The end of the year--the holiday season--is a popular time for families to travel and visit relatives, or have grandparents and others visit to celebrate the holidays together. It is also a time when families' usual schedules are inevitably disrupted, and sleep schedules frequently suffer as well, for both children and their parents. Kids of all ages, from infants to adolescents, are likely to experience sleep difficulties in the six weeks or so between Thanksgiving and the first week in January. Parents can do a great deal to anticipate and prevent these problems. They can apply some simple, commonsense measures to keep sleep--and holiday fun--on track.Parents should not underestimate the importance of kids getting adequate sleep. Sleep is not only essential to good physical health, but to mental health and mood, as well. For example, a recent study of over 2,000 middle school students in Illinois suggests that as adolescents get less sleep and become sleep deprived, they show increasing symptoms of depression and they have declining self-esteem. Why is sleep so important? The answer is not known. But, it is clear that while the body is resting, the brain is very active. Sleep seems to provide some kind of essential nourishment for the brain, particularly in kids, as they require considerably more sleep than adults. In fact, sleep is said to be the primary activity of young and developing brains. A typical 3-year-old has spent more time in his life sleeping than doing awake activities. Kids (of any age) who get inadequate sleep tend to be moody, have poor concentration, learn less well and have trouble doing just about everything that involves the brain. (An interesting recent study in adults suggested that sleep is the trigger for creative thinking and creative problem-solving. And many of us can remember times that we finally figured out the solution to a perplexing problem the morning after a good night's sleep!)How can you tell if your child is getting enough sleep?
Sleep needs differ from child to child, as they do among adults. On average, newborn infants need about twice as much sleep as adults: 17 hours for babies versus 8 hours for adults. By the first birthday, daily sleep needs have decreased to about 13 or 14 hours a day, and by school entry (age 5), 11 hours is about right. Pre-teens may get by with no more than 8 1/2 hours a night. What is surprising, however, is that sleep needs increase in early adolescence, the typical teenager needing slightly over 9 hours per night. It is tempting to attribute this increased need for sleep to teenage brains once again going into a phase of rapid development and maturation toward adulthood. (Sleep deprivation is the rule, not the exception, in teens. But that's another story.)Some signs that your child may be getting inadequate sleep:
-Consistent difficulty waking your child up in the morning (as opposed to "spontaneous waking".-Your child appears sleepy to the teacher in school, and may even fall asleep in school when bored.-Your child is having difficulty concentrating or finishing tasks, again, particularly late in the day.-Your child seems more irritable, or school grades are declining.-Your child wakes up much later on weekends, compared to school days.Getting ready for the holidays:
*Assess your child's sleep needs and adequacy. Keep a sleep diary for a week or so, recording how much sleep your child is getting, whether she wakes spontaneously in the morning or has to be waken with great difficulty, as well as observations about mood, alertness, concentration, and school work.*Watch your child sleep--to assess the quality of sleep. Is your child sleeping quietly or fitfully. Some kids sleep poorly and are never well rested because the quality of their sleep is poor. Sometimes this is due to difficulty breathing when sleeping due upper airway obstruction. Some kids have discomfort when they are sleeping because of stomach reflux. If your child routinely sleeps fitfully or seems to breath with difficulty or irregularly when sleeping, it is time to call the pediatrician, as this may reflect a medical problem.*Get back on schedule. If sleep schedules are irregular or if your child seems to need more sleep, use the days and weeks before the holidays to make corrections. Parents may need to enforce a bedtime that is a half-hour earlier than their child's current bedtime. They may need to build in some quiet "wind-down" time as bedtime approaches, turning off the TV, turning down the lights, and engaging is some quite activity such as reading, as a prelude to bed.*Look at diet and exercise. Adequate sleep, a healthy diet, and enough physical activity are the three things that children need for good physical health. Kids sleep poorly on an empty stomach and they sleep poorly on one that is overly full. A light evening snack is appropriate for most young children. Kids should get at least 30 minute of vigorous exercise (vigorous play) on most days. Active kids sleep better. (And, at last among teens, excessive television viewing is associated with sleep problems as they grow into adulthood.)*Medications can be a problem. A variety of medicines can interfere with normal sleep (as can caffeine and alcohol.) If your child is taking any medicine on a regular basis--and is sleeping poorly--consult with your pediatrician or pharmacist to see if there may be a connection.Holiday and Vacations Tips
*Stay on schedule. Whether you are traveling or if the out-of-town grandparents are spending a few days with your family, insist that bedtimes and wake-up times remain reasonable and as close as possible to the non-holiday schedule. Our children's circadian rhythms (their internal body clocks) are not easily reset from day to day. Rapid changes in schedules lead to poor sleep, and ultimately a "sleep deficit" that is not easy to make up.*Respect routines and rituals. The evening bath, story time, and any other routine that you and your child have established at bedtime should be maintained, even when the daytime schedule is disrupted. These evening activities act as cues to help your child's body and mind get ready for sleep. If you are traveling, your young child will need their Teddy Bear or other "transitional object." Even older kids--yes, teens and college kids--sometimes appreciate their favorite blanket, and they should not be made to feel embarrassed to pack a favorite sleep item when traveling over the holidays.*Avoid overstimulation. This is a hard one...especially around the holidays, with relatives, gifts, and lots of planned family activities. Nevertheless, kids need age-appropriate schedules, and unscheduled quiet time as bedtime approaches. Evening television can be particularly difficult but important issue to get under control.When To Seek Further Help
Attention to schedules, diet, physical activity, and appropriate guidance from parents can help most kids--younger and older--improve their sleep. If these measures don't seem to help, or if sleep problems are accompanied by daytime behavior or physical problems, it is time to get advice from your child's physician. Sleep problems are sometimes symptoms of physical or emotional illness. Respiratory and digestive problems often result in poor sleep as do childhood depression and anxiety. In most cases, these conditions result in daytime problems as well. Diagnosing and managing such problems can result in greatly improved quality of sleep.
Copyright 2004. Mark D. Widome, MD. Dr. Widome is professor of pediatrics at the PennState Children's Hospital and a regular contributor to the TODAY show. He writes regularly on topics of interest to parents.