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Brief insights about childhood sleep problems
March 26, 2014
Dr. Vaishali Verma, BAMS, ND
It is well known that sleep is an important factor for the health and well being of growing children. According to National sleep foundation, sleep is the primary activity of brain during the early development of child. Sleep is not only required for the brain development but also in brain’s day to day ability to function . In fact, sleep is important for the overall growth of the body because there is profound increase in the concentration of circulating growth hormone at night in children.
Short duration sleep's implications: Several studies have shown that short duration sleep in children and adolescents is a risk factor for various medical conditions such as obesity [2, 3], type 2 diabetes , potentially severe mental health problems , cardio-metabolic risk , pre-hypertension, and hypertension .
Duration of sleep: There is no one magic number to answer the question about adequate hours of sleep in infants, children and adolescents. National Sleep Foundation  recommends different numbers of average sleep hours based on the child’s age.Average sleep hours for Newborns (0-2 months) is12-18 hours, for Infants (3-11 months) is 14-15 hours, forToddlers (1-3 years) is12-14 hours, for Preschoolers (3-5 years) is11-13 hours. Aveage sleep recommendations for school aged children (5-10 years) is 10-11 hours, and, for teenagers (10-17 years) is 8.5-9.25 hours.
Types of sleep problems in children: According to the 2005 revision of the International Classification of Sleep Disorders (ICSD), following are the types of sleep behavioral problems in kids :
Sleep onset association: where the child has learned to sleep only with parental intervention such as being rocked, fed etc. It is hard for child to go back to sleep independently unless learnt conditions are provided to the child.
Limit-setting: This is common in preschool aged children and older and is characterized by active resistance, verbal protests and repeated demands at bedtime.
Primary (psychophysiological) insomnia: This is more common in adults but can also occur in adolescents. In this type of sleep problem, there is a presence of conditioned anxiety around falling or staying asleep. It arises from predisposing factors such as genetic vulnerability; precipitating factors such as acute stress; and habitual factors such as poor sleep habits, caffeine use etc.
Transient forms: Transient sleep disturbance occur in a child with previously normal sleep. For example, sleep schedule disrupted due to a trip causing jet lag and sleep disruption due to sickness or acute illness.
Causes of childhood sleep problems: There are two causes- intrinsic factors and extrinsic factors : Intrinsic factors include child’s temperament, medical issues, circadian preferences (night owl vs. morning lark), neuro-developmental disabilities or anxiety disorders. Extrinsic factors include parents or caregivers inability to set clear limits both during the day and at bedtime. These factors include mental illness, emotional stress, long working hours. Also, environmental factors such as sharing a bedroom with a sibling, may contribute to the poor limit setting.
Solutions for childhood sleep problems: Behavioral interventions are the mainstay of the treatment for the behavioral sleep problems of childhood :
Sleep hygiene: Consistent bedtime routine improves both bedtime difficulties and night awakenings. Routine should last for about 20-45 minutes and include soothing activities such as taking a bath, changing into pajamas, and reading stories . Interestingly, while researching I encountered a study  that explored how sleep promotes word learning in preschool children who read books before sleep time. The results of this study demonstrated strong, persistent effects for both repeated readings and sleep consolidation on young children’s word learning.The bed time routine should end in the room where child sleeps . The child should sleep in same sleeping environment every night, in a room that is dark, quite and without a TV .
Watching television should not be a part of routine. One study  examined the potential associations between hours of TV viewing and sleep duration in children. This study found that Children spending longer periods watching television had shorter sleep duration, and that the changes in television viewing duration were inversely associated with changes in sleep duration in longitudinal analysis.
Systematic ignoring: It involves a program of withdrawal of parental assistance at sleep onset and during the night . This will encourage child to fall asleep independently and become a self soother.
Bedtime fading: It involves temporarily setting bedtime to current sleep onset time and then gradually advancing the time of light out. This works great particularly for children who have evening circadian preferences .
Positive reinforcements: Stickers charts can be beneficial especially with preschoolers and older children. Stickers can be given first thing in the morning to the child for meeting the goals.
Educating adolescents about the principles of sleep hygiene; use of relaxation technique in to reduce anxiety; restriction of bedtime to actual time asleep; and, restricting the intake of caffeinated drinks hours before the bed time can help improve the sleep behavioral problems in them.
To conclude, sleep is important for child’s growth and development and to prevent the risks of medical conditions associated with short sleep duration. I believe the average number of hours as recommended by National Sleep Foundation can be used as guidelines by parents and caregivers to ensure the hours of sleep duration in child. However, the “optimal” sleep hours should be individualized based on each child’s own requirements. Keeping sleep diary is a good way to find out the “optimal” sleep requirements of the child.
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