Melatonin use in children

This article discusses melatonin use in children.

What we do know: Supplemental melatonin can help children with sleep dysfunction (those who lie awake for hours at bedtime) fall asleep. However, melatonin only helps with sleep initiation (falling asleep) not staying asleep. So if you are dealing with wake ups during the night... melatonin is not the solution. Normal awakenings shift and change due to all sorts of developmental milestones and changes as children grow. Overnight awakenings will always be normal although how our children get back to sleep on their own changes our night of sleep dramatically!

What Is Melatonin?
Melatonin is a naturally-occurring hormone that our brains produce to help regulate sleep and wake cycles. People call it the "sleep hormone" because unlike the parts of body that drive wakefulness, melatonin drives sleepiness. Normally, melatonin levels begin to rise in the late evening (around 8 p.m. for kids, around 10 p.m. for teens), remain high for most of the night, and then drop in the early morning a couple hours before we wake up. Light inhibits melatonin and affects how much melatonin your body produces. Hence why being outside in the light during the day with a newborn (especially the ones who want to party all night) or when switching time zones makes a lot of sense! Light from screens (Kindles, iPads, tablets, computers, TVs) inhibits melatonin from being released. Getting outside during the day helps teach your brain day vs. night -- an important strategy for anyone struggling with sleep.

The Melatonin Supplement
The melatonin supplement you find at your local drug store is synthetically produced in factories. Because it's a supplement and not a medicine it's not regulated by the FDA like medicines. Therefore inconsistency in dosing is possible (no one can say that one brand's 1-mg tablet is the same dose as another's). Potency varies by brand and even between different batches from the same manufacturer. Always avoid "natural" melatonin (derived from cow or pig brains) and purchase only the man-made synthetic supplement that is far more readily available.

Melatonin Dosing Recommendations
"There are no clear-cut dosage guidelines because neither melatonin nor any other medication or supplement is approved by the FDA for the purpose of treating insomnia in children," said sleep expert Dr. Maida Chen of Seattle Children's Hospital.

Typically you always want to use the lowest dose: 0.5mg or 1mg -- then consider increasing by 0.5mg every few days if your child isn't falling asleep within an hour of bedtime. While increasing dose, make sure you're also working on consistent bedtimes, policing screens in the bedroom, and working to get good exercise OUTSIDE during the day. Many children will respond to a dose 0.5mg or 1mg an hour or two prior to bedtime. Some children and teens with significant challenges falling asleep are often given doses as high as 3mg to 6mg with severe insomnia at bedtime but in my experience many children get the hypnotic effect at smaller doses. Talk with your child's physician about how to determine a dose if or when melatonin is being used and if it's not working, GET OFF OF IT. Not all children respond to the hypnotic effect of supplemental melatonin.

Timing: You want to give melatonin prior to bedtime to help with increasing sleepiness. Most physicians recommend giving about 1-2 hours prior to ideal bedtime when helping little children fall asleep. However, it does depend why and how you plan to use melatonin. Here's a GREAT on how melatonin works and when to administer from Dr. Craig Canapari -- a pediatric sleep expert at Yale.

Children With ADHD and/or Autism Spectrum Disorders (ASD)
Children with ADHD and/or autism spectrum disorder are known to have challenges falling asleep. Studies with melatonin have been done in these populations of children. Dr. Chen explains:
"More trials of melatonin for sleep difficulties have been done in children with ADHD or ASD than studies for typically developing children. Evidence from these trials suggests that melatonin is safe and does shorten the length of time it takes to fall asleep. However, the effects are not generally overwhelming and not every child who takes melatonin shows sleep improvement. The studies mostly evaluate short-term use only." Most worries about long-term use and safety are speculative (based on studies in animals or adults) but without clarity from research it's always best to get kids off melatonin when you can.

Sleep matters. Good sleep is essential. But it's rare for a child to need meds.

Read more here

Work programs can improve employees' children's sleep

A program aimed to reduce work-family conflicts for employees had a positive influence on the employees' children's sleep.

A workplace intervention designed to reduce employees' work-family conflict and increase schedule flexibility also has a positive influence on the sleep patterns of the employees' children.

The intervention, Support-Transform-Achieve-Results (STAR), includes training supervisors to be more supportive of their employees' personal and family lives, changing the structure of work so that employees have more control over their work time, and changing the culture in the workplace so that colleagues are more supportive of each other's efforts to integrate their work and personal lives.

The research team conducted several other tests of the effects of the intervention. In an earlier study, for example, they showed that STAR resulted in employed parents spending more time with their children without reducing their work time.

In this study, the researchers found that children whose parents participated in the STAR intervention showed an improved quality of sleep one year later compared to the children of employees who were randomly assigned to a control group. The researchers published their findings in the June issue of theJournal of Adolescent Health.

"These findings show the powerful effect that parents' workplace experiences can have on their children," said Susan McHale, distinguished professor of human development and family studies, Penn State. "The STAR intervention focused solely on workplace experiences, not on parenting practices. We can speculate that the STAR intervention helped parents to be more physically and emotionally available when their children needed them to be."

The youth in the study were ages 9 through 17, which is a crucial age group for developing healthy sleep habits, as youth become more independent and more involved in friends, school and social activities, McHale said.

McHale and her team measured sleep patterns by interviewing employees' children on the phone every evening for eight consecutive evenings both before and after the STAR intervention. Each night they asked the children about their sleep on the prior night, including what time they went to bed, what time they woke up that morning, how well they slept and how hard it was to fall asleep.

An important part of this method was collecting the data on consecutive nights.

"Precision of reports is enhanced by getting the data on a daily basis," McHale said.

Read more here

Sleep terrors and sleep walking

A study finds a link between sleep terrors and sleep walking.

According to a Canadian study, about a third of toddlers who experienced sleep terrors became sleepwalkers later in their childhood.

"It was thought for a long time that these were related to stress and psychological unrest,” said Dr. Heidi Connolly, chief of Pediatric Sleep Medicine at Golisano Children’s Hospital. “Really, what the issue is, is that these things cause sleep deprivation. And then, if you're more sleep- deprived, you're more likely to engage in sleep walking or night terrors."

Dr. Connolly suggests that parents make sure their kids are on a consistent sleep schedule seven days a week.

"And then, in terms of safety issues, you want to avoid obvious things like sleeping on the top bunk, having stray objects on the floor or on staircases. One thing people sometimes forget is (not to) put a gate at the top of the stairs because it's easy for children to fall over that gate and instead of going down feet and fanny first, they're going down head first because they're falling over the gate."

Serious injuries are not the norm, but Dr. Connolly said there was a recent incident that did turn tragic. "This winter there was a news report of a toddler who was sleepwalking in Canada and froze to death; so there are some really important safety concerns when it comes to sleepwalking."

The Canadian sleep study followed nearly 2,000 children for 12 years.

Read more here

Is melatonin safe for children?

This article discusses the research that has been done on melatonin and children.

Melatonin hormone should be made easily available according to some sleep experts despite the conflict of interest among researchers as to whether it is safe for inducing sleep in children or not, reports The Sydney Morning Herald.

Melatonin is a natural hormone secreted by the pineal gland of the body. The small pea-sized gland which is located just above the middle of the brain is inactive during the day and gets turned on by the suprachiasmatic nucleus (SCN) located in the hypothalamus when it gets dark. It then secretes the melatonin in the blood which is responsible for inducing sleep naturally.

Sleep plays a vital part during the early development of brain in the newborns. The Circadian rhythm or the sleep-wake cycle in the body is regulated by the light and dark and it takes time to develop, resulting in the irregular sleep schedules of newborns. The rhythms begin to develop at about six weeks, and by three to six months most infants have a regular sleep-wake cycle.

However, 30 percent of children aged under three suffer from sleep problems, with the most common causes which are either behavioral or medical, according to a Monash University study.

Pediatric sleep specialist Dr Chris Seton, Woolcock Institute of Medical Research says, melatonin is a better alternative to the antidepressants and blood pressure medication that is commonly used by the parents which cause severe side effects.

But the medical experts do not seem to be readily accepting the claim as some of the research reveals that melatonin could adversely affect development during adolescence. They also have raised concern over the increasing trend of use of the hormone for treating sleep related issues in children.

There are reports which say that children with epilepsy and cerebral palsy were prescribed with melatonin way back since 1991. But it is now believed children with behavioural issues, such as ADHD, are more likely to be given melatonin now.

A senior research fellow at The University of Adelaide, David Kennaway says that the studies done on adults and animals have linked melatonin to a negative impact on reproductive, immune, cardiovascular and metabolic systems. In a research article published in the Journal of Paediatrics and Child Health, he says “It is not registered for use in children anywhere in the world and it has not undergone the formal safety testing expected for a new drug, especially long-term in children.”

But Dr Chris Seton, feels otherwise and says,”There is no evidence that it’s anything but a very safe drug. In the contexts of drugs given to kids, it’s at the top in terms of safety”.

The Sleep Health Foundation has cautiously approved the use of melatonin in children, stating it “appears to be safe and works well in the short term”.

Read more here

At what age should a child stop napping?

This article discusses at what age a child should stop napping.

Whether you’re a helicopter, free-range, or pro-attachment parent, one thing most moms and dads can agree upon is that young kids need daily naps. But that blessed hour or so of peace and quiet may not actually be such a great thing, according to a new report. 

The study, published online Sunday in the Archives of Disease in Childhood by lead author Karen Thorpe of Queensland University of Technology, posits that daytime snoozing after the age of two can actually have a negative impact on kids’ nighttime sleep. Researchers arrived at their findings after analyzing 26 studies to assess “evidence regarding the effects of napping” on child development and health. 

“The evidence suggests that beyond the age of 2, when cessation of napping becomes more common, daytime sleep is associated with shorter and more disrupted night sleep,” Thorpe, a professor in development science, told Today. In other words, so much for that “sleep begets sleep” mantra.

Just keep in mind that “as children will crawl, walk and talk at different times, so too will sleep patterns differ for each child,” Thorpe tells Yahoo Parenting. “The age of cessation of napping varies considerably for individual children typically between 2 and 5 years and likely reflects individual differences in development.” What this study suggests she explains “is that is important for parents to respond to their individual sleep need.”

Two is a pivotal age for sleep, Heidi Connolly,  M.D., director of pediatric sleep medicine services at the University of Rochester Medical Center’s Pediatric Sleep Disorders Center tells Yahoo Parenting, but that’s because “around two is when most toddlers stop napping twice a day and consolidate to once a day,” not because napping becomes a negative practice for all kids at that age. “There are still a lot of kids who nap at age 4 and 5.” 

The aim for children under five should be to get between 11 and 14 hours of shuteye during a 24-hour period, she says, also acknowledging that “the more a child is sleeping during the day, the less they need to sleep at night.” 

To determine if a child of any age needs a nap, observe how they behave in the morning. “If he doesn’t wake up on his own, or is very hard to wake up, he isn’t getting enough sleep and likely needs a daytime nap,” she says. Likewise, if he’s having afternoon meltdowns on daily basis, he may need naps. “But if he’s functioning fine during the day and chipper in the morning, a nap just is not needed,” says Connolly. 

For the restless snoozers, Connolly says to first consider whether a nap is needed, then change behaviors around bed- and naptimes to help kids become better sleepers. For example, establish consistent evening routines and a cool, quiet, dark environment for optimal shuteye. Without help, “Some kids are just good sleepers,” she says, “and some just aren’t, regardless of their age.” 

Read more here

New sleep duration recommendations

New sleep duration recommendations are being recommended by the National Sleep Foundation.

The National Sleep Foundation (NSF), along with a multi-disciplinary expert panel, issued its new recommendations for appropriate sleep durations. The report recommends wider appropriate sleep ranges for most age groups. The results are published in Sleep Health: The Official Journal of the National Sleep Foundation.

The National Sleep Foundation convened experts from sleep, anatomy and physiology, as well as pediatrics, neurology, gerontology and gynecology to reach a consensus from the broadest range of scientific disciplines. The panel revised the recommended sleep ranges for all six children and teen age groups. A summary of the new recommendations includes:

• Newborns (0-3 months): Sleep range narrowed to 14-17 hours each day (previously it was 12-18)
• Infants (4-11 months): Sleep range widened two hours to 12-15 hours (previously it was 14-15)
• Toddlers (1-2 years): Sleep range widened by one hour to 11-14 hours (previously it was 12-14)
• Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13)
• School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)
• Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)
• Younger adults (18-25): Sleep range is 7-9 hours (new age category)
• Adults (26-64): Sleep range did not change and remains 7-9 hours
• Older adults (65+): Sleep range is 7-8 hours (new age category)

"This is the first time that any professional organization has developed age-specific recommended sleep durations based on a rigorous, systematic review of the world scientific literature relating sleep duration to health, performance and safety," said Charles A. Czeisler, PhD, MD, chairman of the board of the National Sleep Foundation, chief of sleep and circadian disorders at Brigham and Women's Hospital, and Baldino Professor of Sleep Medicine at the Harvard Medical School. "The National Sleep Foundation is providing these scientifically grounded guidelines on the amount of sleep we need each night to improve the sleep health of the millions of individuals and parents who rely on us for this information."

A new range, "may be appropriate," has been added to acknowledge the individual variability in appropriate sleep durations. The recommendations now define times as either (a) recommended; (b) may be appropriate for some individuals; or (c) not recommended.

"The National Sleep Foundation Sleep Duration Recommendations will help individuals make sleep schedules that are within a healthy range. They also serve as a useful starting point for individuals to discuss their sleep with their health care providers," said David Cloud, CEO of the National Sleep Foundation.

Read more here

Study: Enforcing bed times helps kids get better sleep

Enforcing bed times and rules helps kids get better sleep, a study claims.

A regular bedtime and other sleep-related rules help children and teens get a good night's sleep, a new study suggests.

"Good quality and sufficient sleep are vital for children," study leader Orfeu Buxton, an associate professor of biobehavioral health at Penn State in College Park, Pa., said in a university news release.

"Just like a healthy diet and exercise, sleep is critical for children to stay healthy, grow, learn, do well in school, and function at their best," Buxton added.

Researchers analyzed survey responses from more than 1,100 American parents or guardians of youngsters aged 6 to 17.

Even though most of the parents believed sleep was important, only 10 percent of the children and teens in the study got the recommended amount of sleep for their age group. For ages 6 to 11, the amount of recommended sleep is at least nine hours a night. It's at least eight hours nightly for ages 12 to 17, according to the study.

Youngsters were more likely to get better and more sleep if they had a regular bedtime and rules such as limited caffeine consumption and no electronic devices on in the bedroom after bedtime, the researchers found.

"An important consequence of our modern-day, 24/7 society is that it is difficult for families -- children and caregivers both -- to get adequate sleep," Buxton noted.

Read more here

Children's academic performance and sleep

This article explains how academic performance in children is affected by their sleep.

Making sure school-aged kids get to sleep at a regular hour is often a struggle for parents. But a study by researchers at McGill University and the Douglas Mental Health University Institute in Montreal suggests it's well worth the effort: the researchers found that a good night's sleep is linked to better performance in math and languages -- subjects that are powerful predictors of later learning and academic success.

In findings published recently in the journal Sleep Medicine, the researchers reported that "sleep efficiency" is associated with higher academic performance in those key subjects. Sleep efficiency is a gauge of sleep quality that compares the amount of actual sleep time with the total time spent in bed.

While other studies have pointed to links between sleep and general academic performance, the Montreal scientists examined the impact of sleep quality on report-card grades in specific subjects. The upshot: with greater sleep efficiency, the children did better in math and languages -- but grades in science and art weren't affected.

"We believe that executive functions (the mental skills involved in planning, paying attention, and multitasking, for example) underlie the impact of sleep on academic performance, and these skills are more critical in math and languages than in other subjects," says Reut Gruber, a clinical child psychologist who led the study. Low academic achievement in children is a common and serious problem that affects 10-20 % of the population. "Short or poor sleep is a significant risk factor for poor academic performance that is frequently ignored," says Gruber, who is a researcher at the Douglas Institute and professor in McGill's Department of Psychiatry.

Gruber's research team, in collaboration with the Riverside School Board in Saint-Hubert, Quebec, studied 75 healthy children between 7 and 11 years of age. The children's nighttime sleep was monitored by actigraphy, which uses a wristwatch-like device to evaluate sleep by measuring movements. "We averaged the data over five nights to build the children's habitual sleep patterns and correlated the data with their report-card grades," Gruber says.

The takeaway for parents

The findings underscore the importance of identifying sleep issues that may otherwise go unnoticed, Gruber says. That doesn't mean parents need to rush out and have their kids tested at sleep clinics -- but it does point to a need for pediatricians to incorporate questions about sleep into routine checkups, she adds.

"I think many kids might have some sleep issues that nobody is aware of," she says. "And if the pediatrician doesn't ask about it, we don't know that it's there. Regular screening for possible sleep issues is particularly important for students who exhibit difficulties in math, languages or reading."

Read more here

Study: Televisions in children's bedrooms impair their sleep

A study shows that children who have a television in their bedroom have their sleep impaired.

Research has shown children who have a television in their bedrooms have later bedtimes and shorter sleep duration. A new study shows similar sleep problems in children who have a “small screen,” such as a smartphone in their room.

The study, “Sleep Duration,Restfulness, and Screens in the Sleep Environment,” published in the February 2015 Pediatrics (published online Jan. 5), surveyed 2,048 fourth- and seventh-graders about bedtimes, wake times, feelings of sleepiness and the presence of televisions, smartphones and other small screens in their bedrooms. Children who slept near a small screen and children with a television in their bedroom had shorter weekday sleep durations. Children who slept near a small screen were more likely to report perceived insufficient sleep. TV or DVD viewing and video or computer game playing were also associated with shorter weekday sleep duration and sleepiness. Children with screens in their sleep environment and more screen time also had later bedtimes.

Study authors conclude the findings caution against children’s unfettered access to screen-based media in their bedrooms.
Read more here

Young kids' sleep and obesity

Young kids not getting enough sleep could lead to obesity later in life.

Lack of sleep and sleep-related breathing problems appear to boost children's risk of obesity, a new study finds.

What isn't clear from the study, however, is whether the sleep issues actually cause obesity, or if something else might explain the association between sleep problems and obesity.

Researchers analyzed data from about 1,900 youngsters in England. The researchers had about 15 years of follow-up on the children. Those who got the least amount of sleep at ages 5 and 6 had between a 60 percent and 100 percent increased risk of being obese at age 15. (For children aged 5 or 6, fewer than 10.5 hours of sleep a night is considered too little, according to the researchers.)

Children who got too little sleep at other ages were not at increased risk for obesity, according to the study.

The researchers also found that one-quarter of the children were at increased risk of obesity due to sleep-related breathing problems such as snoring and sleep apnea. Those with the most severe sleep-related breathing problems were twice as likely to become obese by ages 7, 10 and 15.

The risk was slightly lower in children whose sleep-related breathing problems peaked at ages 5 or 6, but was still 60 percent to 80 percent higher than among those without sleep-related breathing problems.

The researchers didn't look at whether children with both these risk factors had a higher risk of obesity than those with just one of the risk factors.

"In recent years, lack of sleep has become a well-recognized risk for childhood obesity," study author Karen Bonuck, a professor of family and social medicine, and obstetrics, gynecology and women's health at Albert Einstein College of Medicine in New York City, said in a college news release.

"We know that the road to obesity often begins early in life. Our research strengthens the case that insufficient sleep and SDB (sleep-disordered breathing) -- especially when present early in childhood -- increase the risk for becoming obese later in childhood," she added.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented. With childhood obesity hovering at 17 percent in the United States, we're hopeful that efforts to address both of these risk factors could have a tremendous public health impact," Bonuck concluded.

A common cause of sleep-related breathing problems in children is enlarged tonsils or adenoids. If these are a problem, they can be removed through surgery. Another possible cause is misalignment of the jaws and teeth. This problem can be treated with a night guard or orthodontics.

Learning good sleep habits can help children get adequate sleep, Bonuck said.

Read more here

Sleep issues in children with mental health diagnoses

Sleep issues are common among children with mental health diagnoses, and may go undiagnosed due to the co-existing conditions.

Sleep difficulties, particularly problems falling asleep, are common among toddlers and preschoolers with mental health issues, according to a new study.

"Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschool adjustment, and problems of irritability, hyperactivity and attention," said the study's leader, John Boekamp, clinical director of the pediatric partial hospital program at Bradley Hospital in Providence, R.I.

However, he said, sleep disorders may be unrecognized and underdiagnosed in young children, particularly when behavioral or emotional problems are present.

The study, published online in Child Psychiatry & Human Development, involved 183 children aged 6 years or younger receiving outpatient treatment for psychiatric problems. The researchers examined the prevalence of sleep disorders among these children and the nature of the sleep problems.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings. Collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp in a hospital news release.

Recognized sleep disorders, particularly sleep onset insomnia, were more common than expected, the researchers found. Overall, 41 percent of children in the study met the criteria to diagnose a sleep disorder.

Sleep problems were most common in kids with disruptive behavior, and attention, anxiety and mood problems, the researchers found.

Early sleep problems could not only be the result of behavioral and emotional problems, but could also contribute to them, the researchers noted.

"Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms, and psychiatric symptoms affecting their sleep-wake organization," said Boekamp. "It is important for families to be aware of how important sleep is to the behavioral adjustment and well-being of young children."

Sleep problems can complicate treatment for challenging behaviors, such as aggression and attention and mood problems. Daytime sleepiness and fatigue can make these problems even worse, the study's authors noted.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp.

"Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment," he explained.

Read more here

Do weighted blankets help children with autism sleep?

This article discusses a study about the effect of weighted blankets and if they help children's sleep who have autism. While no clinical differences were found, the children and their parents did notice a positive difference.

Children with autism spectrum disorders (ASDs) have much higher rates of sleep disturbance than do typically developing children. Weighted blankets are an intervention widely accepted by families to improve sleep quality for children with ASDs, but the evidence supporting their use is limited. This study was conducted at three clinical sites in England, enrolling children aged 5-16 years with a diagnosis of ASD. All children had a reported disturbance in sleep for at least 5 months prior to enrollment. Sleep disturbances included sleep latency (delay of falling asleep of at least 1 hour after "lights out") and receiving fewer than 7 hours of continuous sleep.

The investigators chose a single manufacturer to make both the weighted and the "placebo" blankets. Two different sizes were used, depending on the age and size of the child. The small weighted blanket weighed 2.25 kg, and the larger blanket weighed 4.5 kg. Control blankets were made of the same material, but plastic beads were inserted into the blanket instead of the typical steel shot. This controlled for the insulating effect of a blanket during sleep, and the embedded beads provided similar tactile stimulation but without the inclusion of the weight.

The children were randomly assigned 1:1 to begin with either the intervention or placebo blanket. During the treatment phases, the children used the blanket for 12-16 nights. After completion of one treatment phase, the children then crossed over to using the other blanket for another 12-16 nights of monitoring. During each treatment phase, parents and children (if old enough) completed sleep diaries that measured sleep latency, duration of sleep, and parental perceptions of sleep quality. Children also wore electronic devices (accelerometers) on the nondominant hand that measured movement, with still times being considered "sleep" and times of movement above predesignated thresholds being labeled as "awake." This allowed the investigators to calculate the total sleep time, which was the primary outcome of interest. The parental measures of sleep duration and quality were secondary outcomes. The parents and children also completed subjective evaluations of the acceptability of the blankets.

They enrolled 67 children in the trial, approximately 80% of whom were boys. At enrollment, more than 80% of the children experienced sleep latency, 53% experienced poor sleep maintenance, and 43% experienced both sleep problems. The final analytic cohort included 64 children; dropout was similar in both groups. The average sleep latency during treatment phases was 77.1 minutes, and the average total sleep time was 453 minutes (7.5 hours). There were no significant differences when looking at within-subject differences in total sleep time during weighted blanket vs unweighted blanket intervention periods. The total sleep time was 454.4 minutes when the children used weighted blankets compared with 457.7 minutes when using placebo blankets. Mean sleep latency was 74.3 minutes with the weighted blanket compared with 69.9 minutes with the control blanket, a difference that did not reach statistical significance. The average time awake after sleep onset (84 minutes) was virtually identical between the two groups. Parental estimates of sleep duration during weighted and unweighted blanket treatment phases did not differ. Children clearly favored the weighted blanket over the unweighted blanket when asked about general likability (48% vs 31%), and the parents believed that sleep was improved using the weighted blanket compared with the unweighted blanket (51% vs 16%). Moreover, parents judged that the weighted blanket made their child calmer (35% vs 14%) than the unweighted blanket. The investigators concluded that the weighted blankets provided no clinically measurable benefit for sleep measurements in these children, including parental assessments of sleep duration and sleep latency. However, parents and children both reported preferring the weighted blankets.

Read more here

Sleep hygiene and children

This article explains how important having sleep hygiene is for children.

Getting kids ready for bed can have its challenges. Without good sleep hygiene, each night could be started with the odds stacked against you. Dr. Brian McGinley says 15-20 minutes is all it takes, on average, to fall asleep. Not getting those Z's can result in poor school performance, difficulty paying attention, weight gain, moodiness and inability to make decisions. In older children, it can result in an increased risk for depression, risk taking behavior and possible suicidal thoughts.

Getting the right amount of sleep can make all the difference, he said. McGinley, an associate professor of pediatric sleep medicine, says a 5-year-old, on average, needs about 10½ to 11 hours of sleep, a 10-year-old about 10 hours and adolescents between 9 and 9½ hours of sleep.

A poll by the National Sleep Foundation found that 75 percent of teens in America are getting less than eight hours of sleep. McGinley says electronic media have played a huge role in this. In fact, studies show the effects of TVs, computers, video games and phones are delaying bedtime even more. Interactive behaviors, such as pushing buttons or socializing online, stimulate the brain, and light signals it's time to be awake. “The commercials get loud, the car crashes and your brain is constantly responding to those things.”

McGinley says another sleep deterrent is caffeine. “Caffeine use can be used to delay the ability to fall asleep earlier and can be disruptive for sleep, and then you wake up and you’re tired and you feel the need for caffeine.” To help combat restlessness, McGinley suggests cutting off caffeine at noon.

For younger children, there’s something called behavior insomnia or the more familiar term, “curtain calls.” “Mom, I need a glass of water, it’s dark, can you read another story.” For those requests, McGinley says be consistent. “It might even be just a pat or a kiss on the forehead and then removing yourself from the room, encouraging them to go back to sleep. If the interaction is minimal and some of those requests are denied, they would likely fall asleep quickly.”

Allowing extracurricular activities or homework to be done up until bedtime does not give the brain enough time to wind down.

If sleep behavior doesn't seem to be the case, a child may be suffering from a biological disorder, which may require a trip to the doctor's office. “If you do get enough sleep but are having problems breathing during sleep, you have sleep apnea.” Signs of sleep apnea include snoring, pauses in breathing, gasping and restless sleep. Another sleep disturbance children face is insomnia. “Insomnia is the inability to fall asleep, stay asleep or wake up too early or any combination of those things.”

A study may also be needed for children who sleep just fine at night but have trouble staying awake the next day. “There’s a real biological process here that can be corrected with treatment.” If a child is believed to have sleep apnea, insomnia or other serious sleep disturbances, contact a physician to discuss the need for a sleep study.

When it comes to good sleep hygiene, McGinley says set a regular time for bed and be consistent. Turn off all electronic devices one to two hours before bed, allowing the brain time to wind down. Focus on activities that are more relaxing like reading, writing, painting or coloring. Create a comfortable sleep environment. Cooler temperatures at night are best and the room should be dark and quiet. “Your brain is very responsive to noise and especially changes in noise fluctuations.”

If noise is a problem, try listening to white noise like a fan, static or rain. Those who like to take a hot shower or bath at night, bump that up two hours before bedtime to give the body time to cool down. McGinley adds that it’s OK to eat a light snack before bed, “especially if they’re waking up and they’re hungry in the middle of the night.”

Read more here

Technology in a child's bedroom is associated with less sleep each night

A child sleeping with technology in his or her bedroom has been shown to be associated with up to one hour less of sleep per night.

Sleep, or lack thereof, and technology often go hand in hand when it comes to school-aged kids. Nearly three out of four children (72%) between the ages of 6 and 17 have at least one electronic device in their bedrooms while sleeping, according to a National Sleep Foundation survey. Children who leave those electronic devices on at night sleep less -- up to one hour less on average per night, according to a poll released by the foundation earlier this year.

Dr. Jill Creighton, Assistant Professor of Pediatrics, Stony Brook Children's Hospital says the key to a successful school year starts with Z's. So parents, how can you power down your kids at night and make bedtime easier? Dr. Creighton shares her tips. "First -- develop a nighttime routine," says Dr. Creighton. Whether it's a bath, reading a book or listening to soothing music, these actives will have a better impact on your child to help them relax before going to sleep.

Second -- Power off! "The hour before bed should be a no-electronics zone," says Dr. Creighton. Studies show that the light from backlit electronics (like tablets, smartphones and video games) can disrupt our ability to fall -- and stay -- asleep. Dr. Creighton says designate a spot in your home for electronics to be plugged in, then have your kids start their bedtime routine by plugging in one hour before lights out. Ban hand-held devices from the bedroom. "The burst of light from a phone (even if it's just to check the time) can break a sleep cycle," says Dr. Creighton. "A regular alarm clock is best."

If your child has a slight addiction to technology and is resistant about turning off their device, try dialing down the screen time. "Reduce screen time by 30 minutes or more each week until you reach your goal," says Dr. Creighton. "A good rule of thumb is try to limit recreational screen time to 60 minutes every day. And for every 30 minutes of screen time, make sure your kids get 30 minutes of physical activity."

Try to replace screen time with an activity. "It's sometimes hard to get kids off the couch and get them moving, especially if they think of physical activity as "exercise'' or "boring," says Dr. Creighton. "Parents, get creative and make moving fun for kids." Some of Dr. Creighton's ideas: a 20-minute family walk, 20 minutes of shooting hoops outside, walking the dog, going bike riding and doing chores (with the promise of an allowance) such as vacuuming, putting away laundry, raking leaves, shoveling snow and helping with the garbage/recycling, which are big favorites in her household.

Lastly, establish good habits. Being distracted by phones, hand-held devices and TV shows during mealtime cannot only lead to overeating, but additional unneeded screen time. And be a good role model. Parents, set a good example when it comes to screen time.

So how much sleep do your children need? General sleep guidelines from the National Heart, Lung and Blood Institute show that sleep time change as we age, but experts say there is no magic number for sleep, with individual needs varying.

• Newborns: 16-18 hours a day.

• Preschool-age children: 11-12 hours a day.

• School-age children: at least 10 hours a day.

• Teens: 9-10 hours a day.

• Adults (including the elderly): 7-8 hours a day.

Read more here

Pediatricians urge later school start time

This article explains why pediatricians are urging for later school start times for older kids in middle and high schools.

U.S. high schools and middle schools should start classes later in the morning to allow kids some much-needed sleep, a leading group of pediatricians is urging.

Ideally, the American Academy of Pediatrics says, the first bell should ring at 8:30 a.m. or later -- which is the case at only 15 percent of U.S. high schools right now.

At the very least, classes should start no earlier than 8 a.m., said Dr. Judith Owens, the lead author of a new academy policy statement on school start times.

The recommendations, published in the academy's journal Pediatrics, are based on research showing that U.S. kids are sleep-deprived, which has consequences for their health, school performance and safety.

"This is an important issue," said Dr. Marcel Deray, a Florida sleep specialist who wasn't involved in the recommendations.

"I see a lot of teenagers who are tired and have problems in school because they have to get up so early," said Deray, who directs the Sleep Disorders Center at Miami Children's Hospital. "Some kids are getting up at 5 a.m., 6 a.m."

Many people think the answer is for kids to just get to bed earlier, Owens noted. But it's not that easy, she said, because biology has other plans.

Around puberty, the body's natural sleep-wake cycle shifts, and it's actually hard for teenagers to fall asleep earlier than 11 p.m.

"Teenagers' bodies release melatonin later than (adults') do," Deray explained, referring to a hormone the brain secretes in the evening to induce drowsiness.

"The other issue," Owens said, "is that teenagers' sleep needs are greater than many people think. They need nine to nine-and-a-half hours."

Yet, 43 percent of U.S. public high schools start classes before 8 a.m., according to the U.S. Department of Education. Middle schools, meanwhile, typically start classes at 8 a.m. -- with about 20 percent starting earlier than that.

"And that's the first bell," Owens said. "That's not even counting the commute time."

So in areas where kids take the school bus, the actual school day could begin before sunrise.

According to Owens, U.S. high schools started bumping up start times back in the 1950s and '60s, mainly to space out bus runs. Many school districts start high schools and middle schools first, then circle buses back to pick up elementary school kids.

One option would be to flip elementary and high school start times, but parents often oppose that -- since young children could be standing at bus stops in the early-morning dark, or have no one at home after school. Another option -- running more buses -- would be expensive.

Transportation is not the only obstacle, according to the National Sleep Foundation, which supports pushing back school start times. Some other arguments are that sports and extracurricular activities would end too late; teenagers would have no time for after-school jobs; and a later start could conflict with working parents' schedules.

Owens acknowledged the logistical challenges, and said parents and school staff sometimes oppose later start times. As an example, she said the Fairfax County, Va., school district has been debating the issue for years. Four options, including one with a 9:15 a.m. high school start, will be put to a vote this fall.

Some districts have found "creative solutions" to certain obstacles -- like having high school students switch from school buses to public ones, according to the academy.

Deray thinks tackling the practical challenges is worthwhile. He said studies have linked kids' sleep deprivation not only to poorer school performance, but also to higher rates of car accidents, obesity and depression.

In a recent study of eight U.S. high schools that delayed their start times, researchers found improvements in kids' grades, attendance and car crash rates.

Later school starts are just one way to help sleepy kids, however. Deray offered parents some tips.

"All electronic devices should be turned off an hour or two before bed," he said. "The blue light from them suppresses melatonin production."

He also advised avoiding physical and mental stimulation close to bedtime -- which means exercise and homework should be done earlier in the evening. And while teenagers love to sleep till noon on weekends, that will only further disturb their sleep/wake cycle. Deray said kids should get up by 9 a.m. on weekends and get plenty of morning sunlight.

He acknowledged, though, that all of that is easier said than done.

Owens agreed. "One of the issues is that kids are overscheduled," she said. "Don't give them so many things to do that they can't get to bed before midnight."

Read more here

Children need to ease into school sleep schedules

This article explains that children need to be eased back into their school sleeping schedules after summer and that the transition cannot happen overnight.

Parents shouldn't wait until the last minute to help children get back into their normal sleep schedules for school, an expert says.

"Getting back on a normal sleep schedule doesn't just happen overnight," Peter Bidey, instructor of family medicine at Philadelphia College of Osteopathic Medicine, said in a college news release.

"A gradual transition back to regular sleep habits is essential. A drastic change in sleep habits can be a shock to your child's system," he explained.

During summer vacation, children tend to stay up later and sleep in longer. Letting them continue that pattern until school starts can lead to trouble that first morning they have to wake up early for class, Bidey pointed out.

Getting children back into a sleep schedule for school "should start at least a week before school begins," Bidey said. "Parents can begin waking their children up earlier each day with an alarm clock, and sending their child to bed a bit earlier each night."

One way to make mornings before school less hectic is to be well-organized, he suggested.

"Parents can pack lunches and lay out school clothes the night before. That will help them stay calm in the mornings, which will in turn keep children calm," Bidey said.

Research shows that adequate sleep benefits children's mental health and school performance, he noted.

Read more here

Headaches in children

This article discusses headaches in children, which is becoming more prevalent as the school year begins.

As the school year approaches and begins, many parents may start to hear their children complain about headaches.

According to Nick DeBlasio, MD, a pediatrician in Cincinnati Children's Hospital Medical Center's Pediatric Primary Care Clinic, about 10% of school-aged children and 15-27% of teens experience them from time to time.

Headaches can be triggered by a number of different things. Here are the most common causes of occasional headaches in children:

Inadequate hydration. Not drinking enough fluids is one of the biggest causes of headaches. This is especially true when the weather gets warmer and kids become more active outside and lose fluid through sweating. If this is the case, the cure might be as simple as having your child drink more water.

Diet. Does your child eat regular meals? Skipping one meal, like breakfast, can trigger a headache. It's also important to make sure that your child is eating a well-balanced diet with lots of fruits and vegetables. Too much caffeine and certain foods can cause a headache as well.

Sleep. Kids in middle and high school typically need at least 10-12 hours of sleep a night. Not sleeping enough at night can cause a headache. And getting less than 10 hours isn't enough to feel well-rested.

Stress. We all experience stress from time to time, and children and teens are no exception. If your child is under a lot of pressure from school, or experiencing big changes at home like a divorce or a big move, a headache can result.

Vision problems. If your child is unable to see what's happening at the front of the classroom, he might be straining his eyes to see far away, which can result in a headache. A vision test can give you a better understanding of whether or not your child's headaches are being caused by vision problems.

Family history. Your child is more likely to have headaches if a parent gets them as well.

If your child has a headache, try giving her water and over-the-counter ibuprofen. Follow the instructions on the package for the appropriate dosage and do not give it to your child more than three times in a week. If it persists for a few days or worsens, call your child's pediatrician.

Fortunately the majority of headaches in children are not a cause for alarm. However, there are a few instances which require a little more investigation. If your child's headaches have become more frequent or severe, if he wakes up in the morning of the middle of the night from it, or if the headache causes vomiting, it's best to have your child evaluated by your pediatrician.

He or she will perform a physical exam and decide if any tests need to be done. Brain MRIs and CT scans are rarely needed. If your pediatrician suspects a migraine, she might refer your child to a neurologist who is familiar with medications to help prevent and treat them.

And if your child or teen is suffering from chronic headaches and migraines, recent research by Cincinnati Children's found that adding cognitive behavioral therapy to treatment of pediatric migraines improves relief.

Read more here