If you want healthy smart children, and who doesn’t, it is vital, imperative, crucial, fundamental, even axiomatic that you ensure that they get the recommended amount and quality of sleep that they need. Do you know what promotes the best sleep in your children? Well, stay tuned to find out in this important installment of Portable Practical Pediatrics.
Photo by Angela Ferguson, Pixabay Images
A True Life Story
Recently, I was asked to speak to a group of parents of “at risk children” who had come to a family education evening to talk about how to maximize their children’s performance in school. We talked about the research that has been discussed on this blog many times. Specifically, I wanted to stress the factors that parents have control of that have been shown to improve a child’s academic achievement;
-Enforcing a regular healthy bedtime and keeping TV’s and electronics out of a child’s bedroom. Limiting entertainment screen time being part of that.
-Getting an adequate amount of physical activity and unstructured play during the day.
-Having a diet rich with unprocessed foods
-Ensuring that every child is getting an adequate amount of sleep something that has been found by investigators to often be lacking in at risk children.
Well, the night this event occurred was actually the second time I had spoken at this church and talked about this topic. I thought my first talk with this group of parents had gone pretty well but I had no idea of how well. At the onset of my this visit with these parents, an amazing thing happened. Before we got into the talk, an older gentleman raised his hand and told me he had a testimonial to share. That’s what he called it, a “testimonial”. He told the audience and me that he and his wife were raising their grandson who was currently in 4th grade and not doing very well academically. He said that he and his wife had decided, after hearing my first talk, to try getting their grandson a structured regular bedtime, free of screens and junk food to see what would happen. Specifically, they wanted to get him to bed early enough for him to get up the next morning without a fight. That was their goal. To do this, they completely restructured his bedtime: they removed the TV from his room and cut off screen time after 7pm. They insisted that he was to eat all of his food at dinner and was to get nothing no more after that. Bedtime was set at 8pm and enforced. Lights out and time to sleep.
After doing all of this, they said the transition was nothing short of miraculous. He almost immediately stopped fighting about getting ready for school in the morning and actually woke up in the morning on his own. He also stopped fighting about going to sleep. And the best thing is that his grades showed an immediate improvement. Whereas he had been struggling to keep up in school, now he was getting good grades! They said even his personality was more pleasant. They attributed all of this great stuff to him having a regular bedtime and adequate sleep. They had no idea that not having a structured bedtime, letting him play video games late into the evening, eating junk food at night, and falling asleep in front of screens was so detrimental to him. Needless to say, this family’s story had a big impact on everyone in the audience, including me!
Why is Sleep So Important?
But don’t just take my word for it, listen to what a panel of 13 sleep pediatric specialists at the American Academy of Sleep Specialists who carried out an extensive literature review on the issue of childhood sleep have to say about the issue.
“Healthy sleep requires adequate duration, appropriate timing, good quality, regularity, and the absence of disturbances and disorders. Sleep duration is a frequently investigated sleep measure in relation to health outcomes. Many studies have shown that adequate sleep duration is associated with better attention, behavior, cognitive functioning, emotional regulation, and physical health among children.1–3”
Pretty strong statement if you ask me, wouldn’t you say?
How Much Sleep Does My Child Need?
But, how much sleep does your child need you ask? Here is what the AAP consensus group, June 2016, thinks about that issue. Note that these are ranges, taking into account that there are variations from child to child about how much sleep an individual child needs but I think this list can serve a serve as a good measure for your family.
Recommended sleep hours of sleep by age:
- Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health.
- Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health.
- Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health.
- Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health.
- Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health.
I think the key words here are regular and optimal health. Your child’s body and brain just cannot function to its capacity without regular high quality sleep.
What is sleep hygiene?
But what constitutes high quality sleep and how can parents provide that for their children? That brings us to the concept of “sleep hygiene”. What is “Sleep Hygiene” you ask? It is the term sleep experts use for the behaviors and conditions that lead to the best quality sleep for your child. Here is a list of what sleep experts at Seattle Children’s Hospital think are best practices with regards to sleep hygiene: I’m quoting now.
1. Keep consistent bedtimes and wake times every day of the week. Late weekend nights or sleeping-in can throw off a sleep schedule for days.
2. Avoid spending lots of non-sleep time in bed – spending hours lying on a bed doing other activities before bedtime keeps our brains from associating the bed with sleep time.
3. Child’s bedroom should be cool, quiet and comfortable.
4. Those children who stare at clocks should have their clocks turned away from them.
5. Bedtime should follow a predictable sequence of events, such as brushing teeth and reading a story.
6. Avoid high stimulation activities just before bed, such as watching television, playing video games or exercise. Do not do these things during a nighttime awakening either. It is best not to have video games, televisions or telephones in the child’s bedroom.
7. Having physical exercise as part of the day often helps with sleep time many hours later.
8. Relaxation techniques such as performing deep, slow abdominal breaths or imagining positive scenes like being on a beach can help a child relax.
9. Avoid caffeine (sodas, chocolate, tea, coffee) in the afternoons/evenings. Even if caffeine doesn’t prevent falling asleep it can still lead to shallow sleep or frequent awakenings.
10. If a child is awake in bed tossing and turning, it is better for them to get out of bed to do a low stimulation activity (e.g., reading), then return to bed later. This keeps the bed from becoming associated with sleeplessness. If still awake after 20 to 30 minutes, spend another 20 minutes out of bed before lying down again.
11. Worry time should not be at bedtime. Children with this problem can try having a “worry time” scheduled earlier when they are encouraged to think about and discuss their worries with a parent.
12. Children should be put to bed drowsy, but still awake. Letting them fall asleep in other places forms habits that are difficult to break.
13. Security objects at bedtime are often helpful for children who need a transition to feel safe and secure when their parent is not present. Try to include a doll, toy or blanket when you cuddle or comfort your child, which may help them adopt the object.
14. When checking on a child at night, checks should be “brief and boring.” The purpose is to reassure the child you are present and that they are OK. Follow these tips to help your child adopt good bedtime routines.
15. If your child is never drowsy at the planned bedtime, you can try a temporary delay of bedtime by 30 minute increments until the child appears sleepy, so that they experience falling asleep more quickly once they get into bed. The bedtime should then be gradually advanced earlier until the desired bed time is reached.
16. Keep a sleep diary to keep track of naps, sleep times and activities to find patterns and target problem areas when things are not working.
Common Mistakes Parents Make at Bedtime
In my practice, here are the most common mistakes that I see parents make when they come to my office, complaining that their children are poor sleepers-families where bedtime and nighttime seem to be a struggle. Where are these parents going wrong and as we just talked about, getting bedtime wrong can do serious harm to a child’s health and cognitive functioning. See if your family is falling into any of these sleep traps:
–Parents not ritualizing bedtime. These parents failed to establish a ritual that the child and family can reproduce easily that involves minimal effort and equipment. This should be at a predictable time so that your children just accept that it is bedtime. Many parents have just not thought this whole process through and don’t understand how important it is for their children’s overall well-being.For example-allowing TV and video games in the child’s bedroom. Many parents think that a TV is soothing to a child and can help with sleep onset. And they are right, TV and movies at bedtime makes sleep onset easy in the beginning but it starts a cycle of dependence and over stimulation. Studies have found that electronics and screen time in bedrooms do not lead to healthy sleep. Falling asleep is a skill that children need to learn to do without external aides.
–Letting children fall asleep outside their bed. These parents chose to avoid the entire issue of establishing a bedtime ritual all together, simply letting the child do what they want, a bad parenting mistake.
-Parents allowing viewing exciting games and entertainment just before bedtime. This is quite prevalent today and common sense tells us that this is not a good idea.
–Parents spending too much time in the child’s bedroom just prior to bedtime. This mistake usually begins soon after the child gets out of their crib. Yes, separation from your parents is frightening for most children but something all children need to master. Many parents allow themselves to be over manipulated with the barrage of requests from their child- I’m thirsty, I’m hungry, I need to potty, or I’m scared etc. Some brief attending to requests and reassurance is acceptable but not sitting by the bed until Janie or Johnny falls asleep except in the rarest of circumstances in my opinion. Reading aloud until they are asleep, or as we just went over, letting your child fall asleep somewhere other than their bed and then taking them there-those are mistakes as well in my experience.
Limit Setting is at the Heart of Most Parenting Difficulties
If you think about it, you could argue that all of the above problems I just mentioned are all problems with parents setting limits for their children. In fact, I feel that the subject is so important, that I dedicated an entire chapter if my recent book, Great Kids Don’t Just Happen to this topic. I know you want the best for your children so give them their best shot at life success by ensuring that you get the basics right, one of them being a good nights sleep. Of course, if your child is having sleep problems and having trouble correcting some of these basics, make sure to bring this to the attention of their pediatrician. They know your child and family and will be able to help.
If you find the information you heard in this pedcast valuable, please take a minute to recommend Portable Practical Pediatrics to a friend and hit a few like buttons when you are at a docsmo.com social media outlet, and of course subscribing to Portable Practical Pediatrics. This is Dr. Paul Smolen, broadcasting from studio 1E, hoping that when it comes to the sleep thing, get it right for the little ones under your wing. Until next time.
Many thanks to Drs. Charlotte Rouchouze and Monica Miller for their help in producing this episode of Portable Practical Pediatrics.