Helping Children Get the Sleep They Need

The rising numbers of first graders through high school seniors who fail to get adequate rest are a wake-up call for parents to become more proactive in promoting healthy slumber.

Sometimes teacher Debbie Welch can tell from yawns or heads down on desks that her students didn’t get enough sleep the previous night. Other times, they volunteer the information.

Her first graders at Highlander School in Dallas, Tex., “love to come in and tell me what they’ve done,” Welch says. “So if I’m hearing a lot of, ‘Did you go to the junior high volleyball game last night?’ that means 9 or 9:30 [was their earliest possible bedtime].”

That also means that many did not get a full night’s sleep.

School starts at 8:30 A.M. at Highlander. The 9:30 night owls would have had to have fallen asleep in 15 minutes, sleep until 7:45 the next morning (and still make it to school on time), to get 10 hours of rest, the minimum experts recommend for first through fifth graders to function at their healthy best.

“Sleep is an important part of a child’s life,” the American Academy of Sleep Medicine notes in “Sleep and Children,” a fact sheet posted on its Web site, “and a lack of sleep can impair a child’s performance in the classroom, hinder physical abilities, shorten attention span, and stunt social growth.”

Not to mention the negative ripple effects created in families by a sleep-deprived child whose wakefulness, or crankiness, or both, rob parents—and possibly other siblings—of their sleep and good humor, too.

According to a 2004 Sleep in America poll by the National Sleep Foundation (NSF), a majority (54 percent) of school-age children regularly failed to reach that healthy sleep level that the experts recommend. The poll, which queried parents and adult caregivers about youngsters’ sleep behaviors, revealed that first through fifth graders were getting an average of nine and a half hours of sleep a night.

“They really need between 10 and 11 hours,” Jodi A. Mindell, Ph.D., a psychology professor and associate director of the Sleep Center at The Children’s Hospital of Philadelphia, says.

A subsequent survey last year by NSF, an independent nonprofit that supports sleep-related education, research, and advocacy, showed that adolescents age 11 to 17 fared worse. Just 20 percent of those youngsters slept the recommended nine hours on school nights.

Among children, “we have an incredible amount of sleep deprivation,” says Dr. Mindell, who chaired the NSF task force for the 2004 poll.

Parents in the dark

Parents often either don’t recognize this slumber deficit or fail to see that it can be fixed.

If she sees her students acting lethargic or sleepy, Debbie Welch says, “I certainly mention it to their parents.” Sometimes, she says, “[the parents] are not even aware of it.”

Other parents may be aware but believe their child “is by nature a poor sleeper or doesn’t need as much sleep as other children of the same age,” Richard A. Ferber, M.D., director of the Center for Pediatric Sleep Disorders at Children’s Hospital Boston, writes in Solve Your Child’s Sleep Problems (Simon & Schuster, revised edition, 2006).

“These beliefs are almost never true,” he adds. “Virtually all children without major medical or neurological disorders have the ability to sleep well.”

Here are some suggestions for parents and caregivers who want to ensure their children are getting enough sleep:

Ask questions. “You need to talk to the children, and you also need to talk to their teachers,” Dr. Mindell, co-author with Judy A. Owens, M.D., of Take Charge of Your Child’s Sleep: The All-in-One Resource for Solving Sleep Problems in Kids and Teens (Marlowe & Company, 2005), says.

Ask the children: “How do you sleep at night?” she says. At parent-teacher conferences, make such inquiries as “Does my child seem tired to you?”

Debbie Welch says that sleep has become enough of an issue over the past decade that she addresses it at parent orientation each year. She won’t “impose what time I think [their child] should go to bed,” she says. But she does “tell them that we feel the children need a nice long sleep time.”

Know the signs of inadequate sleep. Some children may not tell their parents they have trouble falling or staying asleep. Others may be unaware they snore or have other disorders that contribute to insufficient rest. For such reasons, Dr. Mindell asks, “Do you have to wake your child for school in the morning?” If you do, she says, he or she “didn’t get enough sleep.”

If your kids routinely sleep longer on weekends or vacation days, “that will give you an indication of how much sleep they really need,” Dr. Mindell says.

Conduct may be a third indicator of sleep adequacy. If a child behaves better on days he gets more sleep, Dr. Mindell says, if “he attends better—he pays attention, he sits still,” then parents should pay attention, too.

Establish bedtime schedules and routines. Developing a set sleep schedule, “which is the same bedtime every night, and, similarly, the same wake time every morning,” Dr. Mindell says, is a first step toward sleep sufficiency.

Also, a routine for working their way toward sleep is as essential to kids as a regular bedtime. “They need a wind-down time,” Dr. Mindell says. “They can’t just go from after-school and evening activities to getting home, grabbing dinner, doing homework, and turning out the light.”

Debbie Welch encourages her students’ parents to read to their children when they get in bed. “We encourage closeness, the physical part of it as well as the reading practice,” she says. But “keeping the ritual” is most important.

She has noticed, Welch says, “that those kids whose parent can keep them on some kind of routine have fewer times during the day that they’re tired than those who don’t seem quite as structured.”

Deal with the “disrupters.” The NSF 2004 poll revealed that the 43 percent of school-age children with TVs in their bedrooms went to sleep an average of 20 minutes later and slept more than two hours less per week than their counterparts without televisions.

The poll also showed caffeinated beverages accounted for a sleep loss of about 3.5 hours a week in this group.

Experts advise parents to take a hard look at the place and placement of such “sleep disrupters,” not only caffeinated drinks and televisions, but also computers, cell phones, and other electronics.

Model good sleep habits and be prepared to make more changes. Parents also need to take a look at the example they set for their children. “They need to make it clear,” Dr. Mindell says, “that they believe sleep is important, which means…they need to get sufficient sleep.”

Once a family establishes good sleep habits, if a child still has difficulty going to sleep, staying asleep, or has daytime sleepiness, “you really want to talk to your child’s doctor and/or contact a sleep specialist in your area,” Dr. Mindell says.

The medical specialty known as sleep medicine “has just completely taken off,” Dr. Mindell adds, and “the number of sleep centers that have opened across the country is tremendous.”

Contributing editor Kris Imherr also wrote “Helping Children Do Their Best on Group Projects” in the November-December 2006 issue.


Sleep Problems in Children

Failure to get enough sleep constitutes one of three broad categories into which the National Center on Sleep Disorders Research (NCSDR), operating under the auspices of the National Institutes of Health (NIH), groups sleep-related problems.

The second category includes sleep disorders—more than 80 have now been classified—which are specific disturbances in patterns of sleep and wakefulness.

The third category covers sleep loss as a secondary condition; that is, deprivation caused by an underlying medical or mental cause or medication.

NIH has identified the four most common sleep disorders among all ages as:

  • Insomnia—An inability to fall asleep or stay asleep for a restful period.
  • Apnea—Breathing that is very shallow or intermittently stops during sleep, impeding airflow to the lungs and decreasing oxygen in the blood. Apnea sufferers are often very sleepy during the day.
  • Restless Legs Syndrome—Tingling or prickling in the legs that can be relieved only by moving or massaging them, which interferes with sleep.
  • Narcolepsy—Excessive and overwhelming daytime sleepiness, even after a full night of sleep. Narcolepsy is caused by the brain’s inability to regulate sleep-wake cycles normally.

“The most common sleep problems in children,” sleep researcher Mary A. Carskadon, Ph.D., writes on the National Sleep Foundation (NSF) Web site (www.sleepfoundation.org), “include difficulty falling asleep, nighttime awakenings, snoring, stalling and resisting going to bed, having trouble breathing, and loud or heavy breathing while sleeping.”

NSF, NCSDR (www.nhlbi.nih.gov/about/ncsdr/), and The American Academy of Sleep Medicine (www.aasmnet.org) are three of the many organizations that offer public education and guidance on sleep issues.

One starting reference is Your Guide to Healthy Sleep (NIH Publication No. 06-5271), published by the National Heart, Lung, and Blood Institute, which can be downloaded online atwww.nhlbi.nih.gov/health/public/sleep/healthy_sleep.htm or ordered in print for $3.50 by calling the NHLBI Health Information Center at (301) 592-8573 or (240) 629-3255 (TTY).

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