State University news release.

It’s not only the light from smartphones that can disrupt your ability to fall asleep, but the content you’re reading. Social media has a way of pulling teens into a discourse or “following” marathon that can eat up those precious hours of rest.

The best solution for electronic sleep deprivation is to make sure your teen puts his or her phone away and shuts down the tablet or computer at least an hour before bedtime.

Story sources: Mary Elizabeth Dallas, https://teens.webmd.com/news/20171020/smartphones-screens-sabotaging-teens-sleep

Kevin Loria, Skye Gould, http://www.businessinsider.com/how-smartphone-light-affects-your-brain-and-body-2017-7

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.

Your Teen

Teens Getting Less and Less Sleep

2:00

Today’s American teens are getting a whole lot less sleep than they did in the 90s according to a new study. Too little sleep makes focusing difficult and depletes one’s energy. As a result, school performance often suffers and unhealthy and/or unwise decisions are much easier to make.

Just 63 percent of 15-year-olds reported getting seven or more hours of sleep a night in 2012. That number is down from 72 percent in 1991, according to the study.

Between the ages of 13 and 18, teens getting 7 hours or more of sleep a night plummets. At 13, roughly two-thirds of teens get at least seven hours of sleep a night; by 18 that percentage drops to about one-third.

"After age 16, the majority are not meeting the recommended guidelines," said study author Katherine Keyes, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health in New York City.

Why is it so important that teens get enough sleep? A lack of sleep can impact just about every part of their life. Hormones are escalating, social interactions are fragile, school demands are heightened, self-image is developing and many begin testing boundaries with parents, teachers and each other. It can be a rugged time for teens and those around them.

For the study, researchers from Columbia University looked at sleep data from a national survey of more than 270,000 teens from 1991 to 2012. Each year, teens reported how often they got seven or more hours of sleep, as well as how often they got less sleep than they need.

The most recent recommendation from the National Sleep Foundation says teens aged 14 to 17 need eight to 10 hours a night and people aged 18 to 25 need seven to nine hours.

The largest declines in those getting enough sleep occurred between 1991 through 2000; then the problem plateaued, Keyes said.

Researchers also found that girls were less likely to get an adequate amount of sleep compared to boys.

So what’s causing the decline? There a several theories about what may be contributing to this downward slide in teen sleep.

Keyes did not have access to information about the teens' use of electronic media, a factor often blamed for lack of sleep as teens text, check social media, play video games and work on laptops late into the night. However, that might be a factor, she said.

"On an individual level, excessive use of technology may impair an adolescent's ability to sleep," Keyes said.

Caffeine may also be a culprit. It’s estimated that about 30 percent of adolescents report consuming energy drinks which are packed with caffeine. Many teens drink specialty coffees as well.

Another issue may be early school start times. Some sleep disorder experts believe that starting school – even an hour later- could help teens get more valuable sleep. Starting school, for instance at 8:30 a.m., is an approach favored by the American Academy of Pediatrics.

Other studies have noted that a lack of sleep is linked with many other teen health problems including obesity, car accidents, depression and a drop in school performance.

When kids are younger, parents are more likely to set limits on bedtime behavior as well as bedtimes. Once kids reach their teens, some of those limits may get a little lax, but this is the time when they are needed most.

Parents still have the authority to set a bedtime and require that computers, tablets and phones are off at least an hour before bedtime. Many kids (and adults) are addicted to their smartphones, so it’s a tough rule to set; it takes a strong commitment and a good example for it to work.

Lack of sleep is hard on everyone, but teens really need the extra help to stay healthy and function well in school. It has such a big impact not only on their present but for their future as well.

Source: Kathleen Doheny, http://www.webmd.com/children/news/20150216/us-teens-getting-less-sleep-than-ever

Daily Dose

Nap Time!

1:30 to read

I am a huge believer in the necessity for naps for babies, toddlers and children until they start kindergarten. Not only do children benefit from napping, so do their parents and caregivers who also need a “break” and some time to get ready for the end of the day.

 

During check ups I routinely ask parents if their children are still napping?  While some children may not fall asleep, everyone can spend some “quiet time” in their own room or bed.  Most children will nap well until the age of 3-4 years. After that some children just don’t need as much sleep and “want to give up their afternoon nap”.  Those words do not typically make a parent happy….as they realize that their child typically is cranky and whiny before dinner, bath and bedtime….not a fun way to end the day.

 

So…I had to laugh the other day when I asked a 3 year old if he was going home after his check up for lunch and a nap?  He looked right at me and said, “I don’t take naps, I am a big boy”.  I paused a minute and about that time his mother said quite calmly with that knowing look in her eyes, “of course he doesn’t nap….he just takes a rest”.  Clever right?

 

While you can’t make a child fall asleep, you can set the routine that your child spends some quiet time for an hour or so in their bed reading, playing, singing or just talking to themselves and their favorite stuffed animal. I have often found that while a 2-3 year old may stop falling asleep during nap time for a few months they may suddenly start napping again…it just happens. But, you have to continue the nap time routine…with or without the sleeping.  No choices on whether or not they “rest”…just part of the days routine.

 

Even children in day care, preschool and most kindergartens have afternoon quiet time on their mats.  At the beginning of the school year many kindergarten children will fall asleep during the afternoon story time, until they become accustomed to the long school day. It is funny to hear 5 year olds discuss who fell asleep during quiet time….never realizing that they too had “snoozed” for a bit. A lovely thing to re-set your brain for the rest of the day!

 

 

 

  

Tags: 

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

When should you keep your child home from school?

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.