Are your kids sleeping? Pediatric Sleep Issues Carrie Cadwell PsyD HSPP Cadwell Psychological Services, LLC
Sleep Statistics in Children 2004 Sleep in America poll (NSF) 1/3rd of school age children getting insufficient sleep BUT 90% of parents of school age children think their child is getting enough sleep more than two-thirds of children experience one or more sleep problems at least a few nights a week
Why do we need to focus on sleep? Think of the demands on children today… Think cumulative effects of lost sleep… Poor sleep exacerbates all psych/med conditions
Why do we need to focus on sleep? Sleep linked to Attention/hyperactivity Memory/Learning (acquisition/consolidation/recall) Emotional regulation Decision making/impulse control Weight/obesity Brain development Physical health/immune fx/body reparations
Developmental Sleep Needs 2 yo (13 hrs) 3 yo (12 hrs) 4 yo (11.5 hrs)—no naps 5-7 yo (11 hrs) 8-9 yo (10-11 hrs) yo (10 hrs) yo (9.5 hrs)
Click to edit the outline text format Second Outline Level Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles Second level Third level Fourth level Fifth level Developmental Sleep Needs NSF Task Force RecActual Infant Toddlr PreSch School Teen
Does my school age child have a sleep issue? Is she/he falling asleep within min of bedtime (average 20 min) Can he/she getting going fairly easily in the morning? Is there are any daytime sleepiness/does he/she doze/nap during day? Is your child “crashing” early on some nights? How cranky/whiny, inattentive/hyperactive, over emotional, and trouble with thinking is my child having?
Sleep Hygiene Bedtime before 9pm for school age and younger Children put to sleep awake/tired No more than 1 hr difference between weeknight and weekend bedtimes Consistent routine 3-4 quiet activities close to bedtime (30-45min) No media/electronics within 1 hr No intense physical exercise within 1 hr
Sleep Hygiene Avoid naps after 4-5 yo (phase out) and none after 4pm Limit caffeine within 4-6 hrs of bedtime Light snack only Low light/dark/cool sleep environment (high light in morning)- night light ok Bed should be for sleep only
Sleep Hygiene No TV in bedroom best, no tv at bedtime/to fall asleep good White noise/fan appropriate Ensure at least 60 minutes physical activity per day (just not close to bedtime) Think about the sleep environment Are there toys all over? Is the gameboy/DS in the bedroom at night?
Sleep Problems/Disorders First: Is sleep the primary issue or is sleep interference secondary Example: ADHD/Autism Spectrum/Anxiety/Mood Disorders Second: rule-out medical issues (allergies, asthma, medicines, adenoids/tonsils) Noisy breathing/snoring/excessive daytime sleepiness
Sleep Issues/Problems (not exhaustive list) Developmental issues preschool most common for night terrors, increased fears for school age, 2hr delay in melatonin secretion for teens Sleep Fears/Nightmares Sleep Associations Sleep Refusal/Stalling/Limit setting Conditions Nighttime awakenings Sleep walking/Night terrors/Narcolepsy Insomnia Restless legs
Types of Intervention Depends on the nature of the sleep issue and age/developmental level Parents often ask: What about Melatonin?