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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

Crib Deaths

1:15 to read

Crib bumpers may cause deaths and should never be used!  A recent study in The Journal Pediatrics looked at the incidence of crib bumper related deaths from 1985- 2012.  The authors reviewed data from the U.S. Consumer Product Safety Commission (CPSC) and found that there were 3 times more bumper deaths reported in the last 7 years than the 3 previous time periods that had been reviewed. Bumper pads caused 48 suffocations of which “ 67% were due to the bumper alone and not clutter in the crib, and 33% of the deaths were due to wedgings between a bumper and another object in the crib”.  An additional 146 infants had sustained injuries from the bumpers, which included choking on the bumper ties or near suffocation.  

The study also looked at the number of CPSC reported deaths compared with those from the National Center for the Review and Prevention of Child Deaths, 2008- 2011. When using that data the total number of deaths increased to 77. 

While bumpers had been marketed to prevent a baby from falling out of a crib or to keep a baby’s arms or legs from getting stuck between the crib rails, in reality they cause injury and death.  In 2012 a national standard was revised which required that crib bumpers must be 2 inches in thickness or less.  At that time the thought was that “thinner bumpers” would be less likely to cause suffocation. But the recent study found that 3 of the deaths occurred in cribs that had thinner bumpers.   

According to Dr. N.J. Scheers, the lead author in the study, “these deaths are entirely preventable” if bumpers were not used and were not widely available.  But when flipping through a baby store catalog, or even shopping for cribs, parents  and grandparents) see beautiful cribs that are adorned with bumper pads!!  So, if they cause death why are they being sold?  Mixed messages are very hard for parents to understand. Concrete recommendations and guidelines save lives.  

Several cities and states have already banned the sale of crib bumpers and the CPSC is currently in the process of publishing new recommendations on how crib bumpers should be regulated. 

I don’t see the need for any more studies to show that bumper pads may cause deaths and injuries.  Clear guidelines from the AAP state, “bare cribs are the best”  and “all infants should be put to sleep on their backs”.  Save your money and your baby’s life…no bumpers.

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

How To Prevents SIDS

1:15 to read

A new study on swaddling and sudden infant death (SIDS) was just published this week in the journal Pediatrics. Not surprisingly, it found that infants who were swaddled and placed on their sides or stomach had a higher incidence of SIDS. It has been routinely recommended for more than 15 years that all babies sleep on their backs and since that time the incidence of SIDS has been dramatically reduced.  Unfortunately not everyone follows the AAP recommendation. 

While it has been known that tummy sleeping has been associated with SIDS this meta analysis looked at data which was gathered over two decades and from 3 different global sites. The review found that infants who were swaddled and placed on their sides were almost twice as likely to experience SIDS and the risk of SIDS did double in those babies who were swaddled and placed on their stomachs.  

I discuss swaddling with all of my patients as there are so many different swaddle blankets available.  Actually, one of the first things a newborn nurse seems to teach a new parent is how to swaddle their baby.  While swaddling has been promoted to aid in calming a newborn as well as to help their sleep, the recommendation that the baby be placed on their back in their crib continues..  Many a baby looks like a little burrito….. rolled up in the swaddle and then being placed on their back in the crib.

But is seems from this study that some babies were being swaddled and then placed on their side to sleep. Unfortunately, even a newborn may squirm enough that they then move from their side into the prone position.  Older infants who are swaddled may actually roll from their back to their tummies, even while swaddled. While the association between swaddling and SIDS remains unclear, I think this is a good reason to start getting a baby out of a swaddle once they are rolling. So around the 3 month mark I start having parents loosen the swaddle and try to just lay the baby on their back without being swaddled.

Let me re-iterate, this article does not confirm an association between swaddling and SIDS.  I do think it is a good reminder for putting a baby, “back to sleep” and once they are rolling “ditching” the swaddle seems to make even more sense. Once less thing to worry about, right?

 

Daily Dose

Why Is Your Baby Not Sleeping?

1.15 to read

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

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

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

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

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

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

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

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

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

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.  

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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!

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