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Kids and Sleep: When Should a Parent be Concerned?

Posted on Aug 05, 2019

Luis Ortiz, M.D., is a physician in the Sleep Center at Johns Hopkins All Children’s Hospital. In this week’s On Call for All Kids, he discusses childhood sleep issues and when a parent should be concerned.

How much sleep is enough for my child?

Parents know that getting eight hours of sleep is important for good health, but is that true for children? No, because while there may be variations in how much one person needs every night, the sleep requirement for a child does not reach the adult range until their late teens or early 20s.

Infants and toddlers should be spending the majority of the day asleep. Toddlers, a little over half of the day, and preschoolers, a little under half. School-age kids should aim for 10 hours a day and teenagers should aim for nine hours.

What happens when kids don’t get enough sleep?

Sleep is an important biologic function. Instead of thinking of sleep as an inactive time period, think of sleep as your brain and body shifting gears and entering a different mode of function. Certain processes that involve aspects of healing and clearing of toxins as well as learning and retaining memories only occur during sleep.

Studies have shown that children who do not get enough sleep have:

  • Decreased cognitive function. It’s more difficult for them to focus, learn and control their behaviors.
  • Decreased rates for graduating high school or entering college.
  • Increased risk for mood disorders such as depression and anxiety.
  • Increased risk for becoming obese and developing insulin resistance.
  • Increased risk for injuries while playing sports.

My child likes to take naps a lot, is that OK?

Napping can be normal and there are cultural variations on how much someone naps. In some cultures, children sleep more at night and nap less during the day compared to other cultures. However, at least in the United States, regular napping can start to taper off at age 2 and is mostly gone around age 5.

A nap every now and then can be normal, but if your child still requires naps on a daily basis after the age of 5, this can be a sign of insufficient sleep at night or a sleep disorder.

What are appropriate bedtimes for teens?

Teens are at a transition stage from childhood to adulthood and if they haven’t done so yet, will want to start setting their own bedtime schedules. When negotiating with your teen about potential sleep schedules, there are some things to keep in mind.

A child’s circadian rhythm shifts to a later time at around age 13-14 and doesn’t go back until the early to mid-20s. It may be impossible for them to fall asleep at a certain time if it is too early in the evening.

Even if they look like adults, teens need around nine hours of sleep a night. A good rule would be to count back nine hours from when they need to get up in the morning for school and then go back an additional 30 minutes to allow time for them to fall asleep.

Many teenagers have multiple extracurricular activities, however, keep in mind that sleep should come first.  No matter what your age, having a regular sleep schedule is good for you. Try not deviate from the regular sleep schedule by more than an hour on the weekends.

If your teen is going to start high school, now is the time to get back into the school night bedtime routine. It can take up to 10 days to adjust to a sleep schedule.

School is starting soon. How do I get my kids back into a good sleeping routine?

Think backward. What time do they have to get to school in the morning and how long does it take them to get ready? And then decide the appropriate amount of sleep your child needs. Give them about a half an hour to fall asleep. It also helps to have a clear bedtime routine: bush your teeth, read a story and lights out. Keep it simple.

How do electronics affect sleep?

Blue light from screens in TVs and electronics reset the body’s internal clock to a later time by delaying the release of a hormone called melatonin, which helps promote sleep.

Electronics are worse for teens, whose circadian rhythms are already shifted to a later time, causing them to feel even more awake later at night.

Kids are essentially giving themselves a mini case of jet lag when they watch TV or use electronics close to bedtime. Even if you can fall asleep, blue light exposure before bed can result in deep sleep and less dream sleep, and waking up feeling sleepier.

To prevent these issues, I recommend stopping all electronics at least one hour before bedtime.

My child snores, should I be concerned?

Prevalence of snoring is estimated to be 8-12% of children between 2-8 years of age. When a child has snoring, you should think about the possibility of sleep apnea.

Children with sleep apnea typically have complaints and symptoms of a child that does not get enough sleep, despite clearly sleeping enough. This includes:

  • Difficulty concentrating
  • Hyperactivity
  • Mood and behavioral problems
  • Fatigue
  • Metabolic changes like obesity and diabetes

Sometimes these children can present with other complaints such as headaches. Children also don’t need to be obese to have sleep apnea.

Testing involves an overnight polysomnogram, where we measure multiple physiologic measures during sleep to determine the presence and severity of obstructive sleep apnea.

First line treatment for sleep apnea includes removal of the tonsil and adenoids, but other treatment options such as treating allergies, reflux and achieving a healthy weight can be considered for mild cases.

Some children may need to use a continuous positive airway pressure (CPAP) device if the other options do not adequately treat the sleep apnea.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital medical experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report.


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