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Sleep in Children - Discussion with Pediatric Sleep Specialist

children sleep disorders
Dr. Victor Jerome Ambrose is a pediatrician with special interest in pediatric sleep disorders. He underwent fellowship training in pediatric sleep and long term ventilation at Greater Ormond Street Hospital, London, UK. We interview him on sleep related issues in children.
1) How much sleep do children require for optimal physiological outcomes?
According to the recommendations cited by the Centers for Disease Control and Prevention, the required duration of sleep is for:
12 to 14 hours for children aged 1 to 3 years, 
decreasing to
11 to 13 hours for children aged 3 to 5, 
10 to 11 hours for children aged 5 to 10, 
and to
8½ to 9½ hours for adolescents
This has been reflected in various studies as well.
2) In today’s fast paced society, several factors are competing with child’s sleep time. Many children seem to spend disproportionate amount of time with smartphones late into the night. This behaviour is also curiously supported by working parents who tend to sleep late. Children are again woken up early to attend school.  For example, pre-school children (3 to 5 years) need approximately 11 to 12 hours of sleep per day. But they hardly get so much sleep. What are the adverse consequences of inadequate sleep in children? 
Reduced sleep appears to be a norm in our society but not likely in the best interests of the children’s and their families’. According to various studies, children with reduced sleep are more likely to struggle with verbal creativity, problem solving, inhibiting their behaviour, and generally score lower on IQ tests. In some small studies, it has been noted that poor sleep leads to high blood pressure which can be ameliorated with replenishing the sleep time. The metabolic effects are long found with cross sectional studies in middle and high school students provided support for an association between short sleep and overweight and/or obesity.
3) What symptoms should parents look for in children with possible sleep related disturbance/disorder?
Taking the two aspects of sleep disorders – Sleep quality/quantity and sleep disordered breathing, there are a variety of symptoms the parents could take note of. The consequences of poor quality or quantity of sleep results in:
a hard time waking up in the morning.
falls asleep after being woken up and needs parents to wake again or repeatedly.
yawns frequently during the day.
prefers to lie down during the day, even if it means she'll miss activities with friends and families.
wants to nap during the day.
feeling tired, lacks interest, motivation, and attention.
falls asleep or seems drowsy at school or at home during homework
School reported hyperactivity, crankiness, impulsiveness, and a short attention span.
In sleep disordered breathing, there are associated changes in the gas exchange (Oxygen / Carbondioxide) which are manifested with additional signs or even may be the leading factor for the poor sleep. Some of them are:
Abnormal head / neck posture while asleep
Startled to wake-up with choking / grunting noises or cough
Thirsty while asleep – wakes up for a drink
Sweating while asleep
Frequent change in position and posture while asleep
Wakes up unfresh in the morning
Early morning headache
4) What is limit-setting sleep disorder in children?
Limit setting disorder is more common in children who are fully ambulatory and have developed language skills. It typically begins after the age of two. It occurs when the parents or guardians of the child are unable to establish appropriate sleep behaviors and enforce bedtime limits for the child. This results in the child refusing or stalling bedtime. When limits are not set and enforced or are only enforced sporadically sleep will be delayed and may not be enough to meet the child’s sleep needs.
5) How do you manage a child with limit-setting sleep disorder?
For a child with limit setting disorder, it is essential to establish a nightly routine prior to bed, a consistent bedtime and encourage good sleep hygiene. Parents should ignore complaints or protests at bedtime. If the child is upset or crying, the child should be checked on briefly and returned to bed if necessary. Providing a transitional object, such as a blanket, doll or stuffed animal may be helpful. It is important to be consistent and firm when responding to delays. “Giving in” will only encourage the behavior. 
Ref: Norms and Trends of Sleep Time Among US Children and Adolescents - Jessica A. Williams, MA; Frederick J. Zimmerman, PhD; Janice F. Bell, PhD - JAMA Pediatr. 2013;167(1):55-60. doi:10.1001/jamapediatrics.2013.423
Tuesday, December 8, 2015