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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” already know how to survive with interrupted and less sleep.      

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. 

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

Teens Not Getting Enough Sleep

1.30 to read

If you're the parent of a teen, this does not surprise you at all:  teens do not get enough sleep!    

An online study released by the Center for Disease Control and Prevention says, “70 percent of high school students are not getting the recommended hours of sleep on school nights”.  I could have done that study in my office on any given day of the week! 

Having raised 3 teenagers as well as thousands of teens in my practice, I know this to be true, first hand. The problem is this age group is least likely to believe or convince that lack of sleep causes a plethora of physical as well as psychological problems. 

According to the CDC study, which was just published online in Preventive Medicine, insufficient sleep is associated with numerous “risky” behaviors including drinking alcohol, smoking cigarettes, fighting, lack of physical activity and being sexually active.  The data on sleep was accumulated from the 2007 National Youth Risk Behavior Survey where students were asked, “on an average school night, how many hours of sleep do you get?” Insufficient sleep was defined as less than 8 hours, while sufficient sleep was 8 or more hours per night. On an average school night, almost 70% of responders reported insufficient sleep.  

In my practice I ask every child/adolescent about their sleep habits and routinely find teens are averaging between 5–7 hours of sleep per night. They also come in everyday with a chief complaint of FATIGUE! 

I used to tell my own sons throughout their high school years that they needed to be in bed at 10:30p.m.  They could not understand why I was up “prowling around their rooms” in the dark of night demanding, that they go to bed. “No one else has a bedtime in high school” was the common complaint.  

But I also told them that I made my living out of telling teens (and their parents) that the reason their child “felt badly” was not mono, or a dreaded disease, but lack of sleep.  

Those teens who did not have adequate sleep also drank more soft drinks (did not include diet), used computers for 3 or more hours every day, admitted to current alcohol, cigarette and marijuana use, were sexually active, and also expressed more feelings of being sad or hopeless or even of having suicidal thoughts. 

If we could improve these statistics and reduce so many teenage “health risk behaviors” by just having parents enforce bedtimes, it sure seems like an easy sell. 

Set a time, turn off the electronics and “put your teen to bed”. I know they have homework and tests and papers to write, but they also must be healthy, and rested to make good choices in both school and outside the home. 

Oh, the study also found that watching 3 or more hours of television each day was not related to insufficient sleep. You might leave that part out!  

Teens Are Not Getting Enough Sleep


These days, teenagers are running on empty. A new report from the U.S. Centers for Disease Control and Prevention (CDC,) says nearly 58 percent of middle school students in nine states and almost 73 percent of high school students across the country don’t get the recommended amount of nightly sleep they need.

A lack of quality sleep could also have a negative effect on their health as well as school performance, the report states.

"Children and adolescents who don't get enough sleep are at increased risk for obesity, diabetes, injuries, poor mental health, and attention and behavior problems, which can affect them academically," said report author Anne Wheaton, a CDC epidemiologist.

How much sleep should adolescents get at night? According to the American Academy of Sleep Medicine, children aged 6 to 12 need nine to 10 hours of sleep a night, while teenagers aged 13 to 18 should get at least eight hours per night, Wheaton said.

A big part of the problem is that teens stay up late using smartphones and computers, playing video games or watching TV, said Dr. Thomas Kilkenny. He is director of sleep medicine at Staten Island University Hospital in New York City.

Wheaton is also a proponent of schools starting later to help teens get the sleep they need.

In addition, parents can help their children practice good sleep habits. "These are things like having consistent bedtime and rise time, and that includes not just during the week, but on the weekends," Wheaton said. "That's good for everybody -- the adults, too."

Studies have shown that teens that have a set bedtime get more sleep than those that don’t. A media curfew is also recommended by Wheaton to cut down on the amount of light kids are exposed to before bed.

"Adolescents who are exposed to more light in the evenings are less likely to get enough sleep, and using media can contribute to having later bedtimes," she explained.

If your teen thinks that he or she can make up their lack of sleep on the weekend, Wheaton says that ‘s not what typically happens. If they sleep in and then go to bed late on Sunday night, they wind up sleep-deprived on Monday morning when they have to get up early, and the cycle starts again, she said.

According to the National Sleep Foundation, teens that get too little sleep can be become limited in their ability to learn, listen, concentrate and solve problems. It can also make them more prone to acne and other skin problems. When explaining how critical sleep is, you can let them know that they may start forgetting important information like names, numbers, homework or a date with a special person in their life – and that, could get them in real trouble!

Story sources: Steven Reinberg,



Daily Dose

Head Flattening

2.00 to read

I have received a number of messages via twitter and facebook about sleep positioning. Several of the responses related to back sleeping and the relationship to head flattening.

While there has been an increased incidence of plagiocephaly (flattening of the skull in either the front or rear of the head) since the recommendation that infants sleep on their backs, the reduction in SIDS has impressive. Several readers stated that their children had slept on their tummies and “they were fine”.

My own children were tummy sleepers (as that was the recommendation prior to 1992), but I personally knew 3 friends whose children succumbed from SIDS. That does not include the babies within our practice whose deaths were also attributed to SIDS, and there were several every year.

Since 1992 we have had 2 babies within our practice that died from presumed SIDS, one of whom was sleeping on their tummy.  I know that this is anecdotal data but nevertheless, a wonderful and impressive difference. While an article in the August issue of Archives of Pediatric and Adolescent Medicine confirms that there has been more than a nine fold increase in the incidence of plagiocephaly between 1999-2007, this finding should “in no way dissuade parents from protecting their babies from SIDS by placing them to sleep on their backs”. But there are ways to try and prevent head flattening while still adhering to “back to sleep”.

Tummy time can begin right from the start and an infant may be placed on their tummy off and on throughout the day (unless they fall asleep, when they MUST be turned over). Patients always ask, “how long” but it differs depending on the mood of the baby. Some babies love tummy time while others resist it.  But, just like many parenting issues, a baby has to have some tummy time and with time most babies will become less resistant.  

Those babies that “detest” tummy time often seem to be early rollers and flip from tummy to back just to get off their tummies!! At the same time, once a baby is rolling from back to front, you can’t be a”professional" tummy flipper” and be up and down all night or try to rig a contraption to keep your baby on their back. They will roll over in their sleep just like we all do and once they can roll on their own they may become a tummy sleeper.

The Bumbo chair is a huge help in preventing head flattening, as well as the exersaucer and the jumper-roos (or whatever they are called now).  These products all help support a baby’s back while keeping their heads upright which prevents flattening.  I encourage all of my patients to begin using these gizzzmos around 3 months of age, and especially for any baby that is already showing some flattening or tummy avoidance on their early newborn exams.

I also notice that more of my 2nd and 3rd babies seem to have some flattening because they spend a great deal of time in their car seats as they are “carted” around town with an older sibling. In these cases I encourage the parent to pick the child up once out of the car and carry the baby rather than keeping them in their carrier.  This is good for bonding, head control and keeps the baby off of their back as well. So with all of this being said, if a head is severely affected there are “molding helmets” that can be utilized to prevent the cosmetic consequences of head flattening.  This should be a separate discussion with your doctor, but my philosophy is to try and discuss the issue of positional head flattening at every visit to try and avoid the problem all together.

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

Daily Dose

Why Babies Should Sleep in Their Own Bed

The risks of accidentally suffocating an infant while bed sharing are real and too frequent.I have discussed the dangers of co-sleeping with your infant in a previous blog. The issue was brought to mind again today when I read an article stating that four infants had died in 2009 within 6 weeks of each other in Wisconsin, all who had been co-sleeping with an adult.

The idea of " bed sharing", which in my mind is not the same as co-sleeping, may sound like a great idea for snuggling and bonding with that precious newborn, and especially in those first months when parents are so terribly sleep deprived. Unfortunately, the risks of accidentally suffocating an infant while bed sharing are real and too frequent. No one expects to roll over and suffocate their infant, but we all toss and turn while sleeping and may not realize that you have rolled over on the your-baby. The whole incident is silent, but may be deadly, as the your-baby suffocates underneath the parent or when pushed up against a pillow or headboard. The risk is even greater on a couch or futon. Other risk factors with bed sharing include the use of alcohol or other drugs, which also may cause a deeper sleep. You may not even realize that your infant is in bed with you, and many moms may still be taking a pain medication in the first week's post-partum. The American Academy of Pediatrics officially recommends against bed sharing, but does endorse having the infant in a bassinet (with a firm mattress, and a light blanket) right next to the mother's bed to promote bonding and breastfeeding. But once fed, the your-baby should be returned to the bassinet and sleep on their backs. No tummy sleeping, even if you are convinced that your infant "prefers" that position. The risks are too great to keep that sweet your-baby in the bed. So....back to sleep and in the crib or bassinet. There are plenty of other opportunities to snuggle with that newborn! That's your daily dose, we'll chat again tomorrow. More Information: The Dangers of Co-Sleeping With Your Baby More Information: American Academy of Pediatrics

Daily Dose

Give Your Family a Sleep Check-up

Now that school is back in session, I wonder if everyone has gotten back into healthy sleep habits.Now that your kids are back in school this new year, I wonder if everyone has gotten back into healthy sleep habits?

It seems that the high school and college crowd takes advantage of long weekends or breaks to “catch up” on sleep. That means sleeping from about 1 or 2 am until at least noon. That also means that I rarely saw my children awake. The same thing was reported by many of my adolescent patients. The ones that came in for morning appointments looked like they had literally rolled out of bed, and were not even fully awake. They looked at it as a “punishment” to have to go to an appointment before noon. I, on the other hand know that morning appointments tend to get seen in a more timely manner than those late in the afternoon when I have had a chance to get behind (despite my best efforts, I promise!). Now the statistics released from the Youth Behavior and Risk Survey of 12,000 high school students just reinforced that our teens are truly sleep deprived. Only about eight percent of teens reported getting the recommended nine hours of sleep on school nights. There were 10 percent of teens that reported sleeping only five hours a night, while another 25 percent reported getting six hours of sleep on average on school nights. Thus, it appears that adolescent sleep deprivation is rampant and cumulative. As any parent knows, kids of all ages get irritable when they don’t get enough sleep. Lack of sleep also leads to difficulty learning and concentrating, but may also affect other activities outside of academics. Teen drivers may be more prone to have automobile accidents when sleep deprived. They are also found to have a higher incidence of depression. There are also studies that lack of sleep may contribute to obesity. With a new semester starting what better time to review bedtimes and sleep habits. I firmly believe that all children need to have bedtimes and that means adolescents too. For that to happen a family needs to not only be organized to get everyone ready for bed, but a parent needs to check on their teen to make sure that they are going to bed. I know it is hard to stay up after a long day at work, but if unsupervised many teens will stay up. They are not only studying, but they are on line on Facebook, or texting on their phones or playing video games or watching TV. Teens are the kings and queens of multitasking, or so they think and somehow the time just slips away. That is until morning when they are exhausted. So make a commitment to “tuck in your teen”, even if that means setting your alarm to get up and do it. That’s your daily dose, we’ll chat again tomorrow.

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.


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Potty training can be tricky.

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