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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

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.  

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!

 

 

 

  

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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

Calming Parent's Fears About Night Terrors

1;30 to read

I received an e-mail from a viewer today about night terrors. Her concern was “my son is having what I think are nightmares, but he talks and makes no sense and seems to be afraid and I am not sure what is going on.”

Her description is perfect for night terrors, which typically occur in children during the pre-school and early elementary years. The peak age is between five and seven years, and night terrors usually resolve before adolescence. About three percent of children experience night terrors.

Night terrors are part of sleep disturbances known as parasomnias, and are characterized by partial arousal during non-REM sleep. Night terrors therefore typically occur during a child’s early hours of sleep, when non-REM sleep is deepest. Most children with night terrors will stay in their bed, but cry out and appear anxious and upset, but are also very confused. Some children may run down the hallway with heart racing and breathing fast as if they are being chased. Until you see a child having a night terror it is difficult to explain how anxiety provoking it is for a parent who doesn’t realize what is going on.

I speak from experience as our third child had classic night terrors, but the first time he appeared in a “semi” awake state screaming and sweating, I would have sworn he was in horrible pain. Not the case, as after about two to five minutes most children will calm down (on their own as you cannot awaken them or comfort them during the event) and return to sleep and have no recollection of the episode the following morning. It is a very helpless feeling until you realize that your child is really not awake at all.

The other big difference between night terrors and nightmares is that the child has no sense of dread or of being scared to sleep. They have no fear or anxiety about these events occurring, and while the sleep terror ends abruptly with rapid return to deep sleep there is complete amnesia to the event. The best treatment is in reassuring parents. It is also important to make sure that your child has a regular bedtime routine and that they are getting sufficient sleep. This sleep disturbance is really more disturbing to the family than the child and will resolve over time. Just remember to let babysitters know, as it may be quite unsettling for a new sitter who has just put precious children to bed!

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue right now!

Daily Dose

What Causes Circles Under a Baby's Eyes?

I received an email from a patient who had just weaned her your-baby from breast milk to formula. She was concerned because the your-baby sometimes looked as if she had circles under her eyes.I recently received an email from a patient who had just weaned her your-baby from breast milk to formula. She has a beautiful eight-month-old daughter and she was concerned because she thought the your-baby sometimes looked as if she had circles under her eyes. She felt like the your-baby was getting plenty of sleep, did not seem sick or tired but was concerned about the circles. She thought it might be allergies from changing from breast milk to formula. She was also concerned that she might have seasonal allergies.

In looking at her your-baby I really did not notice the circles, as you know mothers are the most critical about their own children. (Sorry Mom, I think my own Mother talks about my circles too!) At any rate, infants do not manifest symptoms of milk allergy with circles beneath their eyes. They have diarrhea, or vomiting or blood in their stools or failure to thrive. I do not think that the change in milk was the cause of the discoloration she described. Infants also do not develop seasonal airborne allergies until they are over the age of two or three and then they may present with the classic "allergic shiners" beneath their eyes, and the crease of the allergic salute across their nose, clear runny nose and often itchy eyes. I think this precious your-baby just had familial thin skin beneath her eyes with superficial veins that led to the appearance of circles. They were not always visible, and it would also depend on the position the your-baby slept in etc ...as to how much you might notice them. Will have to see if they bother her as she gets older, as there is always concealer and I use a lot of it when around my own Mom. That's your daily dose, we'll chat again tomorrow.

Daily Dose

New Sleep Recommendations

1:30 to read

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

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

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

Newborns (0- 3 months) 14 - 17 hours

Infants (4 -11 months) 12 - 15 hour

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

Preschoolers (3 - 5) 10 - 13 hours

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

Teens (14- 17)  8 - 10 hours

Young adults (18 - 25) 7 - 9 hours

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

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

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

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

Daily Dose

Start the Back-to-School Sleep Routine Now

2.00 to read

Getting back into the routine of school days also means getting back to good bedtime routines.How can it be that school is just around the corner? Getting back into the routine of school days also means getting back to good bedtime routines. With that being said, you have to start the process now to ensure plenty of time to slowly get bedtimes re-adjusted. By starting early you can avoid the battles that some parent’s talk about when discussing bedtimes.

Children need a good night’s sleep to wake up happy, rested and ready to learn. Numerous studies have shown that elementary age kids need about 10 hours of sleep a night while tweens and teens still need a good 8 – 9 hours of sleep. I wonder how many children really get the recommended amount of sleep? I think too few. Unfortunately, I know from my own experience that teens seem to operate on a different sleep schedule and rarely are in bed as early as they should be. Most of us have relaxed bedtime a little during the summer and children are staying up later and sleeping longer in the mornings. This is great during the lazy summer months, when schedules are also different. But within a few weeks the morning alarms will ring forcing everyone to get up earlier to get to school. In order to try and minimize grouchy and tired children (and parents too) during those first days of school, going to bed on time will be a necessity. Working on re-adjusting betimes now will also make the transition from summer schedule to school schedule a little easier. If your children have been staying up later than usual, try pushing the bedtime back by 15 minutes each night and gradually shifting the bedtime to the “normal” hour. At the same time, especially for older children, you will need to awaken them a little earlier each day to re-set their clocks for early morning awakening. Why is it that pre-school children want to get up early, no matter what, while school-aged children are happy to sleep through alarms?  Such is life. Also, make sure that you are not only ensuring that you children get a good night’s sleep during the school year, but they also awaken in time for breakfast! Just like my mother used to say, “breakfast is the most important meal of the day’” and that adage is still true. A good night’s sleep followed by a healthy breakfast has been shown to improve mood, attention, focus and over all school performance, as well as even helping to prevent obesity. Start off the school year on the right foot. It is easier to begin with good habits than to try and break bad ones. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Sleep & Your Baby

1:30 to read

Once a new baby joins a family one of the first questions I am often asked is, “when will my baby sleep thru the night?”.  SLEEP is one thing that all parents crave and for one reason or another many parents with infants over 6 months of age, complain that their baby is still not “sleeping through the night”. If your baby or child is not sleeping well, that typically means that parents are having disturbed sleep as well.   

By 6 months of age a baby should be able to self soothe and fall asleep on their own and the majority of babies are sleeping 10-12 hours thru the night as well.  After many years of practicing pediatrics and dealing with my own children’s sleep issues, I spend quite a bit of time with my patients discussing healthy sleep habits.  Like most things, it is easier to start off with good habits and bedtime routines.

So….when parents come in at the 6 month visit and are concerned about their baby’s sleep and awakenings I typically discuss “letting their baby cry it out”. This advice is met with varying responses.  Some parents are ready to get a good night’s sleep and will do “anything”, while others think I am “a mean doctor” and would “never let their baby cry”.  Like most things it is not always black and white and that is why we have chocolate and vanilla.  But, in my experience, the sooner you deal with sleep issues the faster they seem to resolve…

A recent article in Pediatrics should now reassure parents that they are not “harming their baby” by letting them “cry it out” which is called graduated extinction.  The study done in Australia found that infants whose parents let them “cry it out” fell asleep 13 minutes sooner than a control group and woke up less often during the night, and had no significant differences in stress levels (based upon salivary cortisol levels). The study also found no long term effects on parent-child attachment.  All good news for some sleepless parents who are considering this method to get their baby to sleep through the night. 

The researchers also looked at another behavioral sleep training intervention called “bedtime fading” which some feel is a “gentler” method of sleep training. In this case a baby’s bedtime is delayed with the thought that a sleepier child will fall asleep faster and may not cry as long.  This may be an easier method for some parents who continue to be anxious about “graduated extinction”.  This too showed that infants fell asleep sooner than controls but they showed no change in the number of nighttime awakenings.

Bottom line, sleep is important for the entire family ….all ages.  This article should hopefully go a long way in reassuring sleep deprived parents that a baby’s cries are not harmful and may actually get everyone to sleep faster, longer and more peacefully….you just have to believe the research and hang in there. 

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