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Your Baby

FDA Warns that “Sleep Positioners” Are Dangerous for Infants

2:00

The U.S. Food and Drug Administration (FDA) issued a warning to parents and caregivers of infants about the dangers of using sleep positioners. The products are also known as “nests” or “anti-roll” supports.

The two most common sleep positioners include two raised pillows or "bolsters" attached to a mat. Babies younger than 6 months old are placed on the mat between the pillows to keep them in a specific position while they are sleeping. 

But putting babies to sleep on or near soft objects, such as positioners, toys, pillows and loose bedding, increases the risk for accidental suffocation and Sudden Infant Death Syndrome (SIDS), the American Academy of Pediatrics (AAP) says. 

Some babies have been found in dangerous positions next to a positioner they had been placed in for sleeping. Federal officials also reported that infants have died after being placed in one of these products. In most cases, the infants got out of position, rolled onto their stomachs and suffocated, the FDA explained.

The FDA and infant heath experts say that babies should always be put to sleep on their backs on a firm, empty mattress, preferably in a crib.

Babies should never sleep with a positioner, pillow, blanket, sheets, a comforter or a quilt, the FDA advised. Appropriate clothing keeps babies warm enough while they are sleeping.

Some sleep positioner companies claim that their products prevent SIDS. But the FDA noted it has never cleared an infant sleep positioner that promises to prevent or reduce the risk of SIDS since there is no scientific evidence to back up this claim.

Some of the companies also promote their products as helpful for easing gastroesophageal reflux disease (GERD), a condition that causes stomach acids to back up into the esophagus. Others suggest their positioners help prevent flat head syndrome (plagiocephaly), a deformation caused by pressure on one part of the skull.

While it’s true that the FDA has previously approved some of these products for GERD and flat head syndrome, the government agency has asked these companies to stop marketing these items because it feels that the risks outweigh the benefits.

Every year about 4,000 infants die unexpectedly while sleeping due to suffocation, SIDS or another unknown cause, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The FDA urged parents and caregivers to talk to their child's doctor if they have questions about how to make sure their baby sleeps safely.

Story source: Mary Elizabeth Dallas,  https://consumer.healthday.com/kids-health-information-23/sudden-infant-death-syndrome-sids-news-643/sleep-positioners-a-danger-to-baby-fda-727180.html

 

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.

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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

 

Your Baby

Sing to Soothe Your Crying Baby

1:30

Have you ever reached the end of your patience trying to soothe a crying baby? Next time, switch to singing instead of talking. You may be surprised at the results.

Researchers at the University of Montreal in Canada, found that infants respond sooner and stop crying longer when listening to a song instead of speech.

The small study involved 30 healthy infants, aged between 6 and 9 months. The purpose of the research study was to investigate how the emotional self-control of the infants would be influenced when they are exposed to music or speech.   

The researchers maintained the objectivity of the study by not using any sounds that could have been recognized by the children.

For their study, researchers at the University of Montreal in Canada, played Turkish music and two types of speech -- ‘baby-talk' and regular adult-directed dialogue to the infants.

Researchers deliberately chose a language and music that would be unfamiliar to the babies.

Mothers were placed behind the children to avoid contact and the environment cleared of any other possible stimuli.

After playing both the music and regular speech to the children, researchers found that singing was twice as effective at calming distressed babies compared to exposure to regular dialogue: Babies remained calm for an average duration of nine minutes before breaking out in tears, while dialogue -- both the ‘baby-talk' and adult speech -- kept them calm for less than half that time.

The findings are significant, authors note, because Western mothers speak more to their babies, than sing.

"Our findings leave little doubt about the efficacy of singing nursery rhymes for maintaining infants' composure for extended periods," said study co-author Isabelle Peretz in a statement.

"These findings speak to the intrinsic importance of music, and of nursery rhymes in particular, which appeal to our desire for simplicity, and repetition."

Next time your baby is cranky, don’t be bashful; break out all the nursery rhymes you know and sing away. It may be the just the sound your baby wants to hear.

The study was published in 2015 in the journal Infancy.

Story source: http://www.ctvnews.ca/health/singing-more-effective-than-talking-to-soothe-babies-study-1.2631472

 

 

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 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.'

Daily Dose

Pre-Schoolers & Sleep

1.30 to read

Many parents of pre-schoolers report that their children have some sleep problems, whether it is delaying going to bed, having a hard time falling asleep, or awakening during the night with nightmares and bad dreams. All of these behaviors lead to sleeplessness for both child and parent. 

A recent study from the Seattle Children’s Research Institute published in Pediatrics looked at 565 children between the ages of 3-5 years.  The parents of these children were asked to replace “violent or age inappropriate media content with quality educational and pro-social content”. In other words, less super heroes and more Sesame Street and Dora. (I still long for the serenity of Mr. Rogers). The researchers then monitored these 565 children’s sleep patterns for 18 months. 

The study found that the children in the group advised about healthy media were 29% less likely to have sleep problems than the children in the control group. 

Once again there is data to support what one would intuitively assume, children who watch violent and age inappropriate TV and videos have more problems with sleep. I have known that since I watched ‘The Wizard of Oz’ as a child, I dreamed about those flying monkeys for at least the next 10 years. Still don’t like them!  That goes for ‘The Birds’ too, another scary movie for sure! 

With easy access to so many cable channels and constant internet options, parents need to be extra vigilant about what their pre-schoolers are exposed too. When parents were coached on making healthy media choices for their child in this randomized trial, there was a sustained reduction in sleep problems, so it lasted! 

I think a trip to the library and books at bedtime are also a great idea and better than watching TV or videos.  Curious George, Dr. Seuss, and Richard Scary books all seem to stand the test of time and will probably not keep your pre-schooler up at night. More sleep for Mom, Dad and child! 

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

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!

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DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

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