Pediatric Neurology Telemedicine Tips

A NICE GRAPHIC. EXCEPT,  WE TRY TO GET PEOPLE USED TO THE PLATFORM WELL-BEFORE VISITS. - JR

Pediatric Neurology Telemedicine Tips

Child & Adolescent Neurology TELEMEDICINE

Pediatric Pulmonary TELEMEDICINE

Sleep Disorders Telemedicine

Pediatric Neurology Coronavirus Emergency Telemedicine link HERE! 

Pediatric Neurology Services at Home During Corona / Covid -19

Social Distancing Saves Lives in Child Neurology Too

19 March 2020

To: HSC Houston Specialty Clinic Child Adolescent  Neurology Patients

Subject: Dr. Rotenberg, Kara Schmidt, Testing and EEG  - Appointments during Coronavirus Emergency 

• The State of Texas is in the midst of a public health emergency due to coronavirus. 
• It is imperative to “flatten the curve” of this pandemic by practicing strict social distancing. 
• Our practice is committed to our patients' needs. 
• We need to make changes to safely deliver care under these unusual circumstances. 
• Telemedicine visits are an established part of our practice.  It's business as usual. 

Therefore, effective immediately: 

1. All appointments will be moved to telemedicine status ONLY. 
2. New patients will be completed by telemedicine ONLY. 
3. Most testing, dietician consults will be completed by telemedicine.  
4. There will be very few exceptions based on medical need. 
5. EEG visits will be rescheduled to a different time or place. 

Regarding pulmonary:  Dr. Susarla to release updated guidelines later today. 

This process will stay in place during the course of this emergency. 

Please call your insurance and/or employer to check telemedicine benefits. 

Thank you, 

Dr. Rotenberg 

Information on Covid19

https://www.facebook.com/groups/coronavirus.houston/

http://publichealth.harriscountytx.gov/Resources/2019-Novel-Coronavirus

Texas Telemedicine

Governor Abbott Waives Certain Regulations For Telemedicine Care In Texas

March 17, 2020 | Austin, Texas | Press Release

Governor Greg Abbott today waived certain regulations and directed that the Texas Department of Insurance (TDI) issue an emergency rule, all relating to telemedicine care for patients with state-regulated insurance plans to help doctors across Texas continue to treat their patients while mitigating the spread of COVID-19. The suspensions and emergency rule will work together to allow telemedicine visits for patients with state-regulated plans to be paid the same as in-office visits for insurance purposes. These actions build upon waivers the Governor issued last week of portions in the Occupations Code to expand provider flexibility in providing medical services over the phone.

“As the State of Texas responds to COVID-19, we continue to work to maintain regular health care services and operations throughout the state, and telemedicine is one of the most valuable tools we have to ensure Texans continue to receive the health services they need,” said Governor Abbott. “Expanding telemedicine options will help protect the health of patients and health care professionals, and help Texas mitigate the spread of COVID-19.”

Doctors will be eligible for payment from insurance plans regulated by TDI for medical visits they conduct over the phone instead of in-person at the same rate they would receive for in-person visits. 

Medical providers seeking guidance on the impact of the new rule can expect guidance from the Texas Medical Board to be issued in the coming days, including administrative guidance for billing to ensure that claims are processed smoothly.

Insurers seeking guidance on implementation of the emergency rule should contact TDI or visit their webpage for more information.

This coordinated efforts between the Office of the Governor, the Texas Department of Insurance, the Texas Medical Board, and health insurance plans will increase access to health care for all Texans. Today’s action will expand telemedicine options by giving health care providers greater flexibility to perform audio-only telephone consultations with their patients.

As a reminder, Texans covered by CHIP or Medicaid will not be charged copays for test or telemedicine consults. Individuals covered by Medicare or large employer plans should check with their health plan administrator to determine their specific benefits. 

Cannabis Treatment for Epilepsy: Where is the evidence?

Is there good evidence for cannabis efficacy and safety in treating epilepsy?  Yes.  - JR

Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?

Evidence for cannabidiol / CBD superiority over placebo in treating
refractory epilepsy syndromes. 

The interest in cannabis-based products for the treatment of refractory epilepsy has skyrocketed in recent years. Marijuana and other cannabis products with high content in Δ(9) - tetrahydrocannabinol (THC), utilized primarily for recreational purposes, are generally unsuitable for this indication, primarily because THC is associated with many undesired effects. Compared with THC, cannabidiol (CBD) shows a better defined anticonvulsant profile in animal models and is largely devoid of adverse psychoactive effects and abuse liability. Over the years, this has led to an increasing use of CBD-enriched extracts in seizure disorders, particularly in children. Although improvement in seizure control and other benefits on sleep and behavior have been often reported, interpretation of the data is made difficult by the uncontrolled nature of these observations. Evidence concerning the potential anti-seizure efficacy of cannabinoids reached a turning point in the last 12 months, with the completion of three high-quality placebo-controlled adjunctive-therapy trials of a purified CBD product in patients with Dravet syndrome and Lennox-Gastaut syndrome. In these studies, CBD was found to be superior to placebo in reducing the frequency of convulsive (tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet syndrome, and the frequency of drop seizures in patients with Lennox-Gastaut syndrome. For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes.

J Epilepsy Res > Volume 7(2); 2017 > Article Review Article Journal of Epilepsy Research 2017; 7(2): 61-76. Published online: December 31, 2017 DOI: https://doi.org/10.14581/jer.17012 Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?

Helmet laws by the state

This useful resource lists helmet and bicycle laws by the state. In Texas, there is no universal helmet law for motorcyclists, however those under 21 years old need to wear helmets while riding a motorcycle. Additionally, there is no required laws for bicyclists to wear helmets.

Motorcycle Helmets

In 1967, the federal government required states to enact universal motorcycle helmet laws to qualify for certain highway safety funds. By 1975, all but three had complied. In 1976, Congress revoked federal authority to assess penalties for noncompliance, and states began to weaken helmet laws to apply only to young or novice riders.

Learn More About Motorcycle Safety

Issue Brief

2010 Motorcyclist Fatalities

2009 Motorcyclist Fatalities

Survey of the States: Motorcycle Safety ProgramsPublished 2008

Related Links

Currently, about half the states require helmets for all motorcyclists. Most other states require helmets for certain riders, and a few have no helmet law. GHSA urges all states to adopt a universal motorcycle helmet law and vigorously enforce existing laws.

• 47 states, the District of Columbia, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islandshave a helmet law for motorcyclists.
  • 19 states, the District of Columbia, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands have a universal helmet law, requiring helmets for all riders.
  • The remaining 28 states and Guam require helmets for specific riders.
• 3 states (Illinois, Iowa and New Hampshire) do not have a motorcycle helmet law.

Bicycle Helmets

Learn More About Bicycle Safety

Issue Brief

Related Links

Fewer states have enacted bicycle helmet laws. GHSA only tracks state laws. However, many localities require helmet use for some or all bicyclists.

• 21 states, the District of Columbia, the Northern Mariana Islands and the Virgin Islands have a helmet law for bicyclists below a certain age, generally about 16.
  • Only the Virgin Islands requires helmets for all bicyclists.
• 29 states and Guam have no bicycle helmet law.

NOTE: GHSA does not compile any additional data on helmet laws other than what is presented here. For more information, consult the appropriate State Highway Safety Office.

State	Motorcyclists			Bicyclists
	Universal Helmet Law (Year Enacted)	Partial Law	Universal Helmet Law Repealed
Alabama	1967			<16
Alaska		<18 or instructional permit; all passengers	1976
Arizona		<18	1976
Arkansas		<21	1997
California	1992			<18
Colorado		<18; all passengers <18	1977
Connecticut		<18	1976	<16
Delaware		<19	1978	<18
D.C.	1970			<16
Florida		<21 or those with <$10,000 in medical coverage for motorcycle-related injuries	2000	<16
Georgia	1969			<16
Guam		<18
Hawaii		<18	1977	<16
Idaho		<18	1978
Illinois			1970
Indiana		<18	1977
Iowa			1976
Kansas		<18	1976
Kentucky		<21 or licensed <1 yr.; no medical insurance	1998
Louisiana	2004			<12
Maine		Licensed <1 yr.; all passengers <18	1977	<16 ($25 fine for 2nd or subsequent violation)
Maryland	1992			<16
Massachusetts	1967			>1 and <17 (<1 prohibited)
Michigan		<21 or no additional insurance (riders and passengers)	2012
Minnesota		<18 or instructional permit	1977
Mississippi	1974
Missouri	1967
Montana		<18	1977
Nebraska	1989
Nevada	1972
New Hampshire				<16
New Jersey	1968			<17
New Mexico		<18	1977	<18
New York	1967			>1 and <14 (<1 prohibited)
North Carolina	1968			<16
North Dakota		<18; all passengers if operator is <18	1977
Northern Mariana Islands	Yes			<18
Ohio		<18 or licensed <1 yr.; all passengers if operator required to wear helmet	1978
Oklahoma		<18	1976
Oregon	1988			<16
Pennsylvania		<21 or licensed <2 yrs. except those who complete a PnnDOT- or Motorcycle Safety Foundation-approved safety course	2003	<12
Puerto Rico	Yes
Rhode Island		<21 or licensed <1 yr.; all passengers	1976	<16
South Carolina		<21	1980
South Dakota		<18	1977
Tennessee	1967			<16
Texas		<21; those who have not completed safety course or have no medical insurance (secondarily enforced)	1997
Utah		<18	1977
Vermont	1968
Virgin Islands	Yes			All
Virginia	1970
Washington	1990
West Virginia	1971			<15
Wisconsin		<18 or instructional permit	1978
Wyoming		<18	1983
Totals States	47 + D.C., Guam, Northern Mariana Islands, Puerto Rico, U.S. Virgin Islands		31 stateshave had a universal helmet law repealed	21 + D.C., Northern Mariana Islands, U.S. Virgin Islands Age (# of States) All (Virgin Islands) <18 (3 + Northern Mariana Islands) <17 (2) <16 (12 + D.C.) <15 (1) <14 (1) <12 (2)
	19 + D.C., Northern Mariana Islands, Puerto Rico, U.S. Virgin Islands	28 + Guam Age (# of States) <21 (8) <19 (1) <18 (18 + Guam) Passengers <18 (1)

Sources: Insurance Institute for Highway Safety (IIHS) and State Highway Safety Offices.

Read more here

Texas bill will limit full-contact football practices

A new bill in Texas would reduce the amount of full-contact football practices making football practices safer for the players and less likely to have a concussion.

Even on the football field, lessons in physics are inescapable. When two football players collide, the force can equal that of a head smashing against a wall at 20 mph. Hits that serious can cause concussions or more serious brain injuries.

If national averages hold true, about 8,000 of the 168,000 high school football players in Texas will be diagnosed with concussions each year, and untold numbers more will suffer head injuries that aren’t discovered.

“There are a number of horror stories out there about concussions,” said state Rep. Eddie Lucio III, D-Brownsville. “There’s got to be a balance of continuing to play the game at an optimal level and providing safety for the kids.”

Having already successfully pushed laws to make helmets safer and compel schools to safely treat concussions, Lucio has now filed legislation to reduce violent collisions in high school and middle school football by restricting full-contact practices to just one per week.

Right now, the University Interscholastic League — which oversees extracurricular activities for Texas’ public schools — has rules limiting full-contact practices during the off-season. Once the season begins, however, full-contact practices are allowed at all times during the 8 hours a week teams may practice. The UIL set up a program to address concussions in 2005 and has been actively updating it to fit recommendations from its medical board, which receives injury information from selected schools but doesn’t keep statewide concussion statistics.

Lucio cites a Purdue University study finding that repeated blows to the head still change brain activity, even if the individual hits aren’t that serious. Researchers assert that repetitive hits, not just one strong blow, can lead to concussions. By decreasing full-contact practices, Lucio said he hopes to limit those blows and give the brain the proper time to heal.

“If you don’t allow (a) muscle or bone to heal, it’s going to break,” he said. “The same thing is relative to the brain. It can only heal itself at a certain rate, and any additional hits could cause more damage.”

Lucio is still refining his definition of “full-contact” and plans to meet with football coaches this weekend to hash out details of the bill.

Some coaches, however, are concerned that fewer full-contact practices could actually increase concussion risks.

Practicing the fundamentals of safe tackling helps build muscle memory, and athletes can benefit from repetition, said Joe Willis, head football coach and athletic coordinator at Cedar Park High School.

“If you only practice those (fundamentals) once a week, you are moving in the opposite direction of what logic would tell you,” he said. “A kid can’t learn without the experimentation phase.”

Coach of last year’s Class 4A Division II state champions, Willis said Lucio’s bill might be a politically smart move from someone who has never played the game, but he fears it would limit the ability of coaches to teach proper fundamentals.

“I’ve always felt like good coaching prevents those things,” Willis said. “…If you have one day (of full-contact practice), and you go out there with bad technique on that one day, you might get a concussion anyway.”

Not all football coaches share Willis’ concerns. Lake Travis High School head coach Hank Carter said that his team already doesn’t tackle players to the ground during regular season practice to limit injuries.

Concussion awareness has taken center stage over the past few years as more stories about brain injuries trickle out from former players. Former Chicago Bears safety Dave Duerson shot himself in the chest in 2011 to preserve his brain for science. Autopsies of Duerson and other former players found evidence of chronic traumatic encephalopathy, or CTE, a degenerative brain disease linked to brain trauma.

Both the NFL and the Ivy League agreed to limit full-contact practices in 2011 in reaction to public outcry over player safety. The NFL allows only 14 for the entire regular season, the Ivy League two per week. Lucio said he believes that stringent protective measures like these should be in place for the youngest athletes who haven’t finished physical development and don’t have the ability to lobby for themselves.

“We can’t sacrifice (students’) physical or mental health long term,” he said. “It’s got to be a healthy marriage between the two, which is a safe environment to play in but to still play the game like it’s meant to be played.”

Read more here

Prenatal Whole Genome Sequencing: Just Because We Can, Should We?

Prenatal Whole Genome Sequencing: Just Because We Can, Should We?

ScienceDaily (Aug. 10, 2012) — With whole genome sequencing quickly becoming more affordable and accessible, we need to pay more attention to the massive amount of information it will deliver to parents -- and the fact that we don't yet understand what most of it means, concludes an article in the Hastings Center Report. The authors are current or former scholars at the National Institutes of Health's Department of Bioethics.

Most analyses of the ethical issues raised by whole genome sequencing have been "futuristic forecasting," but the authors conclude that "this is problematic given the speed with which whole genome sequencing is likely to be incorporated into clinical care," as its price falls to under $1,000.

Prenatal whole genome sequencing differs from current prenatal genetic testing practice in ethically relevant ways. Most notably, whole genome sequencing would radically increase the volume and scope of available prenatal genetic data. In contrast with current tests, which identify serious genetic conditions in fetuses at high risk of them, the new tests would likely be used by many more expectant parents and reveal a wide spectrum of genetic traits, including disease susceptibility.

Some of the ethical challenges posed by prenatal whole genome sequencing arise from the uncertainty of what the information means. The function of more than 90 percent of genes in the human genome is unknown and as a result, the article says, "much of the data generated from whole genome sequencing over the next few years (or even decades) will be of questionable utility."

After analyzing the kind of information that whole genome prenatal testing will yield, the authors conclude that most of it would probably not be as helpful as information uncovered by the current categories of prenatal tests. They cited specific areas of concern.

First of all, the quality and quantity of information may augment parents' anxiety. "To the extent that parents now think of their child as a 'clean slate' during pregnancy, the prenatal image of a normal, healthy baby will be dramatically altered by this technology," the authors write. The anxiety over the results and changing views of what is "normal" could lead to an increase in pregnancy terminations.
Apart from reproductive decisions, the authors also foresee whole genome prenatal testing having a negative impact on child rearing. For example, if parents were able to get genetic information suggesting that their child's predicted IQ may be low, they might not strongly encourage and support the child's efforts in school.

Finally, the new technology could increase the tension between the interests of parents and children. Although parents have a strong interest in getting information that informs their reproductive choices, children have a competing interest in not knowing certain kinds of information about themselves -- information that could limit their autonomy as they grow into adulthood.

Given the potential harms from prenatal whole genome sequencing, the authors make four preliminary recommendations......

Web address:      HERE

Sleep Guidance for Kids and Teens Is Based on Sound Science

Dr. Rotenberg, among other other sleep specialists, signed on to this letter regarding recent articles in Pediatrics. - JR

Sleep Guidance for Kids and Teens Is Based on Sound Science

Posted: 03/16/2012 8:31 am

Representing scores of scientists who study sleep's role in the health and welfare of children, we need to be clear: Current expert recommendations for the sleep needs of children may not be perfect or immutable, but they are based on sound and rigorous science. For the sake of children whose parents, pediatricians and teachers may have seen recent media reports on two papers that call this into question, we're compelled to offer the context of what decades of research has produced.

Perhaps the best service is to describe current recommendations for healthy child sleep and then to describe why the pediatric sleep community of health care professionals is concerned that parents and other stakeholders have become misinformed about how well research supports these recommendations.

First of all, abundant research shows that sleep is a vital component of physical and mental health in children and adolescents. That and other research provides solid scientific grounding for current recommendations. Experts acknowledge that there is some individual variability in sleep needs, and therefore these recommendations are offered as guidelines for parents. They should be viewed in the context of potential signs of insufficient sleep in children and teens (difficulty waking in the morning, daytime sleepiness, sleeping longer on weekends and school vacations). Also, the recommendations for sleep amounts, such as those posted by the National Sleep Foundation (NSF), should always be applied in conjunction with other healthy sleep practices (such as regular bedtimes and wake times and bedtime routines).

As much as we care about children ourselves, we know we owe it to their parents to make (and defend) any recommendations on the basis of research, rather than intuition. We also need to be clear about the health effects of inadequate sleep, given the outward appearance that sleep cuts into "productive" time. Many lay people may not know that sleep is an enormously productive time -- especially for the developing brain -- when the brain organizes itself and consolidates the day's learning.

Here are the stakes. A large number of studies have shown associations between insufficient sleep and adverse health outcomes in teens and younger children. These include increased obesity risk, higher rates of motor vehicle accidents and accidental injuries, reduced cardiovascular health, and increased risk of depression and suicidal ideation. Many other studies have demonstrated the negative outcomes of sleep restriction and the positive impact of sleep extension on cognitive function of children and teens.

In a recent paper in the Eastern Economic Journal, two Brigham Young University economists dismiss such serious medical findings when they purport to determine an "optimal" amount of sleep for kids based on one question -- "How many hours of sleep do you usually get a night?" -- and a small set of standardized test scores. They report that that teens who got less sleep than experts recommend got better scores. We take issue with aspects of their methodology, but even if their paper were technically unassailable, as health professionals we would still be compelled to ask why a narrow set of test scores should be any parent's benchmark for optimal sleep when so many vital health conditions are endangered by too little sleep.

Ultimately, the key issue is to define how much sleep kids and teens need. That's long been a priority of our field because parents and health care professionals have always worried about this question and have needed science to provide answers. What has changed over time has been the increasing quantity and quality of science we've been able to apply. Many rigorous pediatric sleep research studies have done much to help address the issue of optimal sleep duration and healthy sleep practices in children and adolescents. These studies include large epidemiologic approaches as well as rigorous field tests and in-lab brain wave monitoring.We've posted a selected list of these studies and those referenced above, as well as more than 70 co-signers among our colleagues to this essay, on our website.

For all these reasons, we feel we should put in context a recent paper in Pediatrics that gained substantial and unduly credulous media attention. By looking at historical recommendations for sleep and measured sleep durations, the authors claimed that "there is almost no empirical evidence for the optimal sleep duration for children," and that "no matter how much sleep children are getting, it has always been assumed that they need more."

A careful look at the paper shows that almost all of their findings are driven by data in infants, for whom recommendations around the turn of the last century were hugely different from those around the turn of this century. Meanwhile, the sleep recommendations at other ages are pretty much on par across the century. Fundamentally, by ignoring many strong studies that provide a quantitative basis for current sleep recommendations, the authors do a serious disservice to parents, pediatricians, other health professionals, educators and, ultimately, to children. 

The scientific literature shows that children and adolescents experience better learning and academic success and greater physical and mental health when their sleep is protected and supported to levels recommended by a consensus of experts, such as those posted on the NSF website. Our hope is that by understanding the scientific record and context beyond these two recent splashes in the literature, the pediatric sleep community's service to parents and health professionals can be restored.

Mary A. Carskadon, PhD Judith Owens, MD MPH

Professor, Psychiatry and Human Behavior Director of Sleep Medicine

EP Bradley Hospital Children's National Medical Center

Alpert Medical School of Brown University Washington DC 20010-2970

Providence, RI 02906

                                           

1

 A list of references is provided after the list of sleep professionals endorsing the essay.3

Links to Media Coverage

Stories based on the original articles

Challenging 100 Years of Sleep Guidelines for Children - WSJ.com

Children are sleep-deprived, experts have fretted for 100 years - latimes.com

No science, just expert guesses on how much sleep kids need - USATODAY.com

Kids and Sleep Through History: They Have Never Gotten Enough, but Who's to Say How Much They 

Really Need? | Healthland | TIME.com

Scientists say kids throughout history have never had enough sleep | Mom Houston | a Chron.com blog

Responses to media coverage

How Much Sleep Do Kids Need? Not Such A Mystery After All : Shots - Health Blog : NPR

Sleep Expert Stands By Current Sleep Advice for Kids | Parents News Now, by Holly Lebowitz Rossi

Articles

Articles Referred to Directly in the Essay

• Eide, ER & Showalter MH.  Sleep and student achievement.  Eastern Econ J 2012; 1-13.  

Doi:10.1057/33j.2011.33

• Matricciani LA, Olds TS, Blunden S, Rigney G, Williams MT. Never Enough Sleep: A Brief 

History of Sleep Recommendations for Children. Pediatrics. 2012;129:548-556.

Selected Additional Articles on Childhood & Adolescent Sleep

1. Iglowstein I, Jenni OG, Molinari L, Largo RH. Sleep duration from infancy to adolescence: 

reference values and generational trends. Pediatrics. 2003;111:302-7.

2. Iglowstein I, Latal Hajnal B, Molinari L, Largo RH, Jenni OG. Sleep behaviour in preterm children

from birth to age 10 years: a longitudinal study. Acta Paediatr. 2006;95:1691-3.

3. Eaton DK, McKnight-Eily LR, Lowry R, Perry GS, Presley-Cantrell L, Croft JB. Prevalence of

insufficient, borderline, and optimal hours of sleep among high school students - United States, 

2007. J Adolesc Health. 2010;46:399-401.

4. Galland BC, Taylor BJ, Elder DE, Herbison P. Normal sleep patterns in infants and children: A

systematic review of observational studies. [published online ahead of print July 23, 2011]. Sleep 

Med Rev 2011. http://www.sciencedirect.com/science/article/pii/S1087079211000682. Accessed 

February17, 2012

5. Wolfson AR, Carskadon MA. Understanding adolescents' sleep patterns and school performance: a

critical appraisal. Sleep Med Rev. 2003;7:491-506.

6. Beebe DW. Cognitive, behavioral, and functional consequences of inadequate sleep in children and4

adolescents. Pediatr Clin North Am. 2011;58:649-65.

7. Berger RH, Miller AL, Seifer R, Cares SR, Lebourgeois MK. Acute sleep restriction effects 

onemotion responses in 30- to 36-month-old children. [published online ahead of print October 11, 

2011]. J Sleep Res. 2011. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2869.2011.00962.x/full. 

Accessed February 17, 2012

8. Arman AR, Ay P, Fis NP, Ersu R, Topuzoglu A, Isik U, et al. Association of sleep duration with

socio-economic status and behavioural problems among schoolchildren. Acta Paediatr. 

2011;100:420-4.

9. Gruber R, Laviolette R, Deluca P, Monson E, Cornish K, Carrier J. Short sleep duration is associated 

with poor performance on IQ measures in healthy school-age children. Sleep Med. 2010;11:289-94.

10. Feinberg I, Campbell IG. Sleep EEG changes during adolescence: an index of a fundamental brain

reorganization. Brain Cogn. 2010;72:56-65.

11. Nevarez MD, Rifas-Shiman SL, Kleinman KP, Gillman MW, Taveras EM. Associations of early life

risk factors with infant sleep duration. Acad Pediatr. 2010;10:187-93.

12. Spilsbury JC, Storfer-Isser A, Drotar D, Rosen CL, Kirchner LH, Benham H, et al. Sleep behavior in

an urban US sample of school-aged children. Arch Pediatr Adolesc Med. 2004;158:988-94.

13. Magee L, Hale L. Longitudinal associations between sleep duration and subsequent weight gain: A

systematic review. [published online ahead of print July 23, 2011]. Sleep Med Rev. 2011.

http://www.sciencedirect.com/science/article/pii/S1087079211000608. Accessed February 17, 2012.

14. Vorona RD, Szklo-Coxe M, Wu A, Dubik M, Zhao Y, Ware JC. Dissimilar teen crash rates in two

neighboring southeastern Virginia cities with different high school start times. J Clin Sleep Med.

2011;7:145-51.

15. Boto LR, Crispim JN, de Melo IS, Juvandes C, Rodrigues T, Azeredo P, et al. Sleep deprivation and

accidental fall risk in children. Sleep Med. 2012;13:88-95.

16. Gangwisch JE, Malaspina D, Babiss LA, Opler MG, Posner K, Shen S, et al. Short sleep duration as 

a risk factor for hypercholesterolemia: analyses of the National Longitudinal Study of Adolescent

Health. Sleep. 2010;33:956-61.

17. Lin JD, Tung HJ, Hsieh YH, Lin FG. Interactive effects of delayed bedtime and family-associated

factors on depression in elementary school children. Res Dev Disabil. 2011;32:2036-44.

18. Fitzgerald CT, Messias E, Buysse DJ. Teen sleep and suicidality: results from the youth risk

behavior surveys of 2007 and 2009. J Clin Sleep Med. 2011;7:351-6.

19. Gruber R, Wiebe S, Montecalvo L, Brunetti B, Amsel R, Carrier J. Impact of sleep restriction on

neurobehavioral functioning of children with attention deficit hyperactivity disorder. Sleep.

2011;34:315-

20. Beebe DW, Rose D, Amin R. Attention, learning, and arousal of experimentally sleep-restricted

adolescents in a simulated classroom. J Adolesc Health. 2010;47:523-5.

21. Randazzo AC, Muehlbach MJ, Schweitzer PK, Walsh JK. Cognitive function following acute sleep

restriction in children ages 10-14. Sleep. 1998;21:861-8.

22. Sadeh A, Gruber R, Raviv A. The effects of sleep restriction and extension on school-age children:

what a difference an hour makes. Child Dev. 2003;74:444-55.

23. Van den Bulck J. The effects of media on sleep. Adolesc Med State Art Rev. 2010;21:418-29, vii.

24. Bryant Ludden A, Wolfson AR. Understanding adolescent caffeine use: connecting use patterns with 

expectancies, reasons, and sleep. Health Educ Behav. 2010;37:330-42.

25. Hale L, Berger LM, LeBourgeois MK, Brooks-Gunn J. A longitudinal study of preschoolers'

language-based bedtime routines, sleep duration, and well-being. J Fam Psychol. 2011;25:423-33.

26. Mindell JA, Telofski LS, Wiegand B, Kurtz ES. A nightly bedtime routine: impact on sleep in young

children and maternal mood. Sleep. 2009;32:599-606.

27. Mindell JA, Meltzer LJ, Carskadon MA, Chervin RD. Developmental aspects of sleep hygiene:  

findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Med. 2009;10:771-5

9.

28. Wolfson, A.R. and Carskadon, M.A.  Sleep schedules and daytime functioning in adolescents.  Child 

Development 1998;69(4):875-887.  PMID: 9768476

29. Carskadon, M.A., Harvey, K., Duke, P., Anders, T.F., Litt, I.F., and Dement, W.C.  Pubertal changes 

in daytime sleepiness.  Sleep  1980; 2: 453-460.  PMID: 7403744  PMID: 12224838

30. Carskadon, M.A., Wolfson, A.R., Acebo, C., Tzischinsky, O., and Seifer, R.  Adolescent sleep 

patterns, circadian timing, and sleepiness at a transition to early school days.  Sleep 1998; 21(8):871-

881.  PMID: 9871949

31. Carskadon, M.A., Harvey, K., and Dement, W.C.  Acute restriction of nocturnal sleep in children.  

Percept. Motor Skills  1981; 53: 103-112.

32. Fallone, G., Acebo, C., Arnedt, J.T., Seifer, R., and Carskadon, M.A.  Effects of acute sleep 

restriction on behavior, sustained attention, and response inhibition in children.  Percept. Motor 

Skills 2001; 93:213-229.  PMID: 11693688

33. Ohayon, M.M., Carskadon, M.A., Guilleminault, C., and Vitiello, M.  Meta-analysis of quatitative 

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Link to Essay here

Huffingotn post published  here

The sentiments expressed in the essay were endorsed by the following individuals:

Full Name Affiliation

Candice A. Alfano, Ph.D. University Of Houston

Rosana Alves, MD, PhD Department of Neurology, Sao Paulo Medical 

School, University of Sao Paulo, Sao Paulo, Brazil

Strahil Atanasov, MD 

Kristin T. Avis, Ph.D, CBSM University of Alabama at Birmingham Dept of 

Pediatrics

Robert Beckerman, MD Section Chief, Pediatric Pulmonary and Sleep 

Medicine, Children’s Mercy Hospital, University of 

Missouri in Kansas City School of Medicine

Dean W. Beebe, Ph.D. Cincinnati Children’s Hospital Medical Center and 

University of Cincinnati College of Medicine

Julie Boergers, PhD Alpert Medical School of Brown University, 

Bradley-Hasbro Children’s Research Center

Lee J. Brooks, MD Children’s Hospital of Philadelphia, University of 

Pennsylvania

Tyish S. Hall Brown, Ph.D Assistant Professor, Department of Psychiatry, 

Howard University College of Medicine

Oliviero Bruni, MD Department of Pediatrics and Developmental 

Neurology, Tel-Aviv University

Joseph A. Buckhalt, Ph.D. Auburn University

Margaret A. Cashman, MD, 

FAASM

Harborview Medical Center; Department of 

Psychiatry and Behavioral Sciences, University of 

Washington School of Medicine

Mary Cataletto, MD Director, Children’s Sleep Services, Winthrop 

University Hospital, Mineola, NY

Sangeeta Chakravorty MD Director, Pediatric Sleep Evaluation Center, 

Children’s Hospital of Pittsburgh of UPMC

S.P.Chan MBBS Director of Pediatric Pulmonology, Staten Island 

University Hospital, New York

Barry A. Cohen, MD Pediatric Sleep Specialist, Saint Barnabas Medical 

Center, Livingston, NJ

Heidi V. Connolly, MD Chief, Division of Pediatric Sleep Medicine, 

Associate Professor of Pediatrics and Psychiatry,  

University of Rochester

Penny Corkum, PhD Departments of Psychology, Psychiatry & 

Pediatrics, Dalhousie University, Halifax, Nova 

Scotia, Canada

Flavia Cortesi MD Dept Pediatrics & Child Neuropsychiatry University 

of Rome “La Sapienza”, Italy 

Stephanie Crowley, PhD Assistant Professor, Department of Behavioral 

Sciences, Rush University Medical Center, ChicagoGary Feldman, M.D. Medical Director, Pediatric Sleep Disorders Center, 

Miller Children's Hospital Long Beach, Long 

Beach, CA 

Karyn Gail France, PhD, 

DipClinPsyc

Associate Professor, Programme Coordinator, Child 

and Family Psychology Programme, University of 

Canterbury, Christchurch, New Zealand

Dominic Gault, M.D. Medical Director, Division of Pediatric Sleep 

Medicine, Greenville Hospital System Children's 

Hospital 

Peter Glusker, MD-PhD, FAAN, 

FASM, FACP

Retired Adjunct Clinical Assistant Professor, 

Department of Neurosciences, Stanford Medical 

Center, Texas Childrens Hospital

Roger Godbout, Ph.D., 

psychologist

Professor of Psychiatry, University de Montréal, 

Montreal, Canada and Director of the Sleep 

Laboratory & Clinic, Riviere-des-Prairies, Montreal, 

Canada

David Gozal, MD  The Herbert T. Abelson Professor and Chair, 

Department of Pediatrics, The University of 

Chicago; Physician-in-Chief, Comer Children's 

Hospital 

Michael Gradisar, PhD, 

M.Psyc.(Clin.)

Flinders University, Australia

Madeleine Grigg-Damberger, MD Professor of Neurology, Medical Director of 

Pediatric Sleep Services, Associate Medical 

Director of the Clinical Neurophysiology 

Laboratory, University of New Mexico School of 

Medicine

Jim Halsey, R.R.T., RPSGT, RST Department of Respiratory Care, Stephens County 

Hospital, Toccoa, GA

Allison Harvey, PhD Professor of Clinical Psychology, University of 

California, Berkeley.

Jacqueline MT Henderson, PhD Canterbury Sleep Programme, Department of 

Psychology, University of Canterbury, Cristchurch, 

New Zealand

 Ibrahim MD Cleveland Clinic, Cleveland OH

Kyle P. Johnson, MD Associate Professor, Departments of Pediatrics and 

Psychiatry, Oregon Health & Science University

Lewis J. Kass, MD Westchester Pediatric Pulmonology and Sleep 

Medicine, Mt. Kisco, NY; Pediatric Sleep Disorders 

Center at Norwalk Hospital, Norwalk, CT

Sharon A. Keenan, Ph.D., 

REEGT, RPSGT

Diplomate of The American Board of Sleep 

Medicine and Director, The School of Sleep 

Medicine, Inc., Palo Alto, CA 

Amit Khanna, MD Adult & Pediatric Sleep Center, Lawrence & 

Memorial Hospital

Suresh Kotagal, M.D. Consultant, Neurology, Pediatrics and the Center for 

Sleep Medicine, Mayo Clinic, Rochester, MinnesotaAndrea M. Landis, PhD, RN Assistant Professor, Family & Child Nursing, 

University of Washington School of Nursing, 

Seattle, WA

Albin Leong, MD Chief, Pediatric Pulmonology, Roseville Kaiser 

Medical Center, The Permanente Medical Group, 

Inc.

Robin M. Lloyd, M.D. Mayo Clinic Center for Sleep Medicine

 Mark W. Maholwald, MD Professor, Department of Neurology, University of 

Minnesota Medical School and Visiting Professor, 

Department of Psychiatry and Behavioral Sciences, 

Stanford University

Cami Matthews, MD General Pediatric and Adolescent Medicine, UW 

Health Pediatric East Clinic, Madison, WI

Lisa J. Meltzer, Ph.D. Assistant Professor of Pediatrics, National Jewish 

Health

Richard P. Millman, MD Professor and Vice Chair of Medicine, Division of 

Biology and Medicine, Alpert Medical School, 

Brown University

Paul Montgomery Professor of Psycho-Social Intervention, University 

of Oxford, Oxford. UK

Cynthia D. Nichols, PhD, 

FAASM, CBSM

Neuropsychologist, Munson Healthcare Sleep 

Disorders Center

Camilo Ortiz, Ph.D. Doctoral Program in Clinical Psychology, Long 

Island University, CW Post

Phillip L. Pearl, M.D. Division Chief, Child Neurology, Children’s 

National Medical Center; Professor of Neurology, 

Pediatrics, and Music, The George Washington 

University School of Medicine and Columbian 

College of Arts and Sciences, Washington, D.C.

Rafael Pelayo, MD Stanford University School of Medicine

Rosa Peraita-Adrados, MD, PhD  Sleep Disorders Unit – Clinical Neurophysiology 

Department, Univeristy Hospital Gregorio Marañón, 

Madrid, Spain

Judi Profant, PhD, CBSM Kaiser Permanente, University of California, Irvine

Brandy M. Roane, Ph.D. Sleep for Science Research Laboratory of Brown 

University

Dominic Roca, MD PhD Stamford Hospital, Stamford CT

Mary Rose, PsyD, CBSM Assistant Professor, Director, Psycho-Oncology, 

Lester & Sue Smith Breast Center, Baylor College 

of Medicine

Carol L. Rosen, MD Professor, Department of Pediatrics, Case Western 

Reserve University, University Hospitals of 

Cleveland, Case Medical Center, Rainbow Babies & 

Children's Hospital

Mark Rosenblum, Psy D, LP, 

CBSM

Director, Insomnia Program, Minnesota Sleep 

Institute

Joshua Rotenberg, MD, Diplomate American Board of Psychiatry & Neurology, Child Neurology, & Sleep Medicine, Texas Medical & Sleep Specialists, Houston TX and San Antonio, TX.

Paul A. Rothenberg, Ph.D. Long Island Jewish Medical Center and Greenwich 

Hospital Sleep Disorder Centers

John Saito, MD FAAP FCCP Diplomate in the American Board of Sleep 

Medicine; President, Pulmonary & Sleep Disorder 

Consultants, Irvine, California. 

John N. Schuen, MD Chief, Pediatric Pulmonary and Sleep Medicine, 

Michigan State University-College of Human 

Medicine, Grand Rapids, MI

David C. Schwebel, PhD Professor of Psychology and Associate Dean for 

Research in the Sciences, University of Alabama at 

Birmingham

Yakov Sivan, MD Dana Children's Hospital, Tel Aviv University 

Faculty of Medicine,Tel Aviv Medical Center, Israel

George F. Slade

Kevin C. Smith, PhD University of Missouri -- Kansas City School of 

Medicine, Pediatric Psychologist, Section of 

Developmental and Behavioral Sciences, Section of 

Pediatric Pulmonary and Sleep Medicine, Children's 

Mercy Hospitals and Clinics

Jim Spilsbury, PhD, MPH Assistant Professor & Director, Academic 

Development Core, Center for Clinical 

Investigation,  Case School of Medicine

Kingman P. Strohl MD Case Western reserve University, Cleveland OH

Lisa Talbot, Ph.D. San Francisco VA Medical Center and University of 

California, San Francisco

Douglas M. Teti, Ph.D. Associate Director, Social Science Research 

Institute; Professor of Human Development, 

Psychology, and Pediatrics, The Pennsylvania State 

University; Lead Faculty, Parenting-at-Risk Faculty 

Research Initiative; Associate Editor, Infancy

Amy Walker, PhD, RN Assistant Professor, University of Washington, 

Department of Family & Child Nursing, Seattle

Teresa Ward, RN, Ph Assistant Professor,  Family & Child Nursing, 

University of Washington, Seattle

Shelly Weiss, MD FRCPC Associate Professor, University of Toronto; 

President, Canadian Sleep Society

Luci Wiggs, PhD Reader in Psychology, Oxford Brookes University, 

Oxford, UK

Mark C. Wilson, MD Children’s Hospital and Medical Center, UNMC, 

Omaha, NE

Amy Wolfson, PhD Professor of Psychology, College of the Holy Cross


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