Pediatrics for Parents

Vitamin ZZZZ

Lori Zanteson

As parents of young children, sleep is often in the forefront of our minds. With recent studies that say children are not getting adequate sleep, this may be the year to find out what it's all about. You won't think about sleep the same way again.

We parents expect our newborns to awaken multiple times nightly for the first months. But what of those months and years to follow when baby who has become a toddler and then a preschooler is still waking us up one or more times a week? You may be annoyed, but you're a parent and soothing your child is what you do. At three a.m., the focus is clearly (or groggily) to get them to sleep and then get yourself back to sleep. With any luck, everyone's refreshed in the morning. If not, grit your teeth and deal. Maybe naptime will go better. There's always the hope he will turn in early since he's extra tired. Or there's that quick drive around the block.

Sleep-deprivation in children often goes unnoticed and rarely gets the attention it should. The National Sleep Foundation's 2004 Sleep In America poll shows that nationwide, our children average between 30 and 60 minutes less sleep daily than is recommended. It's easy to see how it adds up: a skipped or abbreviated nap, a prolonged bedtime or early wake-up. The NSF poll reports "two in three children have trouble falling asleep, awaken at night, snore or have trouble breathing, wet the bed, convey nighttime fears, have nightmares, or experience other problems with sleep several times a week." The survey also found that of the one in three children who awaken at least once a night needing help or attention, only eleven percent of those parents responded "yes" when asked if their child has a sleep problem. What parents see as normal or typical, experts say is potentially harmful to children and their parents.

Sleep benefits all of us, but most crucially, our children. Physical and mental development are dependent upon the sleep they get. This is why infants need so much sleep. According to the National Sleep Foundation, "a child will spend 40% of his or her childhood asleep" and " by the age of two, most children have spent more time asleep than awake." That is a time of significant growth. Our sleep alternates between non-rapid eye movement (NREM) and rapid eye movement (REM). REM is known as active sleep and this is the time when our brains are active and dreaming occurs. NREM is known as quiet sleep and during this phase our blood supply to muscles increases, energy is restored, tissue growth and repair occur and important hormones are released for growth and development.

There's a lot going on while we sleep, and this is intensified for our children. If a child isn't getting enough sleep or it is repeatedly interrupted, she won't have the necessary periods of REM and NREM, which can stifle growth and repair. A 2006 study by the American Physiological Society says that sleep is indeed necessary for general health, but found that the brain needs sleep more than any other part of the body. New learning, which for children is a constant process, actually makes the brain grow. Losing sleep can undo the rejuvenating effects learning has on the brain.

All too commonly we believe that a skipped nap, for example, can be made up later. We think a ten-minute power nap in the car or an early bedtime will be enough. Not so, experts say. Jodi Mindell, PhD., associate director of the sleep disorders center at the Children's Hospital of Philadelphia, says children won't gain that missed naptime, "They'll lose the entire afternoon." This is because inadequate sleep makes it difficult for kids to concentrate and focus.

We parents know all too well that a tired child can be moody, clingy and fussy, not to mention what Dr. Alan Greene, author of From First Kicks To First Steps (McGraw-Hill 2004), refers to as a "low threshold to express negative emotion (irritability and easy frustration), and difficulty modulating impulses and emotions." Dr. Greene also notes the frightening similarities between sleep-deprivation symptoms and those of Attention Deficit Hyperactivity Disorder, better known as ADHD. Research actually shows that kids with partial or chronic sleep-deprivation have been misdiagnosed as having ADHD. ADHD patients are often medicated to control their symptoms.

As obvious as our child's tired signs may seem, the symptoms that a child is not sleeping well are not always obvious to parents. A lot of harmful effects aren't easily seen so parents don't realize there is a problem. According to Carl Hunt, director of the National Center on Sleep Disorders Research at the National Institutes of Health, sleep deprived children may not seem tired, and may actually appear to be overly energetic, yet they are not functioning optimally. Studies have shown that these children are more likely to get injured on bicycles and playground equipment. Hunt says "A tired child is an accident waiting to happen."

How can parents determine whether their child is getting enough sleep? Compare the hours your child sleeps to the recommended hours of sleep for her age group. In a 24-hour period, infants ages 3-11 months need 14-15 hours, toddlers need 12-14 hours, preschoolers need 11-13 hours, and school-aged children need 10-11 hours of sleep. Every child is unique, but this is a good general guideline. If your child shows signs of daytime tiredness, yet sleeps within the range of recommended hours, consult your pediatrician. He/She can determine whether your child has a sleep disorder, which then can be treated.

Like most childhood phases, parents may think children will simply outgrow sleep issues. Maybe not, research shows. Sleep habits begin in infancy. According to a 2003 report by Claude Lenfant, director of the National Institute of Health's National Heart, Lung and Blood Institute, "Bad sleep habits in children may lead to health problems in adulthood. Such habits have been linked to various ills including heart ailments, respiratory problems and obesity." The National Institutes of Health estimates that over 70 million Americans are sleep-deprived. This is much more than a childhood phase.

Parents would do well by their children and themselves to teach and model healthy sleeping habits. Specialists at NSF recommend parents teach their children from infancy to be self-soothers, that is, teach them how to comfort themselves when they awaken and fall back to sleep on their own. One way to do this is to put infants to bed when they are drowsy, but not yet asleep. Also, practice a scheduled and regular routine for your child during the day and night. For example, make eat, sleep, play and wake up times approximately the same each day. Establish an enjoyable bedtime routine that is consistent and in a calm, pleasant environment. Set nighttime expectations with limitations that are consistent, communicated and enforced. Your household may decide, for example, that children must stay in their beds until you come get them in the morning. Last, encourage your child to have a security object like a blanket or a comforting stuffed animal or doll.

Sleep-deprivation in our children is a family issue. When they don't sleep, we don't sleep. The same symptoms that appear in our children affect us. We all know how parenting skills, such as patience suffer when we don't sleep enough. Two-thirds of parents in The Sleep in America poll said they were not able to get the sleep they need. Sleep specialists say adults need about eight hours of sleep to function optimally, but the average American adult gets only seven. It is a pattern that can create stress and negative parent-child interactions, not to mention potential conflict between parents.

Take a closer look at your family's sleep habits. Watch your child's daily and nightly routine and determine how much sleep she averages in 24 hours. In addition, pay special attention to any signs of daytime tiredness and whether she operates at 100%. Try an NSF recommendation for better sleep for your entire family, not just the children. Go ahead and sleep that extra hour. Doctor's orders!

Lori Zanteson makes sure she and her family of five get their Vitamin ZZZZs. In addition to family andÊsleep, Lori makes freelance writing a priority. She specializes in child and parenting issues. Contact her at lorizanteson@verizon.net.