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Daily Dose

Sleep

1:30 to read

Back to school bedtime routines are very important!  Now that kids are having to get up, (often before the sun comes up) going to bed on time makes everyone in the house wake up in a better frame of mind and mood for the day ahead.   

 

Bed time battles are typical for a toddler who has learned to ask for “one more book”, or for the elementary school child who swears “they are not tired” but who falls asleep during bath time.  But who knew there would be even more battles with teens and their electronics??

 

Numerous studies have shown that electronics disrupt sleep.  But, trying to convince your adolescent son or daughter that they need more sleep is a daily struggle. While the studies on sleep recommend that teens get between 8 to 9 hours of sleep, most teens are not even close to that!  (90% report less than 9 hours).

 

During the summer teens keep all sorts of crazy hours and many get the majority of their sleep during what we would consider to be “daytime” hours…as they go to bed at 2 or 3 am and sleep past noon.  So, the minute that school resumes after summer vacation they already have sleep issues trying to “re-adjust” their biological clocks…and then you throw in the use of electronics right before bed and you have the perfect storm for sleep deprivation and daytime fatigue.

 

The American Academy of Sleep Medicine found that “adequate sleep duration on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life and mental and physical health”.  There isn’t a parent around who doesn’t want happy, rested, studious and healthy kids…of all ages. If you throw in less moodiness for teens who get more sleep most parents would sign their teens up on the spot.

 

Why do we all need to disconnect from electronics in order to have better sleep?  That blue light from the electronic screen…of any shape for or fashion works against sleep. It signals the brain to suppress melatonin secretion, which is the hormone that makes us get sleepy at the end of the day. The light from the screen also confuses the brain of it being daytime and increases alertness which may delay sleep…even after turning off the screen.

 

Start the school year with the family rule, parents included, that all screens (phones, tablets, computers) will be off and docked outside of the bedroom at least 30-60 minutes prior to bedtime. While your teen may insist that they won’t use the phone, it is often too tempting to not “cheat” once you are in your own room and asleep. 

 

While this may initially be hard to enforce, once it is the family routine it becomes less of a battle. Everyone will have an easier time falling asleep and staying asleep, and maybe get a few more hours of “shut eye”.    

 

 

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

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

Babies Rolling Around in Their Crib

Many babies roll around in their crib, but should parents worry they will spend too much time on their tummy and not be able to roll on their back?I received an email from the parents of a 3½ month old daughter who has recently learned how to roll from her back to her tummy.  Their “conundrum”, as they put it, was twofold.  They were concerned about her sleeping on her tummy, as well as the fact that she would get upset after she rolled from her back to tummy and would then “scream loudly” So,what to do?

Most babies learn to roll around 4 months of age and like everything else there is variability in this milestone.  Many babies learn to roll tummy to back first, typically while they are having tummy time. Suddenly you realize that the baby has used their arms to push up and then over onto their back.  Watching them do this is fun, as they will often look up with big startled eyes almost as saying, “Wow, this is like an amusement park ride!”, while other babies will let out a shriek and start to cry as they were scared by the whole event.  Remember we are all different and some of us (me) like roller coasters that go upside down and backwards and others (one of my children) would still rather give up a week’s allowance than get on a ride like that. There are also babies, like the one in question, who learn to roll from their back to tummy first.  This often occurs at night and causes a lot of concern, as all parents hear from the beginning, put your baby “back to sleep”.  But, even when sleep positioners were being used (they are no longer recommended), many an infant would figure out how to roll from their back to get all cozy and sleep on their tummy. Once your baby has achieved this milestone on their own, you cannot keep them from becoming a tummy sleeper. It is important that you still put the baby to bed on their back, but after that your baby will begin to find their own sleep position which many times is at the opposite end of the crib and may be on their tummy. Trying to be a vigilant parent who turns the baby back over is an exercise in futility as they have a mind of their own and will just flip over again, which is not as cute at 3 am. . You do not  need a video monitor or check on your baby every 10 minutes to see if they have rolled during the night.  As an infant has learned to roll it is also assumed that they will turn their head to clear their nose and mouth and the risk of SIDS decreases. Now, in the case of the baby in the email, she loved to flip from back to tummy, but then it would make her upset and she would scream.  Every time the parents went in there and turned her over and settled her again on her back, she would flip over to her tummy again, and the screaming would re-start.  In this case, I think you have to let your baby fuss (scream loudly) for a few minutes to see if they will either roll back over or fall to sleep again. It is so hard to hear your baby so upset, but she got herself in this mess (first of many) and so it is the beginning of figuring out how to handle it. She will either cry or roll, and you can flip a coin to see which comes first. After she has cried for 5 – 10 minutes I would go back in the room, try to soothe her while she is on her tummy (remember she rolled there) and then see if she will calm down and go back to sleep.  This is going to take patience and time and some sleep deprivation (which you had hoped was past I am sure), as she learns to self-console again after rolling over.  The good news is that she has achieved an important developmental milestone with rolling over. Lastly, once your baby is rolling remember never to leave them unattended on the bed, changing table, couch etc.  I call this 4–6 month old a “floor baby” as it is best to leave them on the floor on a blanket while you run to get a diaper or answer the phone etc.  Many a baby, including my own, has rolled right off that bed to the floor, usually without sustaining any injury but causing a lot of parental worry and guilt.  That experience must be like a free fall ride at Six Flags! That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

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

Prevent 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?

 

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

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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Your Baby

Updated Safety Guidelines for Infant Sleeping

2:00

Elaborate beddings and plush accessories may look stylish and cute in a newborn nursery however, pediatricians know that these things should never be part of a baby’s sleeping environment. Getting new parents to understand why this type of bedding can be dangerous for babies is one of the reasons that the American Academy of Pediatrics (AAP) has updated and issued new safety guidelines.

Nineteen evidence-based recommendations aimed at protecting infants up to 1 year of age are featured in SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment, an AAP policy statement and technical report from the Task Force on Sudden Infant Death Syndrome.

Safe sleep recommendations include placing infants on their backs to sleep; using a firm sleep surface; room sharing without bed sharing; avoiding exposure to smoke, alcohol and illicit drugs; breastfeeding; routine immunization; and using a pacifier.

Every year, about 3,500 infants die from sleep-related deaths. Soon after the “Back to Sleep” campaign debuted in 1994, the SIDS rate declined, but it has leveled off in recent years. Ninety percent of cases occur before an infant turns 6 months of age, with peak incidence between 1 and 4 months.

Most parents know the importance of placing babies on their backs to sleep; the focus now is on the total sleep environment.

“I think the back-to-sleep message has gotten out loud and clear,” said Rachel Y. Moon, M.D., FAAP, lead author of the statements and chair of the task force. “When you ask parents, almost every parent knows — whether they are doing it or not is a different thing. We have been less successful at getting people to not sleep with their babies … and much less successful in getting the soft bedding away from babies.”

The dangers of bed-sharing and soft bedding are two problems that Moon says are often misunderstood.

“For the soft bedding, everybody thinks if it’s soft, then it can’t hurt the baby. But soft bedding is actually really a problem because it’s so soft they sink into it. People will often use pillows to ‘cushion’ the babies, and babies sink into them. …That’s very dangerous.”

It’s similar with bed-sharing, she said. “Some parents also think if baby is right next to them, they can tell if there is a problem … and protect the baby,” Moon noted.

A simple ABC formula can help remind new parents and caregivers of safe sleeping actions.

Michael H. Goldstein, M.D., FAAP, a neonatologist and task force member, lays out the “ABCs”:

 A for the baby sleeping alone

for back sleeping

C for sleeping in an uncluttered crib (or play-yard or bassinet)

“Outside of these, one of the biggest things I would really like to see people take away from the updated recommendations is that no matter what, babies should never sleep on a couch, especially with another person,” Dr. Goldstein said. Babies can get wedged between the adult and the cushions.

Other messages in the guidelines deal with sleeping with an infant, swaddling, breastfeeding and pacifiers.

Breastfeeding, along with the use of a pacifier after breastfeeding is established, also is a key recommendation. “We don’t know if people realize that (by breastfeeding) you reduce the risk of SIDS about 50%,” Dr. Goldstein said.

Parents also are advised to be vigilant about environments out of the home. A study in the November issue of Pediatrics found out-of-home settings are more likely to have certain risk factors for sleep-related deaths, including level placement for sleep and location in a stroller or car seat instead of a crib or bassinet

One of the most important milestones for parents and caregivers is when baby sleeps through the night However, it’s normal and appropriate for newborns to wake up a couple of times during the night, especially if breastfeeding, said Dr. Goldstein. Babies will eventually sleep through the night, but not till their little bodies are ready.

Below are the 2016 infant sleep recommendations for parents, caregivers, researchers, pediatricians and media outlets:

1. Place infants on their back to sleep for every sleep period until they are 1 year old. This position does not increase the risk of choking and aspiration.

2. Use a firm sleep surface.

3. Breastfeeding is recommended.

4. Infants should sleep in the parents’ room, close to the parents’ bed but on a separate surface designed for infants, ideally for the first year, but at least for the first six months.

5. Keep soft objects and loose bedding out of the infant’s sleep area.

6. Consider offering a pacifier at naptime and bedtime.

7. Avoid smoke exposures during pregnancy and after birth.

8. Avoid alcohol and illicit drug use during pregnancy and after birth.

9. Avoid overheating and head covering in infants.

10. Pregnant women should obtain regular prenatal care.

11. Infants should be immunized according to the recommended schedule.

12. Avoid using commercial devices that are inconsistent with safe sleep recommendations, such as wedges and positioners.

13. Don’t use home cardiorespiratory monitors as a strategy to reduce SIDS risk. 

14. Supervised tummy time while the infant is awake can help development and minimize positional Plagiocephal (flat head syndrome).

15. There is no evidence to recommend swaddling to reduce the risk of SIDS.

16. Health care professionals and staff in newborn nurseries and neonatal intensive care units as well as child-care providers should endorse and model recommendations to reduce SIDS risk.

17. Media and manufacturers should follow safe sleep guidelines in messaging and advertising.

18. Continue the Safe to Sleep campaign, focusing on ways to further reduce sleep-related deaths.

19. Research and surveillance should continue on all risk factors.

Parents and caregivers can find more information about the “Safe to Sleep” program at: http://www.healthychildcare.org/pdf/sidsparentsafesleep.pdf

Story source: Alyson Sulaski Wyckoff, http://www.aappublications.org/news/2016/10/24/SIDS102416

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