Sleep is an important part of physical and mental health, especially in school-age children and adolescents. A well-rounded sleep schedule supports healthy brain function, maintains physical and emotional balance and reduces the risk of long-term health problems.
Unfortunately, about 30 percent of parents say their kids are not getting enough shut-eye.
While sleep challenges vary, research aims to explore the different factors that play into problems with getting a good night’s rest.
This excerpted post was originally published on the Seattle Children’s On the Pulse blog.
“On The Pulse” spoke with Dr. Teresa Ward, a principal investigator with the Seattle Children’s Research Institute’s Center for Child Health, Behavior and Development and a nurse researcher specializing in sleep health, to help clear up a few common pediatric sleep misconceptions. She aims to provide guidance and resources for families on better sleep habits.
Is sleep length the only important factor in healthy sleep habits?
Dr. Ward: When I think about sleep health, multiple things come to mind, like timing and regularity of sleep, satisfaction, duration and alertness.
A factor to consider is variability in sleep, such as wake and bedtimes and the consistency of this schedule. For example, the timing of wake and bedtimes could vary because children may not have a structured sleep routine or need to sleep in different households. In partnering with families, we seek to understand the nuances and activities before bedtime to tailor a sleep routine that works for all. Sometimes a routine includes snuggling with a parent, brushing teeth or reading a book. These activities are cues to help your child wind down for the night. It’s best to aim for consistent bedtimes and wake times every day of the week. We encourage caregivers to consider their child’s behaviors and routines around sleep when looking to make changes.
It is also important to think about sleep satisfaction and how rested a child feels after sleeping. When working with caregivers and children, we ask them to consider, ‘What does a good night’s sleep look like?, ‘How do you feel during the day when you had a good night’s sleep?’ A good night of sleep can be different for each family, and other indicators like alertness, restlessness at school and daytime sleepiness can point to what is and isn’t working.
Is it possible for children to catch up on sleep over time?
Dr. Ward: No, this is a myth. During the school week, kids may have varying bed and wake times that can impact how much sleep they receive each night. When the weekend rolls around, they may sleep in for an extra few hours, but this still does not make up for the lack of sleep they lose the other five nights.
A sleep routine is useful because it provides structure around bedtime and cues to start to unwind for bedtime. Children need structure, particularly around sleep.
Can different conditions affect sleep health?
Dr. Ward: Yes. For example, chronic health conditions like lupus, sickle cell, juvenile arthritis, asthma and chronic pain, commonly cause interrupted sleep. Sleep problems are often interrelated with mental health conditions such as anxiety and depression. Take juvenile arthritis for example: symptoms like pain or joint stiffness in conjunction with mental health problems can make it difficult to fall asleep and stay asleep through the night. These challenges are complex for families, and we are learning more about how to help.
Our SLEEPSMART intervention is a web-based application to provide children with arthritis and their parents the knowledge and tools to partner together to improve sleep habits. This intervention was a pilot study designed by children, caregivers and healthcare providers to gain collective input about their needs and wants in the development of a feasible sleep intervention while also providing a sleep coach to troubleshoot with and get through setbacks.
Mental health is also important when sleep problems occur for children and adolescents. Worrying about everyday stresses and anxieties can make it difficult to fall asleep at bedtime. Other kids might fall asleep, but wake up in the middle of the night and struggle to go back to bed. Poor sleep can then heighten anxiety and depression, and in these situations, bedtime can be stressful for both the child and caregivers.
We’ve found external stressors can profoundly affect kids getting restful sleep. School-related stress — grades, peer relations, or the school environment — can impact sleep and a child’s mental health. Other factors, such as food and housing security and access to resources like insurance, before and after school care, and transportation to and from school impact sleep.
Cultural beliefs and practices about sleep are another important area for healthcare providers and researchers to consider and assess. In my opinion, there is still a lot of work to do about inclusive guidelines around sleep. The standard practices for sleep may not be realistic for some families. It is not a one size fits all. Meeting families where they are is important and this requires trust between providers and families. We work to partner with each family to help identify what an ideal sleep routine might look like for them.
How important are naps and do they affect overall sleep health for kids?
Dr. Ward: The need for naps changes throughout development. In the first five years of life, napping is common and important for young children’s physical and emotional development. Young children often need several naps throughout the day.
If an older child is too tired, this can be detrimental to their learning at school and daytime alertness. If a child or adolescent is falling asleep at school, it may be linked to inadequate sleep at night or an undiagnosed sleep disorder, like sleep apnea.
The timing of naps is important. Taking naps too late in the day can affect a child’s ability to get to sleep at their regular bedtime.
Sometimes kids want more time with their families, especially if parents work late or have multiple jobs. So, a child napping after school so they can spend a little more time in the evening with their family might be more important than an early bedtime. We look to honor each unique family and identify a routine and sleep opportunities that works best for them.
How safe is melatonin as a sleep aid for kids and teens?
Dr. Ward: The findings on melatonin and its effectiveness are mixed. Melatonin is not FDA regulated and the amount of melatonin can vary across supplement brands. It is best to consult with your child’s doctor before using melatonin to help with sleep.
What do you think parents should know about managing sleep for their children?
Dr. Ward: For parents, it is important to understand that sleep is multidimensional and ties into kids’ behavior and emotional development. Sleep is an active process that helps the body rest, supports immunity and heart health and releases important hormones. It also helps with learning, regulating emotions and resilience against stressors. Sleep is also connected to effective management of reactions to pain, anxiety and external factors like what might be happening at home or school.
Secondly, we encourage the use of a healthy sleep routine that works for your family. Even a short five minutes spent preparing for bed works much better than not having a routine at all. There is no perfect sleep routine, and it varies for each family.
Lastly, there’s help available for families who are struggling with sleep. Start by asking your child’s doctor if you have concerns about your child’s sleep. Seattle Children’s Sleep Center is staffed with nurse practitioners, psychologists and physicians who can help with pediatric behavioral sleep issues and disorders.
Caregivers often experience guilt or shame when faced with trouble managing their child’s sleep, but help is available. It’s important to remember that as a parent, there is nothing to feel guilty about, especially when looking for a change. Sleep is not an on and off switch. Similar to other behaviors like wanting to exercise more, changing sleep habits takes time. Sleep problems are common, and we encourage caregivers to seek support. There are many resources available and professionals willing to help!
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