Transcription:

Scott Webb: We all need sleep. That's just a fact. And it's especially true for our kids while their minds and bodies are developing. But establishing and maintaining good sleep habits and routines can be challenging. And joining me today to discuss the importance of sleep for our kids and strategies to help them get the rest they need is Dr. Joelle McConlogue. She's a pediatrician with Stanford Children's Health.

This is Health Talks with Stanford Children's Health. I'm Scott Webb. So doctor, thanks so much for your time today. I have a couple of teenagers myself and I have observed that as they've gotten older, it does seem like they need to sleep more, especially my son. So that's what we're talking about today. We're talking about sleep and our kids and sleep habits and patterns and all that good stuff. So let's just start with a baseline question here, why is sleep so important to our children's health?

Dr. Joelle McConlogue: There's a tremendous amount of change that goes on through childhood and also even through the adolescent years. We certainly see that as we watch kids physically grow and change. But even behind the scenes, there's a lot that happens. Children are constantly developing. There's a lot of maturation. They learn appropriate social interactions. They learn emotional regulation. There's processing that occurs. So a child's day is really busy and an adolescent's day is really busy, probably more so than we even realize.

So I think that sleep is a chance to really refresh, to let our kids reset and also to let their bodies sometimes make these needed steps and their jumps in their growth. We don't exactly know what the brain does when it's asleep. But we think that it sorts through the information of the day, we think it kind of stores information and gets rid of the stuff that it doesn't need. We do know that chemicals are replaced and we know that hormones are secreted during sleep. And there's also some problem solving that happens. And so I think that it's both a time to let our brains reset, our kids to kind of make some of those needed steps and just to rejuvenate as well.

Scott Webb: Yeah. That sounds right. And I think I have this right, so correct me if I'm wrong, but I'm pretty sure, you know, children grow when they're sleeping, that that's when the HGH, their HGH really kicks in. I think I've got that right. So I'm wondering just in general, how sleep can impact a child's development.

Dr. Joelle McConlogue: Well, we know that sleep is just essential, not only for healthy growth and physical growth, but we know that it's essential for behavior, for attention, for learning, for memory. And we're also finding there's a direct correlation between sleep and sleep through childhood and adolescence and the risk for some later onset adult diseases. So type 2 diabetes or obesity or cardiovascular disease, there are links between the amount of sleep you get and the risk of developing those as well.

And I think for our adolescents especially, we know that sleep is tied to their mental health. And a lack of sleep directly correlates with increased feelings of anxiety and of depression. And it also increases their risk behaviors and alters some of their decision-making skills if they're not getting enough sleep.

Scott Webb: Yeah, I think that's so true. And I certainly have observed that with my kids. That they're just better, you know, when they're more well-rested. They're better kids. They're better siblings. They're better citizens. They're better students. They're better athletes. They're just better when they're well-rested. They may not take our advice. They may not believe us that they're better, but we as parents, we observe that they're just better all the way around mentally, physically, when they're better rested. And I guess I'm wondering, do children need more or less sleep at certain ages? And if so, why or why not?

Dr. Joelle McConlogue: Well, I think babies and young children need the most sleep. And then this gradually decreases as children grow and get older, but even our adolescents need eight-and-a-half to nine-and-a-half hours of sleep. And I think this is a number that really surprises a lot of people. Most of my adolescent patients and even their parents are surprised when we talk about the recommended amount of sleep. And a lot of teens don't get that amount for a variety of reasons, but the optimal amount of sleep even through adolescence is about eight-and-a-half to nine-and-a-half hours. I think most people underestimate that.

Scott Webb: Yeah, it does seem like that's a good range. I know that my son sleeps a lot more than my daughter and I don't know if that's just the difference in their personalities or how active they are or how busy their brains are right before they go to sleep. I'm sure there's a lot of factors there. And what are some signs maybe that our kids are not getting enough sleep? You talked about the benefits of sleep, but how do we recognize when they're probably not getting enough?

Dr. Joelle McConlogue: Well, I think you just touched on one a little bit earlier. I think parents can certainly see when their kids are cranky or when they're just not functioning as well, when they're irritable or they're moody, that can certainly be a sign. And I think most parents kind of easily recognize that. They can see when their kids are getting tired and not acting right.

Some other signs though I think are that if kids are difficult to wake up in the morning. If parents are going into the room and they're just having a hard time getting their child out of bed. They're not waking up easily, they're not getting out of bed, it's taking multiple times or multiple arousals to get their child up, they're probably not getting enough sleep. There's a little bit of time of transition between sleep and waking. But if you're finding that's really becoming prolonged, that could be a sign.

I think also if your child seems overly tired. If they're falling asleep in school, if they're coming home and wanting to sleep for a long period of time, if they're having difficulty staying awake or difficulty concentrating on their assignments, that can also be some indications that they're not getting enough sleep.

Scott Webb: Yeah, definitely. And I think that one of the things that we've all been concerned about, especially during the pandemic, is the device use. So the virtual learning, you know, they're on their laptops all day, then they're on their phones at night or maybe they're playing video games. And I'm wondering just how active their brains are. You know, the screen time right before bed, I'm assuming that's at least one of the factors in them not getting enough sleep and maybe what are some of the others as well?

Dr. Joelle McConlogue: That can certainly be a big factor for not getting enough sleep. And I think you're absolutely right. It's been a challenge during this pandemic because our kids are on screen so much more. But I always recommend to families that they take screens out of the bedroom at bedtime, and so this includes any screens. So I recommend no TVs in the bedroom, taking the tablets or the phones and charging them outside in a different room.

But in addition, also powering down before bed for about 30 to 60 minutes before bed, turning off those screens, turning off anything that they're looking at and winding down a bit, because we do know that screens can definitely affect the amount of sleep that kids get and can interfere with their quality of sleep as well.

So I think that's one step in the right direction that we can take if we're worried about children not getting enough sleep or quality sleep, is watch the screen time, limit the screen time, take those screens out of the bedroom when they're falling asleep.

I think a couple of other factors that can affect kids not getting enough sleep is sometimes not having a consistent routine. It's important for our bodies to have a little bit of a routine so that our minds and our bodies do know that it's time to power down. And if kids are sleeping at different times or having different schedules or bedtimes, sometimes it's hard for them to have that signal that it's time to power down. So having a fairly consistent routine and an appropriate bedtime does also help kids to fall asleep and to get adequate amount of sleep.

And then I think also one thing that can affect getting enough sleep for our younger kids especially is that often our younger kids will test limits at bedtime. They'll get out of bed. They'll try to seek attention. They'll try to seek comfort or food at that time. So I think it's important also to set appropriate limits around bedtime, and say, "Okay, this is bedtime" and kind of set those limits and set the rules about what children can and can't do and not make it a time where they're receiving some reinforcement for getting out of bed.

Scott Webb: Yeah. And it was always tough. I can remember when my kids were little, you know, and they would get out of bed and they're just so cute, you know, and they want to cuddle and you're just like, "Oh sure. You know, you can lie in mom and dad's bed for a while." And so it's always that balance. It's like, "Oh, they're just so adorable at this age. I don't want to send them back to their room," but you know that, as you say, routines and sticking with, you know, bedtimes and wake up times and all of that is so critical for kids, even if mom and dad just want to cuddle with their kiddos. Let's talk a little bit about stress and how stress impacts our kids' sleep or lack thereof.

Dr. Joelle McConlogue: Can I add one thing into that last comment? Because I think it's a good time to talk about that bedtime, and it is a wonderful time to cuddle with kids and it is a wonderful time to spend time with them. And so I think you're absolutely right, parents do want some time. But rather than have the kids get up, I would build that into the bedtime routine. So make sure that you're building time in before bed, where you do have a little bit, a five or 10-minute time where they're sitting on parents' laps and cuddling. And you have that touch and that personal connection during that time, so that once you send the kids to bed, they've had that. And then you can feel good about telling them to stay on the bed because they've already had that cuddle time.

Scott Webb: Yeah. I think that's such a great suggestion and you're so right. The best part of being a parent is the times when they're being cute and cuddly and fun and well-behaved and all of that. But as you say, we can just kind of work that into their routine, which works better for everybody. So let's come back now, let's talk about stress and how that impacts how our kids sleep or reasons why they don't get enough sleep. How does stress factor into that?

Dr. Joelle McConlogue: I think stress affects everybody's sleep. Whether you're a child or whether you're an adult, we know that stress just makes it harder sometimes to sleep. It can be harder to fall asleep at night. Stress can cause people to wake up during the night and not get that duration of sleep. A lot of times there are some external stresses and, in the daytime, kids can kind of suppress some of those worries because they're busy. There's a lot of other things going on and they kind of suppress those thoughts. But when you're lying in bed at night and things are quiet and you don't have those distracting things, those are when some of the worries can come up and some of the stresses can come up as well. So stress can certainly affect a child's sleep.

Scott Webb: I'm wondering what are some of the concerns you're hearing from parents about children's sleep?

Dr. Joelle McConlogue: I do hear a lot of concerns about the stress and they have a lot of questions about stress in the pandemic, stress with not going to school, stress with their children getting enough sleep. So the recommendations that I give are, first, you can't always control the stress in the outside world.

And so what I would do is focus on what you can control. There may be worries with school, there may be worries with mental health, with family dynamics or family situations. But what you can do is focus on the bedtime routine, you can focus on the time, you can focus on having that one-on-one connection and trying to make that more regular and trying to make that a consistent in the child's life, I think that does a lot to mitigate some of the outside stresses that come.

I also have parents asking a lot about the amount of sleep that their children are getting, because the schedules have been thrown off, I think, with the pandemic and with not going to school. And so parents are concerned whether or not their child is getting enough sleep. And again, I think setting a routine, setting those regular bedtime times and the wake up times also help to ensure that they are on somewhat of a schedule and getting that needed recommendation.

Scott Webb: Yeah. That all sounds right. And sometimes easier said than done, of course. And of course, we want to leave some room for flexibility and it may be a little flexibility on the weekend, stay up a little later, you know, that kind of thing. But as we know with kids, once they're in a routine and you break them of that, you know, like over summer break or something, it can be very difficult to get them back into those routines, which we know are so critical for them.

Dr. Joelle McConlogue: So certainly, Scott. I agree with you. We want to leave room for flexibility, especially on the weekends. So we have time for family activities, but I think it's important that we don't stray too far off of our bedtime routine, because sometimes if we sleep too long on the weekends, if our teens really altered their schedule, it can be difficult to go back to their normal schedule on the weekdays. And so I think even though there's the flexibility, we have to still be mindful of keeping somewhat in the same routine.

I am asked a lot by my teenage parents about sleeping in and whether children can catch up on their sleep on the weekends and, in an ideal world in a perfect world, I would say it's best to keep teens on the same schedule Monday through Sunday, but we don't live in a perfect world, I know that, and our teens are really busy. And often by the end of their school weeks, they're tired and they hit the weekend and they're really feeling fatigued. And I do want them to be able to get that extra sleep.

So my recommendations usually to families in those situations is that go ahead and have that little bit of flexibility in the evening or in the morning, but not too far. So I would usually recommend within about an hour, if they normally get up at seven in the morning, let them sleep until eight in the morning on Saturdays or Sundays. But if they're really tired and if they really need that extra sleep, have them take a nap, not too close to their bedtime, but in the daytime, so they can get a couple of hours of sleep and they can kind of rest and rejuvenate on the weekends, but it doesn't interfere too much with their daily schedule. And then by the time Monday rolls around, they're still on that normal schedule of going to sleep and getting up at a regular time. But they've had a chance over the weekend to catch up on a little bit of sleep.

So have a little bit of flexibility, don't go too far, have your kids still get up within about an hour or so. But if they need that sleep, let them go ahead and nap.

Scott Webb: So, doctor, when we talk about routines, what kind of questions are you getting from parents? Are they wondering how to establish and maintain good routines for our kids?

Dr. Joelle McConlogue: I do get a lot of that, especially how to transition now when they're on screens and doing homework and then transition to bedtime. And so I recommend a consistent routine just because it's important for our bodies to have this schedule and to know that it's time to power down. We talked a little bit about screens and taking those out. But in addition, I would recommend having about a 20 or 30-minute wind-down routine for the child or for the adolescent.

And the parents and the child can figure out what this means. For younger children, this could be taking a bath or putting on their pajamas, maybe reading a story with mom and dad, singing a song or saying a prayer, whatever the family feels is important and also calming for the child.

I think for adolescents, that's the same thing, though. They should have a little bit of a bedtime routine, a 20 to 30-minute period where they're winding down. They can take a shower, they can just turn on some soothing music, they can read a book. They can just do something that's calming to them. And that gives their body a chance to wind down from those screens, to wind down from the stresses of the day. It also reminds them that sleep is coming, and their mind can kind of power down and get them ready for sleep as well.

Scott Webb: You know, it's probably maybe not one size fits all, but when generally do you recommend that parents should reach out to their pediatrician? You know, if they're concerned about sleep habits, sleep patterns, difficulty waking their kids in the morning, when is it a good time to reach out?

Dr. Joelle McConlogue: Certainly if there are any signs of sleep apnea. Sleep apnea is a condition where children have pauses in their breathing or periodic cessation of breathing during the night. Some of the symptoms that you would find with those is if your child snores excessively, if you hear them actually stop breathing, if there's long pauses in between their breaths or if they're just really excessively restless in the night, never seem to settle or never seem to get a good night's sleep, I would be concerned about that and have parents talk to their pediatrician.

I also think that if parents are just having difficulty setting a routine or understanding what the limits are or they want to just discuss, you know, what's an appropriate bedtime or what's the appropriate amount of sleep, I think a pediatrician is a great resource. The pediatricians are always willing to talk through routines with parents, talk through ideas or family situations and come up with ideas of what works and what would be best for the family. So I think just general questions, they should always reach out as well.

Scott Webb: Yeah, I think you're so right. Pediatricians are the best. I wish I could still see a pediatrician. Pediatricians just have such a pleasant and easy way, and everything's always positive. And it seems less like a business when you're in a pediatrician's office. You know, they're just the best.

And this has been a great conversation today, doctor. As we get close to wrapping up here, anything else you want to tell parents about sleep, sleep habits, patterns, bedtimes, routines. What are the takeaways today?

Dr. Joelle McConlogue: I think one thing that's important to remember is that the bedtime can be a really sweet time for affection and a really nice time between parents and children. I think too often, as a parent myself, I know this, bedtime becomes a bit of a battle. Parents are tired after a long day and they just want that quiet time and children are often weary and they don't always act their best. And so bedtime can sometimes be a battle between parents and kids, and it can be fraught with a lot of stress.

But I think the ultimate goal is to try to get our kids going to bed. But also to have that little bit of time, we've talked a little bit about having a bedtime routine and I think as part of that routine, make sure you build in just a little bit of time for cuddling, for touch. Younger kids love this. They love this time to read stories or to have mom and dad sing a song or to just climb on their lap and be wrapped in their arms. And five or 10 minutes of this is just a wonderful time to end their day and also to having a parents day.

But I also want to reiterate with our teens, it's important for us to remember this as well. I think as teens get older, sometimes we lose that time. But I have a lot of parents tell me that the bedtime is a time when sometimes their teens will open up or tell them things about their day that they don't get otherwise. And so I think for parents of teens, I'd encourage them to also just take a few minutes around bedtime when they can and go in and, you know, just sit on their teen's bed or talk to them and just ask, "How was your day? How did that math test go? Did you have a chance to talk with your friend today?" Because sometimes you do get those little bits of nuggets of information or that little window into your teen's life that you don't often get otherwise. And it can be a nice time. It doesn't need to necessarily be long, but it can just be a nice closing part of the day for both children, teens, and parents. And then just not to forget the importance of touch, even our teens need our pats on the back or our hugs or just that little bit of touch from mom and dad.

Scott Webb: Yeah, I think you're so right. I was thinking back to when my kids were little and the best part of my day, no matter how my day went, how long the trip was home from work, the best part of my day was reading Goodnight Moon to my kids and doing different character voices and things. And you're so right. Even with my 17 year old son, you know, we do more of a bro hug, you know, but I need that and I think he needs it too, you know. And I get kind of the side hug from my daughter. You know, we don't get any real deep hugs anymore, but I think that contact is so important, not just for them, but also for mom and dad.

Dr. Joelle McConlogue: I think our teens want it.

Scott Webb: Absolutely. They won't say it, but you know deep inside they need it sometimes. Just a little pat on the back goes a long way. So doctor, thanks so much for your time today. Really great conversation and you stay well.

Dr. Joelle McConlogue: Well, thank you.

Scott Webb: For more information, visit StanfordChildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full library for topics of interest to you. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.