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Melanie:  There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels.

This is Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And I invite you to listen as we discuss normal sleep habits for kids and during the pandemic, what is happening with our children and sleep? Joining me is Dr. Haviva Veler. She's the Director of Weill Cornell Medicine's Pediatric Sleep and Breathing Disorders Center.

Dr. Veler, it's a pleasure to have you with us. This is a really great topic. And before we get into COVID and what it is doing to our children and sleep, tell us about the importance of sleep for our overall health and for our kids' overall health.

Dr Haviva Veler: I am so happy you asked me that question, because sometimes people feel like sleep is redundant, you just lay there, but there's so much things that happen during sleep. It's an essential function. It allows our body and our minds to recharge and refresh. It boosts our immune system. So if you have a wound, during sleep, that's when it heals. When you have inflammation, sleep actually treats inflammation. If we're sleep-deprived, it impairs our ability to concentrate, think clearly, process memories. Believe it or not, but if you don't sleep enough, you're going to gain weight.

There's also a good effect on heart diseases. It improves growth specifically in children. It improves endocrine function, so if you don't sleep enough, you can develop endocrine diseases like diabetes. And in general, you know, if you don't sleep enough, you have more anxiety and depression.

Melanie: Well, you're certainly right on with all of those. And I'm so glad you mentioned the link between things like diabetes and obesity, because these are issues with our children now in epidemic proportions that we're seeing. So, as we talk about this, what are normal sleep patterns for kids? What's normal? Is there a normal? How many hours of sleep they should get based on their age? Tell us about normal sleep patterns.

Dr Haviva Veler: So this is probably the first question I get asked by parents is "How many hours my child needs to sleep?" And the correct answer is as many hours as she needs to function well during the day, to have good energies all day long, because we know there's differences between kid.

In general, the American Academy of Sleep Medicine came up with recommendations. So if we go by age, newborns basically eat and sleep, so they usually sleep 16 to 20 hours a day and there's no rhyme or reason there. But once they go beyond that period, so infants, four months to one year usually need 12 to 16 hours of sleep in the 24 hours. And they will usually have two or three naps throughout the day.

Toddlers, so we're talking about one to two years usually needs about 11 to 14 hours. They usually take two naps throughout the day. So around a year and a half, they will drop one nap and will stay with one. Preschoolers, so three to five years old, usually needs about 10 to 13 hours. Around four, that's when kids usually give up their one nap. Not to say that some kids will continue to nap and some will drop their nap earlier, but this is on average.

Grade schoolers, so the six to 12 year olds usually needs between nine and 12 hours. So of course the six-year-olds will need longer sleep. The 12-year-olds, usually the pre-tween, usually need between eight and nine hours a night. And then teenagers actually need more sleep than the tweens. They need between eight to 10 hours overnight. And that's because they go through a robust puberty. So these are kind of general numbers.

Melanie: But it's important for parents to know. And as you say, they ask you that all the time. Now, based on what you just said, what has COVID done to the routine of so many of our children with school being online? And in some cases, kids just roll out of bed and climb to their desks and start class. Some don't even roll out of bed, they do bed school, which I will not allow in my house. But what is happening to our kids with their routines, with their sleep, in this epidemic and pandemic?

Dr Haviva Veler: So, we know that sleep is highly connected to having a structure and having routine and everything has to be predictable and COVID pretty much disrupted all that. So we know that there's really no scheduled opportunity because there's no strict school hours or there's no distinction between school. Just like you said, school is at home. And sometimes too you do school from bed, right? So there's no distinction between school or naps during the day. Everything's kind of mushed together.

The other problem is there is less cognitive and physical activity. We do less work or less school. And we also don't have recess where we go outside and we run around. We're kind of limited in how much physical activity we can do. There's definitely more screen time and screens and sleep don't go together. And there's also reduced exposure to sunlight again, because we spend less time outside.

And we can't forget that there's also more stress, more worry, more anxiety related to the pandemic. So all that affects sleep a lot. And then there's actually studies coming out from the different countries showing that kids' bedtime is much later, sleep quality is much worse, and the wake up is later. So the whole circadian rhythm or the whole sleep schedule is kind of shifted forward. Kids go to bed later. They wake up later.

I have to say that the only silver lining in that story is with the teenagers, because we know the teenagers have delayed sleep phase. It's almost like their internal clock is moved two hours later. And, usually with the usual school schedule, they will still have to wake up early for school, now they sleep later, they wake up later, the sleep schedule is more adjusted to their internal clock. And they're probably happier. But the other issue really is with daytime sleep. So there's more opportunity for daytime sleep, because kids are not on the go all day long. And definitely, daytime naps interfere with nighttime sleep. So schedules are off. Sleep quality's less, and overall there's a lot of issues there.

Melanie: So important. So then that begs the question, what can we do about it? How can we try and help our children? I mean, Lord knows, Dr. Veler, I have tried, especially with my daughter. And I've said, "Come on now. Go to bed. You've got Early Bird Gym in the morning," but it doesn't seem to work. They're thrown off. What can we do as parents? Now with littler kids, it's probably easier to at least try to set that routine and be insistent, but with teenagers, really, what can we do?

Dr Haviva Veler: I believe that even teenagers can understand the problem and what you do with older kids that you cannot do with younger is engage them in the process. So kind of talk about how changing routines and how the pandemic affected their sleep and their well-being and what things you can do to improve that.

And really with sleep is you go back to basics. Keep a good sleep hygiene. When you go to bed, the room has to be dark and on the cooler side, which is more conducive for sleep, and should be quiet. So there shouldn't be TV playing in the background. If you like to fall asleep with music, light music, nothing loud. And keep everything turned down, so there's no light in the room.

Keep a set schedule. I can't stress that enough, both for the younger kids and the older kids. Because the pandemic kind of mixed up our schedule, it's important to create a set schedule. So go to bed at the same time and wake up at the same time. Our brain falls into routines. And if we go to bed exactly the same time every day, our brain will already be ready to fall asleep at a certain time. So by training our brain and setting our internal clock to a set time, it can really improve our bedtime. And it also helps with people that suffer from issues with falling asleep and insomnia.

Sometimes teenagers tend to kind of have a set schedule during the weekdays and then sleeping through on the weekends and what you have to remember is that what you do by that is you go to sleep all day on the East coast and then fly to the West coast over the weekend and then expect your body to go back to the East coast schedule on Monday. That doesn't really work. So even on the weekends, which I think it's probably the hardest recommendation to keep, but try not to sleep in too much. Try not to go to bed too late on the weekends.

Another big thing with kids is to avoid screens. And I know even the little kids, sometimes you have no option, but just to have them exposed to screens. Screens project very bright light, specifically the blue light and it changes our circadian rhythm, because our brain gets the hints for when it's time to go to sleep by the outside lights. The best example is, in the winter time, like now when the days are shorter, we get tired earlier. But in the summer, when there's sun until eight, by nine, we still feel full of energy. And that has to do with the light cues that the sun gives us and also by a hormone that our body's making called melatonin. So melatonin is what makes us feel sleepy.

If you look at screens at night, you kind of block the melatonin that our body's making and our brain thinks it's still daytime and it's still awake, so shut down your screens and expect to fall asleep right away, it does not happen. So we usually recommend to avoid bright screens at least an hour before bedtime. So the hour before bedtime, dedicate it to staying in a dim light environment, do relaxing activities. It's nice to follow a set routine, especially in the younger kids. You kind of send a message through your body and brain, you know, "If I take a bath and I read a book in my room, the next thing will be falling asleep." So it's not just a message for the kid, it's also a message to our brains.

And then avoid daytime naps, usually the later naps. So if your kids take a nap at 5:00 PM, you can't expect them to go to bed at eight, right? The sleep drive is just not there anymore. So try to avoid sleeping during the day. Try to have a set sleep schedule with enough sleep overnight. Give sleep a priority like we discussed before. It's very important. And keep the same schedule for the pandemic period. That's probably the basic message that I have here.

Melanie: Well, what a good day message it is. Every parent listening can really attest to everything that you've said, and I'm sure we can all relate. So wrap it up. Now, you did just give us your quite best advice about sleep hygiene, but I'd just like you to kind of reinforce that and let parents know when you feel that it's important that they seek out a specialist or speak to their pediatrician about sleep issue questions they may be having for their children.

Dr Haviva Veler: Absolutely. I think parents should talk to the pediatrician regardless about their child's sleep. And specifically, if there's issues. If a child is having hard time falling asleep in the time that he's supposed to fall asleep, if a child wakes up at night multiple times, or if a child wakes up too early in the morning, these could all be related either to insomnia, which can be really easily managed if you catch it early enough.

If your child looks tired during the day, right? So that means that they either are not getting enough sleep. So the quantity of sleep is not enough, but it could be that his quality of sleep is not enough. And in children, we do have the issue of sleep apnea. And sometimes, if your child sleeps enough hours overnight, but still looks tired during the day, you should think about that. And again, talk to your pediatrician about that.

Melanie: Great information, Dr. Veler, and so important for parents to hear. Thank you so much for coming on and sharing your expertise in a topic that I know nearly every parent is going through right now. So thank you so much. That was a great episode.

And Weill Cornell Medicine continues to see our patients in person, as well as through video visits and you can be confident of the safety of your appointments at Weill Cornell Medicine. I want to thank our listeners and that concludes today's episode of Kids HealthCast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. I'm Melanie Cole.  

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