- Case and discussion
- Peds in Review article 2011
- Fabulous sleep blog from Dr. Craig Canapari, (sleep specialist and author of the case discussion and also Dr. Julian Davies’ best friend from college). I really liked the ones on how to establish sleep routines, how to handle sleep problems in toddlers, and how to handle daylight savings
- Www.babysleep.com – Lots of good parent resources and videos about infant and toddler sleep from the Pediatric Sleep Council
Take-home points for pediatric sleep problems:
- Epidemiology: In community surveys, 25% to 50% of preschoolers and up to 40% of adolescents experience sleep-related problems. These are common problems so it pays to know them well!
- Sleep duration varies by age and by person: There is individual variation in need for sleep, but generally, newborns sleep 16-20 hours and most can sleep longer stretches (4-6+ hour stretches) by 3-6 months. Infants sleep 13 to 15 hours, 2 to 5 year olds sleep 11 to 12 hours, school-age kids sleep 10 to 11 hours, and adolescents ideally 9 hours. Most children drop their naps before age 4 (give or take). Remember, sleep duration includes both daytime and nighttime sleep added together. After babies are about 6 months old, the natural rhythm of sleep follows a 70-100 minute cycle through deep sleep/REM/arousal.
- What are common sleep problems at different ages? One of the most common for toddlers is nighttime waking. For many young children, transitioning between sleep stages leads to a fully awake state. Combined with the developmental phase of separation anxiety and fear of the dark, this can increase nighttime demand for the parent. Gradual removal of the parent role in returning to sleep will lead to improved sleep habits. For teenagers, their circadian rhythm shifts and can shift their natural bedtime, often about 2 hours later – a common problem is disrupting sleep drive with light stimulus from phones and devices. Sometimes teens compensate with long afternoon naps that diminish their sleep drive at night. Strategies include removing devices an hour before bed, not taking naps, avoiding caffeine in afternoon/evening, and trying to stick to a regular bedtime and wake-up within an hour of usual time.
- Sleep routines and sleep environment help with regular sleep: A consistent schedule is one of the most important parts of sleep routine. Dr. Canapari recommends keeping it simple enough that one parent can do alone. Use the 3 or 4 “Bs for bedtime”: (Bath), Brush, Book, Bed. (In our house, we added “Ballads” and include nighttime songs.) Environment: quiet, low nightlight, cool, and definitely no TV or other devices. Consider a fan or white noise machine, which can help with sounds in the house or outside (especially in our urban environment!).
- What are important issues we screen for? Ask about Bedtime “BEARS”: Bedtime problems, Excessive sleepiness, Awakenings at night, Regularity and duration, and Snoring. If you can only do one, ask about snoring to screen for obstructive sleep apnea (OSA). The articles above review diagnostic criteria of specific disorders. When concern for OSA, or other sleep disorder that is interfering with function, consult with a sleep specialist. Our own SCH sleep clinic experts provide handouts and info here.