Transcription:

Bill Klaproth (Host):  You’re listening to Children’s Health Checkup, where we answer parents’ most common questions about raising healthy and happy kids. I’m Bill Klaproth. And on this episode, we’ll talk about how to get your child to sleep with our expert Dr. Kamal Naqvi, a Pediatric Pulmonologist, a Sleep Medicine Physician and Medical Director of the Sleep Disorder Center at Children’s Health and Associate Professor at UT Southwestern Medical Center. We’re going to talk about the importance of sleep for a child’s brain, how to get children to sleep and what to do when your child wakes up in the middle of the night. Dr. Naqvi, welcome and thanks for your time. So, how much sleep should children get in relation to their age and why is sleep so important?

S. Kamal Naqvi, MD (Guest):  I think the second question I’ll take first. Sleep is important because it really serves a number of purposes for a growing brain, a developing infant and toddler, it serves to consolidate memory, it helps in the learning process and it may have impact on their mood and behavior.

Host:  And then how about sleep needs in relation to their age?

Dr. Naqvi:  The sleep needs are different in different phases of life. So, as we know, and we see that infants sleep a lot. In fact, sleep is the primary activity they do. Up to 70% of their time is spent in sleep which roughly means about 16 to 17 hours for a newborn. Their sleep is a bit irregular. It occurs in bits and pieces. And then it gradually consolidates to a more nocturnal or a nighttime sleep as they are about three months of age. Sometimes later.

The older infants, maybe the toddlers where the sleep needs are a bit lower to up to 14 hours in our 24 hour cycle. And then as they grow older, into preschool age, the sleep needs are still between 11 and 13 hours. And then the school age children between six and 13 they should be sleeping a good 9 to 10 hours. Teenagers also need a lot of sleep which we frequently sort of underrecognize. They should be sleeping a good 9 to 10 hours too.

Host:  Okay. Got it. So, sleep is really critical, not only for physical growth but as you called it, for the growing brain especially for consolidating memory and learning as well. That’s really interesting. So, let’s run down babies, toddlers and school aged children and the most common reasons that kids have trouble sleeping. So, can we start with babies. What is the most common reasons that they have trouble sleeping?

Dr. Naqvi:  The reasons parents are concerned that the babies are not sleeping is are they related to the physiology or the normal development of sleep. We know that babies do not sleep for a good several hours at a time. They sleep in smaller durations. Like one to two hours, two to three hours at a time. And this duration increases as they grow a little older, a few months older and then several months old. So, as we know that babies who are about five to six months old; are more nocturnal sleepers. While babies who are younger than that or are newborns; would be sleeping all over the place from day to night.

Host:  So, let’s turn to toddlers and their top reasons that they have trouble sleeping.

Dr. Naqvi:  Toddlers are very interesting but sometimes a difficult population. Toddlers are learning their autonomy and the control. And many times, this becomes a display of autonomy at night. So, we see that during the day where we see different behaviors in toddlers where they are sometimes judging the threshold and the tolerance of the parents. They kind of test them. And sometimes, the same testing behavior occurs at night where they are awake, and they are manifesting different behaviors from crying to throwing a temper and more and it sometimes is depending upon how the parent reacts to those behaviors. I think it is important that parents keep their composure and not really respond quickly to a toddler’s behavior. They kind of feed onto that. Parents should be the decision makers, should be the person controlling the situation. So, I think so many times that toddler sleep issues are behavioral.

Now, as I say this, I think there is an important issue of knowing whether there could be a medical problem going on. And there are a few that could be the cause for sleep disturbance which could include sleep apnea, or reflux or some bodily pain conditions which sometimes can happen.

Host:  For those of us with kids, we know bedtime with a toddler can be like okay so let’s talk about now, reasons for school aged children. Some of the reasons that they may trouble sleeping.

Dr. Naqvi:  I think it can be many, a variety of things. It could be the sleep environment. I see families in my clinic and when I question more into the environment and the situation at home; sometimes there is an older sibling who could be awake, sometimes it is the use of electronics in the bedroom which has a negative impact on everybody’s sleep, adults included. Sometimes it is a parent’s schedule. So, if a parent has to really go to bed early and wake up early; they feel that the child’s sleep has to be perfect in order for them to get their sleep.

Some of the times, it could be the stress at school. It could be the interaction with the other children, the experiences at school, the stress of the homework and the endless number of reasons sleep could be affected due to those experiences.

Host:  Certainly a lot more factors when it comes to older kids. So, what can parents do while their child is a baby to help them sleep well?

Dr. Naqvi:  I think the most important way and the most important point to understand is to create a routine. The routine should be a positive, pleasant, enjoyable one. The environment of the sleep should be taken seriously also. The room and the place for sleep should be quiet and dark and a bit cooler about 70 degrees or around. And the routine of the bedtime should be consistent. If there is more than caregiver involved, both parents taking turns; they should be doing it in the same way. So, consistency is important. And then from the time they eat dinner to the time they go to bed; they should be dimming of the lights at home. White noise can be acceptable like a fan running or sometimes some other devices people can use. But reading a book, saying prayers, signing a song and making it a positive, pleasant experience helps.

Host:  Yeah, that makes sense. So, then how can parents help their toddler aged child and above, get enough sleep every night?

Dr. Naqvi:  Yeah, I think consistency creating a routine is important. I think knowing that children need about that amount of sleep is important too and controlling the electronic devices at home.

Host:  Yeah, that controlling electronic devices at night is a big one. So, let’s talk about the most ideal sleep environment. Earlier, you said keep the room quiet, keep it dark, keep the room cool, pay attention to routine and consistency. Do all those things factor into the ideal sleep environment?

Dr. Naqvi:  Yeah, those and also sometimes since there are other people at home too, siblings of different ages, maybe a grandparent. So people have different needs and activities for the evening and that should not affect a child’s routine. They should have a proper specified space for sleeping. There are people who are more fortunate and less fortunate to have adequate space for each child and each person in the household to have their sleep. So, I think that is also important. I recall many families where the children are of different ages and obviously a teenager has a somewhat later time to go to sleep. And those siblings, older siblings could be affecting and impairing the sleep of a younger sibling who should be a sleeping a bit earlier.

Host:  Yea, that's an important point to remember too. I know there are other issues that might impact sleep as well. I'd like to learn more about night terrors. Can you explain what night terrors are and what causes them?

Dr. Naqvi:  So, night terrors or probably a more accurate term is sleep terror because these can happen even during the day while napping. So, it’s a sleep terror and so, it’s a really kind of a loud cry with sometimes panic and apprehensiveness which happens mostly in the first half of the night and as the parent approaches a child who is manifesting that; they see that the child is really not fully oriented and knowing the surroundings and the person. So, they are somewhat disoriented. They don’t what they are doing. And they don’t know why they are doing it. And so, part of a bigger term that we use called parasomnia which includes many other behaviors during sleep. So, these sleep terrors are common in the toddler through elementary school age children.

Host:  How can we help prevent night terrors from happening and how should we care for a child during a night terror or a sleep terror as you call it?

Dr. Naqvi:  So, the best thing one can do in terms of preventing the sleep terror is to assure that the child is getting adequate sleep. Sleep deprivation is the most common reason for these behaviors to occur. There are some other conditions, if a child is sick for example fever can trigger a sleep terror. That has to be considered too. When it’s happening, the best thing a parent can do is to first not panic, do not question the child of why he or she is doing this. Because they don’t know what they are doing. So, very gently the parent should direct the child to go back to sleep, to go back to the bed and not try to wake the child up because that might worsen the behavior. So, just help the child to go back to bed and go back to sleep. Typically, that actually happens. It’s a short-lived episode. It can happen again the same night but typically it is short and then it is also important to not talk about it during the daytime. Because the child does not have a memory of this episode. So, they can get embarrassed or get upset about that.

Host:  So, just be as comforting as possible when it happens.

Dr. Naqvi:  Yes.

Host:  Okay. And Dr. Naqvi, is there anything else you’d like to share with parents about sleep?

Dr. Naqvi:  I think sleep should be taken probably more seriously than what the society in general does. It should be at least as important as feeding. We tend to believe that we can do things through our sleep and we’ll still be okay. That is not the case. The sleep deprivation causes problems in behavior and mood and learning and then it becomes a public safety issue for example, in teenagers who are driving and are sleep deprived. It is true for adults too. We all need our sleep. We should know how much sleep we need to have and do everything possible to get that.

Host:  Absolutely. And I think in this country, I think we’re finally coming to grips with the reality of how important sleep is. Because you’re right. I think we’ve had a cavalier attitude. Heh I only get four hours of sleep a night; I can tough it through. It doesn’t make any sense. It’s been proven that you need sleep and you’re not going to be your best until you have the rest that you need. Absolutely. Well Dr. Naqvi, this has been fascinating. Thank you so much for your time. We really appreciate it.

Dr. Naqvi:  I appreciate that. Thank you.

Host:  That’s Dr. Kamal Naqvi, Pediatric Pulmonologist, Sleep Medicine Physician and Medical Director of the Sleep Disorders Center at Children’s Health. Thanks for listening to this episode of Children’s Health Checkup. To learn more about programs and services and to see other health tips for your family, please visit www.childrens.com. And if you found this podcast helpful, please rate and review or share this episode and please follow Children’s Health on your social channels. Thanks for listening.