Mega Doctor News
By Michael Merschel, American Heart Association News
Anyone who has raised kids knows that managing their sleep can be one of the most challenging aspects of parenting. But not everyone understands just how vital that sleep is.
Adequate sleep is a bedrock of a child’s physical and mental health, said Dr. Jill Kaar, an associate professor of pediatrics at the University of Colorado’s Anschutz Medical Campus in Aurora.
“Everything starts with sleep,” said Kaar, a maternal and child health epidemiologist. Making sure a child gets enough sleep is as important as serving balanced meals or encouraging exercise – possibly more important, she said. “All of it’s related, and all of it stems from sleep.”
Children and teens who don’t get a good night’s sleep are at risk for issues beyond simple fatigue, said Dr. Julio Fernandez-Mendoza, a professor of psychiatry and behavioral health, public health sciences and neural and behavioral sciences at Penn State University College of Medicine in Hershey, Pennsylvania. Insufficient or out-of-sync sleep has been connected to learning problems, attention problems and cognitive issues.
“When youth can’t get enough sleep, we’re exposing them to something that can have long-term health consequences, including cardiometabolic health,” said Fernandez-Mendoza, a clinical psychologist who directs Penn State’s behavioral sleep medicine program.
Not getting enough sleep has been associated with weight gain and obesity, increased blood pressure and insulin resistance among youth, he said, and sleep also is linked to how the immune system works. The American Heart Association considers sleep to be one of eight essential elements for heart and brain health in adults and kids.
But, while sleep’s importance is universally acknowledged, the needs of each family – and each child within that family – can be different.
As spelled out in the American Academy of Pediatrics’ sleep recommendations, needs change with age. The AAP says infants need 12 to 16 hours a day; toddlers 11 to 14 hours; preschoolers 10 to 13 hours; grade-schoolers nine to 12 hours; and teens eight to 10 hours. Those recommendations include naps for younger children.
That guidance shows how sleep patterns shift as a child grows, Fernandez-Mendoza said. A young child may not fall asleep right after dinner like a baby would; a teenager may naturally become more of a night owl. But even within the same family, the experience can vary widely from sibling to sibling.
Kaar said sleep advice also has to be adjusted for each family’s circumstances. The needs of a suburban family where every child sleeps in their own quiet room are different from one that lives in a noisy, brightly lit apartment where four children share a room.
So, one-size-fits-all sleep advice doesn’t exist, she said.
That said, here are ways to help your child get the best possible sleep:
Make sleep a priority
It’s easy to push sleep to the backburner, Kaar said. Sports, homework, even family dinners when both parents work late can get in the way.
But for all the reasons listed above, families need to find ways to make sure sleep is not sacrificed. Sleeping in on the weekends to catch up on missed hours during the week is not the answer, Kaar said. If your sleep hours vary from night to night, “your body doesn’t like that either,” she said. “It wants a regular sleep schedule.”
Fernandez-Mendoza emphasized that the recommendations are for hours spent actually sleeping – not including time spent falling asleep. So, parents need to be “cautious and thoughtful” in scheduling enough time for a child to settle down and for teens to disconnect from daytime activities before getting into bed.
Teach them how
When it comes to helping children and teens prepare to go to sleep, “I think the most important thing is to teach kids that they’re sleepy,” Fernandez-Mendoza said.
A child needs to learn where and how to sleep, he said, and how signs such as drooping eyelids indicate it’s time to settle into bed. Fernandez-Mendoza likens it to toilet training – a child will have a physical need, but they have to be taught the right place for it.
“The moment your kid is falling asleep, if at all possible, take them to bed,” he said.
Such basic steps can make a big difference. A review of research published in 2022 in JAMA Pediatrics showed that simply encouraging earlier bedtimes lengthened the amount of sleep a child got by 47 minutes.
At the same time, Fernandez-Mendoza said, a parent shouldn’t force an older child to adhere to a bedtime they might have outgrown. It would be unrealistic, for example, to make a teenager go to bed at 8:30 p.m. “That’s not going to happen for the majority of teens,” he said, noting that later school start times could help teens get the sleep they need.
Learn a healthy routine
“Behavioral insomnia” is a term used to describe children who have sleep difficulties because they have not learned to fall asleep or return to sleep without the presence of a caregiver or because they have not had consistent sleep schedules and bedtime routines, Fernandez-Mendoza said. Perhaps they were allowed to fall asleep watching television on the couch, or they learned to fall asleep only when someone else was in bed with them.
When such problems affect the child’s or caregiver’s daytime functioning or quality of life, they often can be treated easily with behavioral therapy, he said.
What does a healthy sleep routine look like? Again, each child will be different, Kaar said, but “for little kids, it might be ‘I finished my homework, then I like to shower, and then I like to read a book.'” Older kids should be taught to use their bed only for sleeping, to avoid caffeine and to set a bedtime for their screens.
About those screens …
The AAP recommends keeping screens out of children’s rooms and shutting them off an hour before bedtime. The light from screens can interfere with the body’s sleep rhythms and production of melatonin, a hormone that helps regulate sleep.
Fernandez-Mendoza favors enforcing this in a way that’s more educational than authoritarian. Helping children find appropriate times for video games and phone chats – and helping them understand why setting aside those screens before bed is good for them – could help more in the long run than demonizing the devices themselves or the activities kids enjoy doing with them.
What about melatonin supplements?
Melatonin supplements are increasingly popular, but the AAP recommends talking to a pediatrician before considering them.
“Medications should be a second-line resource for most youth, children and adolescents” who are having trouble sleeping, Fernandez-Mendoza said. Behavioral therapies should be the first line “because they really get rid of the problem for a high proportion of them.”
Families that turn to melatonin should be aware that the Food and Drug Administration less strictly regulates supplements than medicines, he said. The amount of melatonin in different products can vary widely, and studies have shown that actual amounts might not match what’s on the label.
According to the Centers for Disease Control and Prevention, more than 260,000 ingestions of melatonin in children were reported to U.S. poison control centers from 2012 to 2021. In most cases, young children accidentally got into bottles of melatonin.
Fernandez-Mendoza emphasized that helping a child learn how to fall asleep is generally going to be more helpful than any type of drug or supplement that simply shuts them off at night – and sometimes not even successfully. However, he added, “melatonin when given at the right dosage and at the right time, as indicated by a sleep specialist, can be effective in youth in whom behavioral sleep therapies do not work well enough.”
Turning to apps
Kaar co-wrote a 2022 study in JMIR Pediatrics and Parenting on children’s sleep apps that found few were rooted in science. But if they seem to help your child, she sees no harm. She uses them herself with her children: She has a 6-year-old who sometimes listens to a story app, and an 8-year-old who’s helped by a white noise generator.
But families don’t need anything fancy, she said. “With sleep, at the end of the day, you need a quiet environment.”
Similarly, Kaar said, you don’t need to spend a lot to create a suitable space for sleep. Tape a black trash bag to the window to darken a room. Find a free white noise app on your phone or turn on a fan in the room to decrease noise from outside of the room. And if anybody promotes a product that sounds too good to be true, it probably is.
“Don’t give in to the gimmicks,” she said.
When to get help
Talk to your child’s doctor if sleep issues start to affect school or social life or the way the family functions – say, if a child stayed up so late that they can’t be awakened in the morning or are sleepy and fatigued during the day, Fernandez-Mendoza said. “That’s when we have first signs of having a problem.”
If sleep has been a challenge for your family, understand that you’re far from alone, Kaar said. “People think that every other family might be doing it right,” she said, but families of all types of backgrounds end up needing help. “Kids struggle,” she said. “Everyone struggles. It’s hard.”
