Sleep aids for children

The Pediatric Insider

© 2014 Roy Benaroch, MD

J-Mom wrote: “My 10 year old son often has trouble falling or staying asleep, mostly due to anxiety.  My son has not had any help from melatonin in the past.  We do several things to help him fall asleep, back scratch, singing softly, white noise machine, but some days are just impossible for him to sleep.  His doctor mentioned using a magnesium supplement as a natural sleep aid.  Do you have any experience with trying magnesium in kids?  Some cursory research I did suggests that it’s effective in cases of a Mg deficiency. Do some people use it even if no deficiency is found? Do you have to test them first? Any thoughts on this?  Thanks!”

The best ways to help a child relax and sleep are simple steps that J-Mom is probably already doing:

Have a set, relaxing bedtime routine.

Avoid screens for 1-2 hours before bedtime.

Set a consistent time for bed and waking.

Get plenty of exercise (though not in the few hours before bedtime)

Make the bedroom comfortable and happy.

Still, some kids even with great routines can still have trouble falling asleep or staying asleep. That can be especially so for children who are anxious—sometimes worries become magnified at night. Anxiety that causes significant day or night symptoms really should be discussed with a child’s pediatrician, and may need to be treated to help overcome its effect on sleep.

But to answer J-Mom’s question, what other kinds of sleep aids are there for children?

Melatonin is probably the most popular. What’s widely sold is a synthetic version of a natural human hormone that seems important in regulating sleep cycles and setting our “biologic clock” for the day. We know that children with damage to the part of the brain that makes melatonin have problems with sleep cycles, so why not give a little extra to help everyone sleep better?

In general, melatonin seems pretty safe for most people. It can have interactions with some medications, and there is some evidence that in at least some children it might increase the risk of seizures (though that is not seen commonly). There also isn’t great long-term data on daily melatonin use in kids. So I’d treat melatonin with respect, like any other medication: use it only if necessary, at a minimum dose, for a minimum amount of time.

J-Mom also asked about magnesium supplementation. Deficiencies of both magnesium and calcium have been linked to poor sleep in animal and observational studies, and magnesium supplementation in at least one study did seem to help elderly people sleep better. However, I couldn’t find any good evidence that magnesium supplements will help children sleep. An ordinary-dose magnesium supplement is unlikely to be harmful, so trying one isn’t unreasonable. Blood tests for magnesium levels can be deceptive—a one-time test may miss some people who are truly deficient, so testing children for blood magnesium levels is unlikely to be useful.

Chamomille and valerian are two herbs that have some evidence as sleep aids in adults, though again, studies in children are lacking. They’re both probably safe. One “natural product” that had once been touted as a sleep aid is Kava (sometimes called Kava-Kava), which has been linked to liver toxicity and many drug interactions, and should be avoided.

If a child is having significant sleep concerns, this ought to be discussed with a doctor. In addition to anxiety, medical things including asthma, allergies, sleep apnea, and restless leg syndrome can interfere with sleep. Though sedatives and sleep drugs are rarely used in pediatrics, there are often lifestyle changes and simple steps that can make a big difference. Though some natural sleep remedies are probably safe enough to try, they’re not the best way to help most children sleep better.

Hug Enforcement

The Pediatric Insider

© 2011 Roy Benaroch, MD

Here’s a question posed from Mark: “Should I demand that my child allow me to hug him (for example, when saying good night at bedtime)?”

I wasn’t really sure at first where to go with this one. My first thought, as a parent, is “sure!” I pay the bills, I do the work, blah blah, I get the hugs! But then again, my own kids are of the huggy variety, and I really haven’t had to demand them. I more often have to pry little fingers from around my neck so a certain child will go to sleep!

Mark points out some pros and cons from both sides:

There seem to be two schools of thought on this.  Some say that you must give your child the right to control their physical contact, otherwise they may become more susceptible to sexual assault; others say that kids need a certain amount of physical contact and affectionate hugs in their life (whether they think they want it or not) or else they become more prone to depression.

Considering the second point: there is some literature to support this—that children “deprived” of physical affection from parents may have a higher incidence of mental problems and poor attachment as adults. But the studies are really quite hard to interpret. For instance, what was the cause and what was the effect? Maybe these were somewhat-disturbed kids to begin with, so they had fewer hugs, and went on to have other problems as adults (this is an example of “reverse causation”.) Or maybe it’s yet another way around: the parents themselves had mental illness, so they didn’t hug their children as much—but the reason their kids are more prone to depression might be that depression runs in the family, and it has nothing at all to do with the hugs (hugs would then be an “epiphenomenon.”) Research trying to correlate childhood experiences with adult health outcomes are often very skewed by recall bias—do adults remember how often they were hugged? Or, would adults with depression maybe be more likely to mis-remember being hugged infrequently? Furthermore, assuming that the observation that fewer hugs lead to more depression, does it follow that “forced hugs” would be protective? I’m not so sure of that. There are so many assumptions here, I don’t think the “I have to force my kids to hug me to protect them from depression” angle is really something I can agree with.

What about the first point: should a child have the right to their own body integrity, allowing him to reject even loving physical attention from a parent? It sounds cold, but I guess I have to agree with that. It’s his body. No means no.

Still: a little hug is a nice way to end the day. So I’ll end this post this way: forget the science and the rules. I’d try to ask nicely, or joke around, or threaten to tickle, or otherwise add some humor to get a little squeeze in, even if Junior’s a bit resistant. At least every once in a while. After all, I pay the bills and blah blah. Dads need the hugs at least as much as the kids.

Early to bed

The Pediatric Insider

© 2010 Roy Benaroch, MD

“Early to bed and early to rise, makes a man healthy, wealthy, and wise.”

Maybe Ben Franklin* was talking about his teenager.

A study published in the January, 2010 issue of Sleep compared teenagers who had early bedtimes (before 10:00 pm) to teens who reported that their parents let them stay awake past midnight.

The authors found that the teens reporting the later bedtime had about a 24% increased incidence of depression, and a 20% increased risk of suicidal thoughts. Further analysis showed that the main way that the earlier bedtimes was protective was that the kids with later bedtimes got less sleep overall.

I speculate that the earlier bedtimes might also be more likely to be a rule in families where parents take a more “active” role in their teenagers’ lives, which probably also protects their teenagers against depression.

I don’t know about making a teen wealthy and wise, but one way to keep them healthy is by sending them to bed at a reasonable time. Teens need 8 or 9 hours of sleep a day– and catching up by sleeping until noon on weekends doesn’t count. If your teen is surly and hard to wake up in the morning, an earlier bedtime might be just the thing to improve everyone’s mood.

*The quote is often attributed to Benjamin Franklin, but apparently there were many earlier versions, like “Who soo woll ryse erly shall be holy helthy and zely.” This predated spell-check.



Early to bed

The Pediatric Insider

© 2010 Roy Benaroch, MD

“Early to bed and early to rise, makes a man healthy, wealthy, and wise.”

Maybe Ben Franklin* was talking about his teenager.

A study published in the January, 2010 issue of Sleep compared teenagers who had early bedtimes (before 10:00 pm) to teens who reported that their parents let them stay awake past midnight.

The authors found that the teens reporting the later bedtime had about a 24% increased incidence of depression, and a 20% increased risk of suicidal thoughts. Further analysis showed that the main way that the earlier bedtimes was protective was that the kids with later bedtimes got less sleep overall.

I speculate that the earlier bedtimes might also be more likely to be a rule in families where parents take a more “active” role in their teenagers’ lives, which probably also protects their teenagers against depression.

I don’t know about making a teen wealthy and wise, but one way to keep them healthy is by sending them to bed at a reasonable time. Teens need 8 or 9 hours of sleep a day– and catching up by sleeping until noon on weekends doesn’t count. If your teen is surly and hard to wake up in the morning, an earlier bedtime might be just the thing to improve everyone’s mood.

*The quote is often attributed to Benjamin Franklin, but apparently there were many earlier versions, like “Who soo woll ryse erly shall be holy helthy and zely.” This predated spell-check.

Stay in your own bed

Bill posted, “My son is almost four, and used to be a good sleeper. Lately, though, he wakes up several times a night to sneak into bed with my wife and I. He says he just wants to sleep with us. But I can’t sleep with him in the room—he kicks and rolls around too much, and I end up on the couch. Why is he doing this, and how can I get him to stay in his room?”

Usually, a preschooler who starts wanting to sleep in his parent’s bed is just going through a phase, without any particular reason behind it. Still, you should ask yourself if there’s any reason you can think of for changed sleep habits. Sometimes an illness, family stress, or some other event leads to this kind of disruption. But even if you know the answer, you’ll still need a way to get his sleep back on track.

At this age, I suggest a method based on a system of rewards. Every morning when he wakes in his own bed, after having spend the whole night in his own bed, he gets a sticker on his “Happy in My Bed Chart.” Getting 5 stickers earns him a trip for ice cream with dad; earning 15 stickers earns him a radio controlled car! (Feel free to change the details. But that car is cool—it climbs walls? Sorry, I’m getting distracted.)

You’ll want to make a big show out of making the chart, decorating it, and helping him understand how he can fill the boxes by earning stickers. Be sure to look at the chart at bedtime to talk about the plan for the night, and go right to the chart to put a sticker on it first thing after a successful night. If he does creeps into your bed at night, you quietly take him by the hand back to his own bed—don’t scold him, and don’t remind him just then that he lost the sticker. In the morning, remind him why he isn’t getting a sticker, but don’t make a big deal out of it. Don’t take stickers away once he’s earned them.

One other thing: you mentioned that he kicks and rolls around a lot at night. It’s possible with this going on that something medical is interfering with his sleep. Does he have loud snoring with pauses, indicating sleep apnea? Is there a family history of restless legs syndrome? If the answer to either of these questions is “yes,” you need more input directly from your pediatrician.

Best of luck, and let us know how it goes!

Sleep habits broken

Beverly posted: “Our four year old daughter is having trouble sleeping. Until a few weeks ago, she usually slept very well and only occasionally needed us after she went to sleep, unassisted, at 7:30pm until she woke at 6:30 the next morning. Now she is hysterical if we leave her before she falls asleep. She wakes ups frequently throughout the night and runs screaming from her room in search of us. We put her back to bed repeatedly, but eventually we let her fall asleep with us where she sleeps quite soundly for the rest of the night. Do we continue to put her back in her room despite her crying? Do we let her get through this phase and sleep with us until she’s ready to sleep alone again? Here’s a bit of additional info: She sleeps with two lamps on. She doesn’t nap during the day. She doesn’t receive much refined sugar. She doesn’t watch any TV – and gets a moderate amount of exercise. Her only outstanding medical condition is eczema.”

My first thought is: what happened a few weeks ago when her whole night routine changed? I would guess that a four-year-old would be pretty set in her ways, and some sort of medical or social change would be needed to upset her so much. It might not be something that would seem like a big deal to an adult, but think more from her point of view. Is she no longer spending time with her friends at school? Did Grandma move away? Are there workmen in the house? Did she see a scary movie (this includes just about any Disney production)? Or an episode of the local news—which is often much scarier than anything else on TV? If there was a specific factor that disrupted her routine, you’ll probably need to address that directly.

You mentioned she has eczema—if it’s been acting up, and she’s itchy, that will definitely disrupt sleep.

If there really doesn’t seem to be anything else going on, you’ll need to gradually withdraw your snuggly support at bedtime.

Ending the night bottle routine

A question from Cameron: “I have made the mistake of letting my daughter keep her bottle when she goes to bed. She is now almost 3 1/2 and her sister is about to turn one. Do you have any suggestions as to how to how to wean both of them off the bottle?”

For the one year old, I suggest you just do it all at once. Change your bedtime routine to include a snack, like some banana slices, plus a cup of whole milk. After the snack, give her a bath, read some books, and put her down in her crib. Do this consistently, and stop offering or even mentioning a bottle at bedtime. She’ll develop a better routine that’s healthier for her teeth and will reinforce good independent sleeping through the night.

For the 3 ½ year old, it’s going to be more difficult.

Why won’t she stay asleep?

DM posted on the suggestions thread: “I have a 21 month old that is still waking up several times a night. She cries in her sleep, and 75% of the time, she puts herself back to sleep with no intervention. She will do this anywhere from 1 – 8 times a night. Some of these episodes last just a minute or two, but some of them are getting to be much longer. If she is teething (currently 2 yr molars are breaking through early) or sick, I intervene as briefly as I can after about 20 minutes of crying. Currently, the episodes are lasting up to an hour or hour and a half. She has a consistent night time routine, and goes to bed at the same time each night. Is it normal for her to be crying in her sleep throughout the night? Am exacerbating the issue by ever intervening? Thank you for any insight you can provide. I am getting worried (and tired!).”

The post was made at 4:30 am!