1. Are your kids sleeping? Pediatric Sleep Issues Carrie Cadwell PsyD HSPP Cadwell Psychological Services, LLC

2. 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

3. 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

4. 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

5. 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) 10-11 yo (10 hrs) 12-15 yo (9.5 hrs)

6. 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 Infant14-1512.7 Toddlr12-1411.7 PreSch11-1310.4 School10-119.5 Teen8.5-9.57.2

7. Does my school age child have a sleep issue? Is she/he falling asleep within 15-30 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?

8. 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

9. 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

10. 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?

11. 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

12. 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

13. Types of Intervention Depends on the nature of the sleep issue and age/developmental level Parents often ask: What about Melatonin?