Naps may mean worse sleep in children

A study out of Australia shows that napping may be tied to children getting worse quality sleep.

New research has raised questions about something that's common practice in 80 per cent of Queensland childcare centers.

The Sleep in Early Childhood Research group found children exposed to more than an hour of forced napping at centers slept worse at night, even when they started school a year later.

Lead researcher Dr. Sally Staton, from the Queensland University of Technology, said childcare providers needed to question whether mandatory nap times were appropriate.

"Certainly we're not suggesting that sleep time is not an important component or providing for sleep is not an important component," she said.

"But certainly (they need to be) thinking about whether mandatory sleep times, in particular really long mandatory sleep times, are actually the most appropriate way of meeting sleep needs, particularly for these pre-school aged children where their needs are so diverse."

Dr. Staton said another recent study found children had grown out of napping by the time they were three or four years old.

Federal legislation calls for centers to cater to the individual sleep needs of all their students but there is limited guidance about what exactly that means.

In practice, Dr. Staton's previous research found about 80 per cent of centers enforced mandatory nap times, where children were forced to lie on their sleeping mat without access to any other activities.

Those sleep periods could be as long as two and a half hours but were about an hour on average.

But the study, to be published in the US-based Journal of Developmental and Behavioral Pediatrics next month, found even in long mandatory nap periods only half of the children actually slept.

The QUT research fellow's study of 168 children across 130 services, which were selected from a larger representative study, found children exposed to mandatory napping slept an average of 24 minutes less at night.

"I guess what's particularly concerning is when we got to the second year of the study, so once the children were in school, they were getting less sleep overall," Dr. Staton said.

"So their total sleep was less, probably because now they weren't napping and the amount of sleep they were getting was actually dropping below what we could consider the normal range for children of that age group."

Australian Childcare Alliance CEO Gwynn Bridge disputed the 80 per cent figure, saying most centers gave children options to cater for their individual needs.

"Most of them are encouraged to read a book or they can lay next to their friend and have a chat," she said.

"A lot in the older groups aren't even putting mats out now.

"[For] the children who want to sleep and the ones the educators know will sleep mats will be offered, but it's certainly not the case where every child must sleep for an hour and a half."

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Study: Sleep issues common for children with psychiatric disorders

A study found that sleep issues are more common for children with a psychiatric disorder.

John Boekamp, Ph.D., clinical director of the Pediatric Partial Hospital Program (PPHP) at Bradley Hospital recently led a study that found sleep difficulties - particularly problems with falling asleep - were very common among toddlers and preschool-aged children who were receiving clinical treatment for a wide range of psychiatric disorders. The study, titled "Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders," is now published online in the journal Child Psychiatry & Human Development.

"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. "Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschooladjustment, and problems of irritability, hyperactivity and attention."

Boekamp's team was interested in learning more about sleep and sleep problems in young children with behavior problems, as early sleep problems may be both a cause and consequence of children's difficulties with behavioral and emotional self-regulation. "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.

The partial program that Boekamp leads at Bradley Hospital is a family-centered, intensive day treatment program for very young children aged from newborn to six who have serious emotional, behavioral or relationship disturbances. This study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a group of 183 young children admitted to the program. Diagnosable sleep disorders, particularly SOI, were quite common in the group, exceeding previous estimates obtained in community settings. Overall, 41 percent of children in the study also met diagnostic criteria for a sleep disorder. Sleep problems were especially common in children with disruptive behavior, attention, anxiety and mood problems.

"It is important for families to be aware of how important sleep is to the behavioral adjustment and wellbeing of young children," said Boekamp. "Sleep disorders may be unrecognized and under-diagnosed in young children, particularly when other behavioral or emotional problems are present."

Difficulties with sleep may be particularly important to address when children are also struggling with challenging daytime behaviors, such as problems with compliance, aggression, attention and mood. Sleepiness and fatigue may exacerbate these problem behaviors.

"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."

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Sleep education for preschoolers helped them get more sleep

A study based on a sleep education program for preschoolers caused the children to get 30 minutes more sleep per night.

Taking part in an educational sleep program resulted in a 30-minute average increase in sleep duration at a one-month follow-up for preschoolers, according to a new study from the University of Michigan.

In the study, published in the journal SLEEP, families in two Head Start programs participated in the Sweet Dreamzzz Early Childhood Sleep Education Program™. The Detroit-area nonprofit organization, Sweet Dreamzzz, Inc. developed the program and offers it for free when funding allows. Head Start programs aim to give preschool opportunities to low-income families, in part to improve readiness for elementary school.

Researchers found that among 152 preschool children and their families, the sleep education program produced a 30-minute increase in sleep duration among the kids, says lead author Katherine (Wilson) DeRue, M.D., M.S., who conducted the study while a postgraduate fellow at the University of Michigan Sleep Disorders Center and Departments of Neurology and Pediatrics.

"We know that an increase in sleep duration of that magnitude is associated with better function for kids during the day" says DeRue, who is now a pediatrician and sleep physician at IHA Pulmonary, Critical Care and Sleep Consultants in Ann Arbor, Mich.

"Parents often underestimate how much sleep their kids require, so an educational program like this, directed at parents when they have more control over their kids' sleep schedules, can have great impact."

The study also found that parents' awareness and knowledge of good sleep behaviors also improved after program participation, but this effect was not sustained when parents were retested one month later.

The educational program included a one-time, 45-minute sleep education program for parents, and two weeks of classroom sleep education for the preschoolers. Parents were asked to keep diaries for assessment of their children's sleep habits.

"So we found that a two-week program of daily exposure to sleep education in the preschool classroom, along with an initial presentation for parents, can be an effective strategy," says Ronald D. Chervin, M.D., M.S., the study's senior author, director of the U-M Sleep Disorders Center, and a volunteer on Sweet Dreamzzz's Advisory Board.

"But repeated exposure or reminders about the sleep information may be necessary to maintain the effects for kids and especially parents over time." This is believed to be the first study to examine the effect of a sleep education program on the sleep of preschool age children.

The Head Start programs were located in greater Lansing, Mich. and Detroit, Mich.

The lessons taught in school seemed to stick with the children. Among the lessons were recognizing 8 p.m. as the desirable bedtime; learning that an apple is a better snack before bedtime than a candy bar; and identifying reading rather than watching TV as a relaxing activity before bedtime.

"We are pleased to see that the University of Michigan researchers have been able to measure the impact of our sleep program. We know a proper sleep environment, regular bedtime routine, and the right amount of sleep hours each night can impact the future of our children," says Nancy Maxwell, executive director of the non-profit Sweet Dreamzzz, Inc.

Sweet Dreamzzz provides educational programs on sleep, along with free sleep essentials- such as sleeping bags, toothbrushes, and books about sleep -- to schoolchildren in low-income areas. Sweet Dreamzzz's main aims are to encourage better sleep -- and thereby better health and learning -- at the earliest ages.

Most evidence indicates that children commonly obtain insufficient sleep, says DeRue, and this study provides a critical demonstration that minimal, relatively inexpensive interventions can make a difference.

"Family sleep education during early childhood years, when the sleep habits are being established, could prove to be a cost-effective but impactful strategy to improve children's overall health," says DeRue.

"Nutrition and exercise are commonly the focus of educational efforts to improve children's health," adds Chervin. "Good sleep -- in quality and quantity -- is no less vital to our kids' future, yet it's rarely if ever discussed. Our new findings suggest that a small amount of effort to promote better sleep could have substantial benefit now, and conceivably for years to come as these youngsters grow older."

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Sleep quality and obesity in children

A new study provides more evidence that sleep and sleep quality are linked to obesity in children.

Young children who get too little sleep are more likely than others to be obese by age 7, according to a new study.

Previous research has suggested insufficient sleep before age 4 raised the risk of obesity. But the new study, published online May 19 inPediatrics, observed the link from infancy to mid-childhood.

"Insufficient sleep is an independent and strong risk factor for childhood obesity and the accumulation of total fat and abdominal fat," said study researcher Dr. Elsie Taveras, chief of general pediatrics at Massachusetts General Hospital for Children in Boston.

"The main strength of this study is we looked at sleep at multiple periods," she added.

Excess body fat in childhood sets the stage for serious health problems, such as heart disease and diabetes.

Taveras and her team studied more than 1,000 children. Curtailed sleep was defined as fewer than 12 hours a day from ages 6 months to 2 years, fewer than 10 hours daily for ages 3 and 4, and fewer than nine hours a day for ages 5 to 7.

Kids who were most sleep deprived were about 2.5 times more likely to be obese than those who slept the most, the study found.

They were also 2.5 times more likely to have higher total fat, higher abdominal fat and a higher waist and hip circumference, said Taveras.

Many possible explanations exist for this association, Taveras said.

"If you sleep too little, it disrupts some of the hormones that regulate how hungry we are and how full we are," Taveras said.

In households with no consistent bedtime for children, there is likely to be chaos around regular mealtimes, too, and that can affect weight, she added.

Children who don't sleep enough may watch more television than kids who go to bed earlier, she said. Watching TV has long been linked with eating more, especially in response to food commercials, she said.

Or the children may have other "high-tech distractions," she said.

The new findings don't surprise Dr. William Muinos, director of the weight management program at Miami Children's Hospital in Florida, who was not involved in the study.

His advice for parents? Set a consistent bedtime. "Limit caffeinated beverages late in the day. Cut out all those electronic distractions; get them out of the bedroom," Taveras said.

Insist that children go to bed earlier, Muinos said. "Lack of sleep does change the physiology," he added. "It will put you in what is called stress mode. The body will read it as, 'I need to hold onto calories and accumulate fat.'"

The new research, Muinos said, "is very good because it studied a large group of children for a long period of time."

Ongoing studies are looking at whether improving sleep may directly improve weight control in children, Taveras said. And it's already known that good sleep has other benefits. "There's really good evidence that shows it improves schoolwork," she said.

For the study, mothers reported their children's usual sleep duration in a 24-hour period, beginning at age 6 months. They also reported it every year from age 1 to 7.

The children got a sleep score, ranging from zero (insufficient sleep) to 13 (consistent sufficient sleep). The average sleep score was 10.2. However, about 4 percent of kids were in the insufficient range, zero to 4. About 40 percent had a score of 12 or 13, termed enough sleep.

Those who slept less than average were more likely to be from poorer families with less educated mothers, the study found.

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Children's internal clock could result in trouble sleeping

This article discusses how a child's internal clock, which regulates their natural melatonin levels, could result in the child fighting off sleep at bedtime.

"Just one more story, please?" ''I need a glass of water." ''Mom, I can't sleep!"

When youngsters continually struggle to fall asleep at night, new research suggests maybe their body clock doesn't match their bedtime.

That doesn't mean tots should be up at all hours.

"Just like nutrition and exercise, sleep is critical for good health," said sleep scientist Monique LeBourgeois of the University of Colorado, Boulder, who is leading the research.

The ultimate goal is to help reset a delayed sleep clock so that young children can settle down more easily, she said. Hint: It seems to have a lot to do with light.

We all have what's called a circadian rhythm, a master biological clock, that regulates when we become sleepy, and when we're more alert. Those patterns vary with age: It's the reason teenagers are notorious for late nights and difficult-to-wake mornings.

But how does that clock work in preschoolers, who need more sleep than older kids or adults? A first-of-its-kind study tracked 14 healthy youngsters for six days to begin finding out.

The children, ages 2½ to 3, wore activity monitors on their wrists to detect when they slept. Parents kept diaries about bedtime routines.

Then on the last afternoon, researchers visited each home, dimming lights and covering windows. Then, every 30 minutes for six hours leading up to the child's appointed bedtime, they also coaxed each tot to chew on some dental cotton to provide a sample of saliva.

The reason: To test for levels of a hormone named melatonin that is key to the sleep cycle and also sensitive to light. At some point every evening, people's melatonin levels surge and a while later, they begin to feel sleepy. Among adults who sleep well, that melatonin rise tends to happen about two hours before whatever is their chosen bedtime.

For preschoolers, the new study found that on average, the melatonin surge occurred around 7:40 p.m. The children tended to be tucked in around 8:10 p.m., and most were asleep 30 minutes later, LeBourgeois reported in the journal Mind, Brain and Education.

When melatonin rose earlier in the evening, tots who hit the sack around 8 fell asleep a bit faster. But when the melatonin surge was closer to bedtime, the youngsters were more likely to fuss or make curtain calls after lights-out.

Two children in the study actually were tucked in before their rise in melatonin ever occurred, and it took them up to an hour past bedtime to fall asleep, she said.

"We don't know what that sweet spot is yet," LeBourgeois said, but the data suggest bedtime is easiest if the melatonin surge occurred at least 30 minutes earlier.

The study reinforces what doctors have long suspected is one bedtime barrier, said Dr. Jyoti Krishna, a pediatric sleep expert at the Cleveland Clinic. Other factors can disrupt a child's sleep, too, such as noise, stress or anxiety, or disrupted home routines, he cautioned.

"But this paper reminds us that, hey, there is a time that the body is more ready to sleep than at other times," Krishna said.

The National Institutes of Health says preschoolers need 11 to 12 hours of sleep each day; some typically comes from an afternoon nap.

Parents don't have melatonin tests as a guide, so Krishna advises looking for cues when setting a bedtime — yawning, rubbing eyes — and then to adjust that bedtime as the child gets older.

"The melatonin onset and our body rhythms change," Krishna said. "You can't stick to what worked two years ago with this child, because this child is now a different child."

About 25 percent of young children experience some type of sleep difficulty, including trouble settling down at bedtime, LeBourgeois said. Harried parents aside, there's concern that early-in-life bedtime frustration might lead to more persistent sleep trouble.

"Listen to your child's physiology," she advised. Some steps that might help:

—Research shows that in adults, too much light in the evening delays the melatonin surge and subsequent sleepiness. While there's no data in young children yet, LeBourgeois says dimming the lights about an hour before bedtime makes sense.

—Avoid electronics near bedtime, because they generate a specific type of light that triggers wakefulness. LeBourgeois was horrified to hear one parent offer a sleepless youngster an iPad to play with as long as the child stayed in the bedroom.

—And make sure blackout shades aren't keeping your children from getting enough morning sunlight, she said. Light in the morning also is key to keeping the biological sleep clock on schedule.

Stay tuned: With funding from the National Institute of Mental Health, LeBourgeois has begun a larger study that will track sleep patterns of 40 2-year-olds until they're 5. She'll also measure their light exposure, and periodically record their brain waves during sleep, in a bid to better understand the influence of sleep patterns on children's development.

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Preschoolers learn better with midday naps

Research shows that a midday nap helps preschool children retain what they learned that morning showing how important sleep is for learning and creating memories.

A midday nap can help pre-school children remember what they learned in the morning, according to a study by psychologists in the US.

The research suggests that carers and nurseries that phase out after-lunch sleeps may be harming children's ability to learn, by disrupting the way their brains store memories.

Pre-schoolers who went without a midday sleep fared worse on memory tests than those who napped. They also failed to improve their scores even after a good night's sleep, the researchers found.

The findings highlight the crucial role of sleep in consolidating memories, a process that underpins the brain's ability to learn new information.

The children who benefited most were "habitual nappers" who would sleep when carers encouraged them to, rather than more mature children who had outgrown the need for a nap.

For the study, psychologists went into pre-school classrooms and taught 40 children aged three to nearly five years old a simple computer game. It required them to memorize the positions on a grid of images including a cat, an umbrella, and a policeman. The children were trained from 10am until they could remember the positions of around 75% of the pictures.

The scientists visited each child twice over the course of the study. On one visit, the child slept for an hour or so between 1pm and 3pm, and stayed awake on the other. To see how sleep affected their memory, the scientists tested each child again later the same afternoon.

Those who napped saw no change in their morning score of 75%, but the ones who stayed awake fared much worse, averaging scores of 65%, according to a report in the Proceedings of the National Academy of Sciences.

"If they stayed awake they forgot more of the items they had remembered in the morning, whereas if they took a nap, they remembered all the items they had learned in the morning," said Rebecca Spencer at the University of Massachusetts in Amherst.

To check whether the nappers were simply more alert and attentive than the others, the scientists returned the next day and tested the children again. Their scores did not change, suggesting that daytime sleep was crucial.

Spencer said that parents and pre-schools are steadily cutting down the time given to children's naps to fit a convenient schedule, or to make more time for a curriculum.

"You often see children forced out of napping, and hopefully this will help parents and pre-schools to understand that maybe that's not the best decision, and that a nap is an important part of the day," said Spencer.

"This is the science that's needed to preserve nap time. If our goals are to prepare children for early education, the naps are consistent with that goal because it's really helping them to learn," she added.

The scientists went on to look at the brain activity of 14 children while they slept in the unversity's sleep lab. They found that children with the best memory recall experienced more "sleep spindles" – brief bursts of activity thought to happen when the brain shunts memories from short-term storage in the hippocampus to the neocortex.

"This demonstrates very vividly the value of sleep for consolidating memories. Very young children find it quite difficult to retain information over the course of a full day, so in those circumstances, a nap is going to be useful for ensuring that whatever they learn is retained in the longer term," said Gareth Gaskell, professor of psychology at York University.

"At these ages, children are shifting from multiple sleeps in 24 hours to a single sleep overnight. It may well be that non-habitual nappers are becoming more adult-like, and have got that little bit further in the process."

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Preschoolers who sleep less have more behavior issues

A study shows that toddlers and preschoolers who do not get enough sleep have more behavior problems than those who get adequate sleep.

Four-year-olds with shorter than average sleep times have increased rates of "externalizing" behavior problems, reports a study in the July Journal of Developmental & Behavioral Pediatrics, the official journal of the Society for Developmental and Behavioral Pediatrics. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"Preschool children with shorter nighttime sleep duration had higher odds of parent-reported overactivity, anger, aggression, impulsivity, tantrums, and annoying behaviors," according to the new research by Dr. Rebecca J. Scharf of University of Virginia, Charlottesville, and colleagues. They recommend that parents and health care providers discuss steps to improve sleep habits for preschool-age children with behavior problems.

Shorter Sleep Times, More Behavior Problems

The researchers analyzed parent responses from a nationally representative study of approximately 9,000 children, followed from birth through kindergarten age. When the children were four years old, nighttime sleep duration was estimated by asking the parents what time their child typically went to bed and woke on weekdays.

On a standard child behavior questionnaire, parents rated their child on six different "externalizing" behavior problems such as anger and aggression. (Externalizing behavior problems are outward behaviors, distinguished from "internalizing" problems such as depression and anxiety.) The relationship between sleep duration and behavior scores was assessed, with adjustment for other factors that might affect sleep or behavior.

The average bedtime was 8:39 pm and wake time 7:13 am, giving a mean nighttime sleep duration of about 10½ hours. Eleven percent of children were considered to have "short sleep duration" of less than 9¾ hours (calculated as one standard deviation below the average).

On the child behavior questionnaire, 16 percent of children had a high score for externalizing behavior problems. Behavior problems were more common for boys, children who watched more than two hours of television daily, and those whose mothers reported feeling depressed.

After adjustment for other factors, "Children in the shortest sleep groups have significantly worse behavior than children with longer sleep duration," Dr Scharf and colleagues write. The effect was greatest for aggressive behavior problems, which were about 80 percent more likely for children with nighttime sleep duration of less than 9¾ hours.

Shorter sleep times were also associated with 30- to 46-percent increases in rates of the other externalizing behaviors studied, including overactivity, anger, impulsivity, tantrums, and annoying behaviors. In a linear analysis, as sleep duration increased, troubling behaviors decreased.

Previous studies in smaller groups of children have identified shorter nighttime sleep duration as a risk factor for behavior problems in preschool children. The average 10½-hour sleep time in this nationally representative sample is less than in studies performed in past decades, and less than currently recommended for four-year-olds.

The new results, along with other recent studies, add to the evidence that preschoolers who sleep less will have more behavior problems, including disruptive behaviors like aggression and overactivity. Although the study can't draw any conclusions about causality, "there is good reason to believe that short nighttime sleep duration leads to externalizing behaviors," the researchers write.

Dr Scharf and coauthors recommend that doctors and health care providers ask about bed and wake times when talking to parents about young children with behavior problems. They add, "Advocating for regular sleep habits, healthy sleep hygiene, and regular bedtime routines may be helpful for young children."

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