Posted tagged ‘sleep’

Could Spongebob be keeping your child awake?

September 3, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

 

Don’t get me wrong: I like Spongebob. And Patrick. And even Mr Krabs. But a new study suggests that our favorite yellow porous invertebrate might be keeping your preschooler awake.

 

Researchers looked at about 600 families of children aged 3-5, and over a 12 month period had about half of the families participate in a program to encourage appropriate media use. The families were taught to avoid age-inappropriate television (no more Spongebob, which is rated TV-7). They were also given information about what shows were better to watch, and were told to watch TV together with their kids and to talk about the shows afterwards. Examples of shows suggested for these kids included Sesame Street (yay!) and Dora (which would give me nightmares). The other half of the families weren’t given any instructions to change their media habits. The families in the study were not encouraged to watch less TV, just to watch more-appropriate TV in a family setting.

 

The children in the no-Spongebob group not only slept better throughout the study period, but were reported to be easier to wake and less groggy in the morning.

 

That’s not the only bad news for Spongebob: previous research has shown that his likeness on packaging is being used to market unhealthy foods—which really isn’t his fault (I understand his agent very aggressively pursues licensing deals.) There was even one study—not a very good study, but who am I to say?—that supposedly showed that kids who watch he-who-lives-in-a-pineapple-under-the-sea become slower thinkers.

 

I’m not so sure that Spongebob is really the cause of all of our children’s ills, but this recent study is worth thinking about, especially if you’ve got a 3 to 5 year old (usually with an older sibling!) who’s having trouble sleeping. The fast-paced, crazy imagery of some cartoons really isn’t for younger children.

 

I’d stay away from Dora, too.

Sleeping through the night in three easy steps

May 18, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Sleep….what every parent of a young baby needs. And ironically, if you’re not getting enough sleep, you probably don’t have the energy to slog through any of the “help your baby sleep” books. Fortunately, we’re here to help. You want to teach your baby how to sleep through the night? I’ll tell you the three necessary steps. Do this, and you and your baby will soon get a good night’s sleep, or at least get closer—sorry, no guarantees here. Babies have their own plans, and their own personalities, and there is never a one-size-fits-all solution for everyone. Still, these ideas should help any baby get closer to a full, solid night’s sleep.

You can start these sleep-training ideas at any time. If getting a solid night’s sleep is a priority, the younger you start training, the better.

Step 1: Ensure that Junior is getting enough calories during the daytime. Think of it this way: he knows how much he needs in a 24 hour cycle, but he doesn’t really care if he eats more in the day or night. “Oh, don’t worry, Mom,” baby might say. “Don’t rush to feed me this afternoon. I’ll just wake you up earlier tonight!” As babies get to 3-4 months of age, they will be able to go longer between day feedings. Do not allow this. Don’t let them stretch out the day feeds until the night is one solid block of sleep.

Nurse frequently. During the day, if Junior is awake and it’s been more than 2 hours since the start of the last feeding, it’s time to eat again (if baby is asleep, wake at 3 hours past the start of the last feeding.)  Start solid complementary foods at 4-6 months (earlier is not better).

Step 2: Don’t react to every little noise babies make as they sleep. You will stir a bit, baby will fuss a bit, and then you’re both wide awake. As soon as you feel comfortable, move your baby to his or her own room so you don’t keep waking each other up. If baby wakes and makes a little noise, don’t rush in immediately. Take your time. At least sometimes, Junior will put herself back to sleep without your going to see her. Give her a chance to soothe herself!  If you must share a room, try to lie quietly when you hear your baby start to make noise.

There’s a persistent half-myth that bottle fed babies sleep better. I call it a half-myth because it is in fact true, but not true for the reason people expect. Bottle fed babies do sleep through the night faster—but that is because it takes mom several minutes to go to the kitchen, warm a bottle, etc. By the time she makes it to baby, at least sometimes the baby will go back to sleep. For nursing moms, it can be quick and convenient to get a feeding started—and that’s a good thing, most of the time. But if you’re trying to sleep train, don’t be so quick to begin nursing the moment your baby starts to wake at night.

Step 3: I saved the most difficult for last. It’s time to allow your child to learn that he can fall asleep alone. Parents usually end up holding their little newborns as they fall asleep,  which isn’t at all a bad thing. Newborns may genuinely need a close warm loved one to help them make the transition to sleep. But many parents neglect to allow their own habits to change as their babies develop. They continue to hold their babies as they fall asleep, never even giving them a chance to begin to learn how to sleep on their own. If you’re holding, rocking, or feeding a baby while he falls asleep, the baby—guaranteed—will wake up again later that night after you sneak away. He will need you to come back and resume holding, rocking, or whatever to ease him back to sleep.

The concept here is “independent sleep associations,” referring to the kinds of things we’re used to having around as cues to help us fall asleep. It would be very hard for most of us to fall asleep without a pillow—because we’re used to having a pillow when we fall asleep. And if someone were to steal your pillow in the middle of the night, you can bet you’d wake up quick. If your baby depends on you as a sleep association, she will not stay asleep if you leave the room. You’ve got to camp out all night. Maybe that’s what you want to do. But if you’d like to have your own nighttime for yourself and your spouse, you cannot be a sleep association for your baby.

I’ll make it simple with some good rules of thumb: by two months of age, you should sometimes be putting your baby down when awake; by four months of age, you should usually be putting your baby down awake; by six months of age, always put your baby down while awake. If you never try, it will never work. It does not get easier to start working on these independent sleep associations as babies get older.

So what do you do when your baby isn’t falling asleep on her own? Follow the plan, and keep it simple. Put your baby down with confidence and no apologies. Say “Good night, honey, I will see you tomorrow.” Then leave. Do not go and check every few minutes—that teaches your baby that hysterics will bring mommy in running. The lesson here is: it is night, you are in your bed. It is time for sleep. This is the way it is. Now, you cannot make a child sleep—but you can control your own reactions. When Junior learns that this is the way it is, the crying stops, and the sleeping begins. Keep in mind that the older your baby is when you start this, the more stubborn she will be, and the longer she will cry.

Is it cruel to let babies “cry it out”? I do not think so. There will be hundreds of other occasions each day when your baby wants you to do something, and you’ll do it right away; there will be dozens of times each day when you’ll quickly respond to crying with hugs and reassurance. There are genuinely times when tough love is needed. When your 2 year old wants a candy bar at Target, she’ll throw a tantrum when you say no. Your teenaged daughter will scream “I hate you!” when you refuse to let her spend the weekend in Panama City with her boyfriend. Letting your baby cry at bedtime is not more cruel than other times when saying “no” is the right thing for a parent to do.

In fact, it may be more cruel to not let your baby learn to sleep through the night. For parents, lack of sleep contributes to marital discord, stress, and depression. You’ll be less patient and less engaged with your baby during the day when you’re exhausted. Furthermore, if you’re not getting a good solid night sleep, then your baby isn’t getting good sleep either—which compounds the cranky. In the long run, parents and babies need to get their solid sleep at night. Parents who delay sleep training are preventing their children from learning an important life skill while making family life miserable. Who’s being cruel?

Some babies will make this easy. Other babies will fight sleep and make this a more difficult transition. Exactly when to sleep train is a personal decision, depending on the parents’ plans and priorities. But if you want to get your young baby sleeping through the night, you don’t need a great big book to read. You just need to follow the three steps above, consistently, every night. It may seem rough at first, but soon you and your baby will all a better night’s sleep.

A shorter version of this was originally published on WebMD.

Early to bed

February 26, 2010

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

February 26, 2010

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.

Sweet dreams

April 13, 2009

Both DM and Angel recently posted questions about nightmares and night terrors, so I’ll mash ‘em up together in a two-for-the-price-of-one post – what a bargain!

Nightmares are common and scary for children and parents alike. Sigmund Freud thought they were the “royal road to the unconscious,” emblematic of repressed experiences that if properly decoded could free you from neuroses and anxiety. For most of us, they’re just bits of genuine memories mixed in with monsters, old roommates, and standing around in public without pants on.

There are good ways to prevent at least some nightmares in children:

  • Avoid video-based entertainment close to bedtime. Even “calm” TV shows really hype up the brain, especially primitive centers that control fear and anxiety responses that seem to be a big part of strong nightmares.
  • Avoid either a full or completely empty belly at bedtime. A small snack that includes some protein is a good idea.
  • Empty the bladder before going to bed.
  • Keep the room comfortable, not warm or cold.
  • Some medicines can trigger nightmares, including common allergy medicines and many over-the-counters. Avoid them, or take them earlier in the day.
  • Don’t let young kids watch the news, especially local news.
  • Try to “program” good dreams right at bedtime, by discussing a happy scene rich in details and color, referring to multiple senses. Maybe talk about the circus, and the noise the clowns make, and the smell of the hay, and the taste of the cotton candy.

A wonderful book for pre-school age kids having nightmares is Tell me something happy before I go to sleep. The book never mentions dreams, but it’s a sweet story with a talented big brother rabbit—he ought to become a psychotherapist, he’s so good with his sister.

Night terrors are different. They scare the heck out of parents—the kids can scream and scream—but the children don’t remember them at all. In fact, they’re not even awake, and won’t recognize their parents or seek comfort. Often night terrors occur at the same time each night. If your child has one of these, tuck them back in quietly and don’t try to wake them up. If they happen several nights in a row, a good technique is to “pre-wake” them about 15 minutes before the time that the night terror usually begins. All of the techniques listed to prevent nightmares can also help prevent night terrors, though they don’t work as well. Night terrors are usually outgrown by school age. Or at least by then, mom and dad are so exhausted they’ll sleep right through!

We’re going to pump (clap!) you up

February 22, 2009

Shelly had a question: “My 14-year-old’s football coach wants him to take at least 120 grams of protein a day. Isn’t this too much? Is this the best way to ‘bulk up’?”

It is a good idea for adolescents looking to increase their muscle bulk to consume a diet rich in good quality protein. However, it sounds like this coach may be pushing this idea to the extreme, and may be over-emphasizing a very specific diet rather than encouraging a well-balanced, healthy regimen.

Growing adolescents need to consume about 50 grams of protein a day. The precise number depends on many factors, including the kinds of protein eaten and in what combination, but 50 grams is a pretty good estimate for most kids. It’s not very difficult to get that much protein, especially from meat sources—50 grams of protein can be found in six ounces of lean meat or fish. Rich plant sources of protein include soy (tofu), nuts, and beans. There are several good tables available showing more precise measurements of the protein content of foods.

Proteins are digested in a broken-down form, called amino acids, that are used in part to make muscle tissue. So it does make sense to adolescents looking to increase their muscle bulk, or “lean body mass,” to have a diet that offers plenty of protein building blocks for growing tissues. But there is no evidence that extra-high protein loading makes muscles grow any faster or bigger.

Super-high protein intake can stress the kidneys, and can lead to a loss of calcium and other nutrients in the urine. Though, again, the exact number depends on many factors, most exercise physiologists recommend a daily protein intake of no more than 2 grams per kilogram body weight per day. For an average 14 year old adolescent male (let’s say, 140 pounds), that’s about 125 grams. Larger kids could probably tolerate more than this, as long as plenty of water is consumed and the remainder of the diet is well-balanced. However, this is an expensive way to eat, and won’t really help build muscle any better than a good balanced diet with a more modest amount of protein.

There is absolutely no advantage to using hi-protein shakes or bars over good quality, protein-rich foods. Some vegetarians (or kids who just don’t like meat) may find it easier to get a high protein intake using these products, but they’re a very expensive source of protein. I would much rather encourage a teenager to consume lean meat, eggs, fish, and nuts at every meal rather than rely on a special, processed protein source.

Beyond diet, there are other essential elements to increasing lean body mass. One is resistance exercise—that is, weight training. Muscles must move against “extra resistance” in order to grow. I suggest that adolescent who wish to weight train do this with the help of a qualified coach or trainer, to teach them how to use the equipment safely and effectively. Maximum lifts should not be attempted until after puberty is complete. Younger adolescents should do exercises using small enough weights that at least 20 repetitions can be done at each set; older adolescents may wish to push the weights higher and reps lower than this to get maximum bulk. Resistance training should occur with a day of rest in between each session, using alternate muscle groups each day or using alternate days for cardiovascular training.

After diet and exercise, the third essential element needed for effective lean body growth is something that’s often overlooked: sleep. Muscle tissues grow most efficiently during sleep, and adolescents who skimp on sleep will find that even a vigorous exercise program will not get them the bulk they’re looking for. Teenagers need nine hours of sleep each night, and there is no short-cut for adequate sleep.

Stay in your own bed

January 6, 2009

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!

White noise at bedtime

November 16, 2008

Lara posted, “My husband and I have always put our son, who is 10 months, to sleep with white noise in the background. It went from the exhaust fan in the bathroom, to a humidifier and now a sound machine. We even take the sound machine with us when we travel for our baby to sleep with. My husband’s family all use fans to sleep with and some have a difficult time sleeping without one. I am concerned that our son will always need white noise in order to sleep if we continue to use the sound machine long into the future. What happens when he goes to sleepovers and there isn’t one there? Should we keep using it or let him learn to sleep without one?”

I’ve written before about the importance of good, fixed sleep associations as an important way to help kids sleep independently through the night. Junior will get used to cues from the environment to know when it’s time to go to sleep and stay asleep. These can be things like being held, a gentle rocking motion, being swaddled, or a dark room. The best sleep associations are those that do not depend on a parent being present. So a white noise machine, running all night, can be an excellent way to help a child learn to sleep solidly and independently.

I’m not too worried about a baby being too dependent on a device like this. They’re easy enough to use every night, and can run on batteries or A/C. They’re cheap, they’re harmless, and I can’t think of any reason not to bring one traveling. In fact, they’re especially good during travel, as the familiar sounds drown out new and foreign sounds that would otherwise keep a baby awake. If a child wants to continue to hear soothing white noise when older, what’s the harm?

If you really want to wean this later, it can be done: just turn down the volume, gradually, so over several weeks Junior will get used to less and less noise, then finally turn it off. But I wouldn’t worry about this kind of habit now. It’s safe, and will help everyone get a good night’s sleep.

Don’t use the car seat as a crib

November 12, 2008

Here’s a sleep question from Kathryn: “Just wondering about the safety of infants sleeping in the car seat (in the crib). My 8 week old sleeps beautifully in the car seat but only naps for 45 minutes at a time in the crib. This is my 3rd child and this is new to me – my others were great sleepers once I “figured them out”. It appears that this one just does better sleeping like that -what are your thoughts? Thank you!”

In the short run, car seat sleeping might save you some trouble, but in the long run it can lead to more serious problems. Best to stop this habit now, before it’s really ingrained.

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Naptime becomes quiet time

September 23, 2008

Amy posted, “I think my almost 4 year old twins are ready to stop napping. They don’t really nap unless I lay on the floor telling them to lay down over and over again until they finally fall asleep and even them it’s usually only for 30min or so. However, after several days of not napping last week, they were visibly more cranky/tired. I sent one to school with red, puffy eyes b/c he was just so darn tired. Should I stop pushing naps? Will they work it out themselves and nap if they are truly tired? I know an earlier bedtime would help, but that’s hard to do in our house b/c they have 2 younger siblings. What do you think about a “quiet time” in their room? Is that reasonable for their age and if so how long should it be?”

Here’s some ironclad rules of parenting: you can’t make ‘em eat, you can’t make ‘em poop, and you can’t make ‘em sleep. Trying to do any of these things will lead to bad things.

Between 3 and 5, most kids will stop napping. Many of them will go through a period of transition, where they still kind of need the nap, but just won’t do it. It sounds like this is where you are—without naps, the kids are getting cranky. Still, if they’ve decided naps are no more, you’re not going to get them to change their minds by laying down with them. In fact, you’ll inadvertently be rewarding their nap-refusing behavior, and you’ll get yourself entangled in the struggle.

I like your idea of enforcing “quiet time” much better. I’d start with an hour, leave them be, they can do whatever they want to in their room as long as it’s quiet. Leave them books and quiet toys, but nothing electronic. After an hour, go get them; if they’re asleep, let them stay asleep until they wake up. Don’t even call it naptime any more. They’re more likely to sleep if they think you don’t expect it!