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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

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

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 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

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

Good Sleep Habits For All Children

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

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

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Daily Dose

Getting Your Baby to Sleep!

1:30 to read

Did you know one of the biggest Google internet searches for parents revolves around “how do I get my baby to sleep?”  I guess that any new parent in the middle of the night is online searching for “THE ANSWER”, so of course you “Google it”!

Now that we are grandparents and the baby is about 6 weeks old (although technically she is a week old, as she was 5 weeks early) my son is also looking for answers on the internet to that same question....how to make her sleep, so I can too! He even asked me if their was “magic” to this?

If only there was an answer on Google or in any book. It just takes time and every baby is different.   I guess there are some babies that sleep through the night from the time they get home from the hospital, but I have never seen one.  I think some parents just forget that at some time or another they were up at night with a newborn.

A newborn baby does not understand circadian rhythm and they are really not “trying” to keep parents up at night.  It takes weeks for a newborn to even begin to have some “routine” to their day and I try never to use the word “schedule” when discussing a newborn.  A baby is not a robot, they do not eat every 3 hours and then sleep for 3 more before eating again. They are “little people” and their tummies sometimes need to eat in 2 hours and then later it may be 3 hours before another feeding.  Don’t you sometimes eat an early lunch one day and a later lunch the next? 

But by trying to awaken the baby throughout the day and offering a feeding every 2-3 hours you will hopefully notice after several weeks that your baby is eating more often during the day and suddenly may thrill you and sleep 4 hours at night. it just takes time....YOU cannot make it happen.  I tease new parents that awakening a newborn during the day and prayer is about all you can do....all babies do eventually sleep, but it may not be right after you get them home from the hospital...think several months (as in 2-4) and you will be happy if it happens sooner.

Lastly, with all of the tech in the room, don’t pick up your baby in the middle of the night if they are just “squirming” around. Babies are notoriously loud sleepers and if they are not crying let them be and you may be surprised that they arouse and went back to sleep. If your baby cries you absolutely go get them and console them and feed them too if it is time. An infant should not be left to cry. 

This too shall pass and sleep will come, but there will be new stages down the road that will keep parents up at night, of that you can be assured. Comes with the territory.

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 for 2017, 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

How to Deal with Different Bed Times for Children

One of the questions I get from parents on an almost daily basis deals with sleep. So I thought I would spend the rest of the week answering some top sleep questions. Question #1: How do you get 2 younger kids to bed on good schedule when you have 2 older sibs too?

Having a bedtime schedule for both the younger and older kids helps. I would enjoy family dinnertime, and some activities together after dinner. Then separate the younger kids from the older ones. You might have older kids doing homework or independent reading (really dependents how much older they are) in a different area of the house while you take younger kids off for bathes and bedtime stories. Even if their bedtimes are only an hour apart, this will give you time alone with both sets of kids and age appropriate activities with each. Once the younger kids have had stories, prayers and are tucked in for the night you can now spend time with the older ones. I often found this a good time to do any review of spelling or homework they wanted me to look over etc and plan for the next day with them. Then we would enjoy “older version” of bedtime stories when they would read to me. Very relaxing, (must admit I sometimes found myself lulling to sleep while they read), and then I would read to them. It was a way to keep us both involved in reading aloud and I enjoyed most of Harry Potter books this way. They too liked saying prayers together, a hug and kiss and then to bed. Try to limit computer or TV for older kids prior to bed, as this seems to disrupt sleep. With that schedule I felt like both sets of kids had parent time, and you can also alternate Mom and Dad doing this routine depending on parent schedules etc. Divide and conquer seemed to work well in our home. That’s your daily dose on sleep for today; we’ll talk about it some more tomorrow.

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DR SUE'S DAILY DOSE

New study reveals how much sleep kids really need.

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