Celebrate your child's love of learning

© Wondertime

You know that up-all-night feeling — a cratered wispiness that makes the world appear as if through a veil of gauze and a haze of crankiness. As a former medical student and as a parent, I'm unfortunately quite familiar with sleep deprivation. What's caught me off guard is how familiar some of my patients are with it, and I don't mean my infamously nocturnal patients, The Newborns. I'm talking about toddlers on up to teens who are chronically sleep deprived.

Most parents are clear about the concept of good sleep habits for their babies. Yet somehow we lose track of this idea as our kids grow older and other forces (like the outside world) increasingly shape their days and nights. But as the demands on a growing child increase — soccer practice, standardized tests — so does the importance of a good night's sleep. Recent studies suggest that children's sleep habits have major effects on everything from mood to school performance and even their risk of being overweight. Talk about a wake-up call.

What I Preach

What do I think about a sound night of sleep? As Gandhi said when asked about Western civilization, I think it would be a good idea. A 2004 study by the National Sleep Foundation tells us that many children don't even meet the low end of recommended hours of sleep each night — a minimum of 10 to 12 hours for kids ages 1 to 12. A bit of lost sleep might seem a small price to pay when there are vocabulary words to learn and video games to master. But even moderate sleep loss can have some nasty effects, such as moodiness, a shortened attention span, poor decision-making, and increased susceptibility to illness. Cortisol, the so-called stress hormone, naturally tapers off during sleep, helping us to rest and relax. Sleep loss keeps cortisol levels ramped up, which can't be a good thing.

Sleep loss also disrupts the body's ability to process glucose, causing major brain freezes, particularly in the prefrontal cortex, an area responsible for feats such as concentration, impulse control, reaction time, and predicting the consequences of actions — pretty important skills for little kids. Recent research from Tel Aviv University revealed that sleeping an hour less for three nights reduced the cognitive capabilities of sixth graders to those of fourth graders.

What's more, sleep loss early in life may have long-term effects. The causation is far from clear, but there is a compelling link between kids who sleep less and being overweight later in life. Sleep loss increases the hormone ghrelin, which stimulates hunger, and reduces levels of leptin, a hormone that inhibits appetite (yep, these are actual hormones, not Tolkien characters). Together, the message to the brain is loud and clear: "Eat more!" And it's not fresh fruit and veggies you're craving — it's that greasy, junky crap. While sleep loss and the bad food habits that follow may be temporary, this pattern influences the way one eats in the days and weeks after sleep loss and can become ingrained.

What I Practice

One of the most common sleep issues I deal with in my practice (and at home) is the classic struggle with children around limit setting and routines. Many of my families have come to expect the patter of feet at 3 a.m. as their child wakes and hunkers down into the parents' bed. For some, it's no big deal. They may subscribe to the family bed idea or maybe are just deep sleepers who hardly notice and don't find it an obstacle to their own "parent time."

For parents who want to reclaim their bed, I suggest they gently tell the late-night visitors to go back to bed, and perhaps escort them to their room. Boring, businesslike, and assuring is the attitude to aim for (try channeling the vibe of an efficient English butler, without the vivacity of Mary Poppins). If they bounce, bring them back each time until they stay. Some resistance (yelling) is possible. Here is where I might be more hard-core than some: If your child is safe in her room, I encourage you to let her sound it out until she goes back to sleep. The idea is for the child to learn to put herself back to sleep, which is best done without an external crutch (you). And, as in all things behavior- modificationwise, celebrate success. A sticker at breakfast or a special treat for logging three or four nights in her own bed.

Of course, just because they're in bed doesn't mean they're sleeping. Remember staying up late with a book, reading under the covers with a flashlight? We were delighted to see our son take to reading with a passion, though less pleased with the socket-eyed zombie who showed up at breakfast. We learned to set a limit to his nocturnal activities, and we're all happier for it. Sometimes the solution to a sleep problem really is as basic as reinforcing good sleep habits (which we try to do . . . sometimes). Encourage a calm pre-bed routine (no video games, scary movies, arguments) and a consistent, firm bedtime. Promote relaxation with 10 to 20 minutes of reading or a book on CD.

Good routine or not, some kids are just poor sleepers who struggle to fall asleep or who awaken periodically. For some, transitions in general are tough, with the wake/sleep cycle being no exception. An unquiet mind could also be the culprit: Relaxation therapy syncs gorgeously with the fertile imaginations and creativity of little minds. With a calm, soothing tone (my mellifluously voiced and patient wife is best at this), begin by suggesting that your child relax his feet, then thighs, belly, arms, on up to his eyelids.

My apologies if all this has left you feeling worn out. The idea isn't to make you lose sleep worrying about your child's sleep. It's to remind you that thinking about sleep is as important as thinking about what you feed your child. I hope these ideas can help everyone, as my kids would say, chillax.

This Just In — (to us, at least)

Warm milk isn't a great sleep aid. Ditto walnuts, turkey, strawberries, and salmon. None of these foods contain enough of the fabled tryptophan to make one sleepy.

Soporifics that work: 30 to 60 minutes of outdoor romping each day, gentle massage at bedtime, and, for some kids, you might consider talking with your pediatrician about the nutritional supplement melatonin (for short-term use).

By the Numbers

• 76 — Percentage of parents who would change something about their kids' sleep habits if they could.
• 69 — Percentage of children ages 10 and under who experience sleep problems at least a few nights a week.
• 2 — Times more likely that parents of sleepless kids are sleep deprived themselves .
• 14 — Percentage of school-age kids who still wake up nightly needing attention.
• 47 — Percentage of school-age kids who get the recommended hours of sleep each night.

What a Snore

Obstructive sleep apnea (OSA) – the disorder that interrupts breathing and can cause snoring, bearlike yawps, and choking sounds during sleep – is well known among adults, but increasingly a concern among children too. Kids or adults may wake several hundred times a night, leading to chronic daytime drowsiness and behavior issues (similar to ADHD).

OSA is a compression of the upper airway, which causes intermittent airway blockage during the relaxed muscle tone of sleep. It can be caused by tonsil or adenoid problems, or by a pad of fat that develops on the neck. (Being overweight may cause or contribute to sleep problems. Sadly, where I practice, 40 percent of kids are obese.) We know that adults can have OSA, but recently, there's been a call to screen children as well. I bring it up to my families by doing a rather stagey (but accurate) buzzsaw snore and by describing the bearlike yawps and snorts, then, gasping, choking sounds, accompanied by some rousing and repositioning, only to have the snoring begin anew. It gets laughs and makes me choke, but it's poignant how often I have parents point at me and say, "Yeah! That's him."

Kids or adults with OSA may wake several hundred times a night, leading to daytime drowsiness, behavior issues (similar to ADHD), or worse. Unaddressed, OSA can lead to long-term strain on the heart and elevated blood pressure.

OSA is diagnosed with a sleep study, among other tests, and possible treatments may include a tonsillectomy or adenoidectomy, nutrition changes or weight control, or even the use of special nasal ventilators, called CPAP machines. In an era of handy gadgets, I suggest you film/record worrisome snoring or odd sleeping patterns and bring them to your health care provider. A picture is worth a thousand words; a video can save you at least a dozen referrals!

About the Author
Jack Maypole, a pediatrician at Boston Medical Center and director of pediatrics at the South End Community Health Center, still misses nap time.