Toddler behaviour

ZZZZZ alert: do your kids get enough sleep?

Sleep experts say too many kids are short on shut-eye. What should parents do?

By John Hoffman
ZZZZZ alert: do your kids get enough sleep?

Is 9½ hours of sleep enough for a four-year-old — one who has to get up at seven each morning for school, and sometimes wakes as early as six? That’s what Natalya gets on her better nights, says Tracy Charpentier of Oshawa, Ont. “Last night she went to bed at about 8:15, but she wasn’t asleep until 9:30. She’s often awake later than that. I remember one night when she didn’t fall asleep until around midnight.”

Natalya has always been a reluctant sleeper. She stopped napping at 14 months, slept through the night for the first time at 18 months and still wakes up some nights. “She’s always fought sleep,” says Charpentier. She and her husband, Louis, have employed many of the standard tricks used by parents of problem sleepers — driving around in the car, walking the floor, singing songs, lying down with Natalya until she falls sleep, not staying with her, altering her diet and making sure she gets lots of exercise. “We noticed that when she was tired she would get restless,” says Louis Charpentier. “So we tried to turn that restlessness into exercise, hoping she’d feel more physically tired.”

Nothing has made much of a difference, although things go a little better when Dad does bedtime. “She’s quieter and will stay in her room for him,” Charpentier says. But still Natalya is getting by on no more than 9½ hours. That’s less sleep than averages reported by parents for her age group in two different studies, and well below what experts recommend. Charpentier thinks the lack of sleep may be affecting her daughter’s behaviour. “She has a meltdown just about every day. With the amount of sleep she gets on some nights, I don’t know how she manages to function.”

Many experts believe that too many of today’s children are going short of sleep. Last year, the National Sleep Foundation (NSF), a US-based network of sleep professionals, released a survey suggesting that one-third of toddlers and preschoolers and about one in four school-aged children weren’t getting enough sleep. In a UK study with similar findings, English psychiatrist Luci Wiggs hinted darkly that “the long-term consequences in terms of physical and mental health for both the child and their family can only be guessed at.”

Are today’s kids really so sleep deprived? And if so, what should parents do?

Sleep by the numbers
We did our own poll (answered by more than 350 parents) on, and our findings were remarkably similar to those reported in the NSF poll.

In both surveys, the average amount of sleep reported by parents is about an hour behind what the experts say kids should get. According to the NSF website, children aged three to five should get between 11 and 13 hours of sleep a day (including naps), while five- to 12-year-olds should be logging 10 to 11 hours. (For teens 13 to 18, the recommendation is 8.5 to 9.25 hours.)

However, the NSF recommendations are not derived from a very extensive body of research on children’s sleep, says paediatrician Judith Owens, director of the Pediatric Sleep Clinic at Hasbro Children’s Hospital in Providence, RI. “How much sleep people need is a subject of intense debate.”

One thing is clear: Children don’t all need the same amount of sleep. Experts acknowledge this and Lynda Lougheed’s twin sons are a case in point. Lougheed, who in her professional life is director of Information Children, a parent support service at Simon Fraser University in Burnaby, BC, says one of her six-year-olds consistently gets about 30 minutes less sleep than his brother. “They both go to bed at 8 p.m. and are usually asleep by about 8:30,” she says. “But almost every day Kyle gets up at 7 a.m. while Mitchell sleeps until 7:30.” Kyle sleeps more than 10 hours and is his brother’s equal in health, behaviour and school performance. “He just seems to require less sleep,” Lougheed says.

Still, the poll suggests that some children are getting by on strikingly low amounts of sleep. Eleven percent of preschoolers were doing the equivalent of going to bed at 10 p.m. and getting up at 7 a.m. — or earlier. Almost a quarter of nine- to 11-year-olds were getting eight hours a night or less. We don’t need experts to tell us that’s not very much, nor do we need research to convince us that, on the whole, enough sleep is better than not enough. However, some research has started to home in on exactly why children (and parents!) are usually not at their best when they go short of sleep.

Average nightly hours of sleep reported by parents
Preschoolers (3-5)
Sleep in America poll: 10.4 hours 10.3 hours
School-agers (6-11)
Sleep in America poll: 9.5 hours 9.7 hours
Young teens (12-14)
Sleep in America poll: No data 8.9 hours
The trouble with tired
Studies of brain functioning show that in adults, sleep deprivation reduces arousal and attention. Psychologist Avi Sadeh, director of the Children’s Sleep Laboratory at the University of Tel Aviv, is one of the few to study children. In one experiment, he asked parents to either restrict (keep them up an hour later) or extend (put them to bed an hour earlier) their children’s sleep. Children who stayed up later did not score as well the next day on several tests of attention, memory and learning.

Other studies support our perceptions about the connection between sleep and child behaviour. John Bates, a developmental psychologist at Indiana University, found, in two different studies, that sleep disruption and behaviour problems tend to go hand in hand. “It could be that the sleep deficit causes the behaviour problems,” he says. “Or it could be that behaviour problems, and all that goes along with that, could make it harder for children to settle down for sleep, or that some other unknown factor is causing both the sleep and behaviour problems.”

Whatever the underlying reason, Bates — who works part-time in a clinic for children with oppositional defiant disorder — says he and his colleagues have sometimes achieved dramatic behavioural improvements simply by increasing a child’s sleep. “We have seen amazing turnaround in some kids,” he says, but cautions that you can’t count on this result.

Hidden sleep issues
In another study, Sadeh used simple monitors worn on the wrist to track the sleep of children in their own homes. He found that children whose sleep was fragmented — defined as at least three awakenings and being awake for at least 10 percent of their sleep period — performed more poorly on neurological tests. Their parents also reported more behaviour problems than parents of good sleepers. Here’s the kicker: Another of Sadeh’s studies showed that almost one in five kids met his criteria for fragmented sleep. And most of the time, their parents didn’t know because the child’s disrupted sleep did not disturb the parents.

Calgary paediatrician Peter Nieman says certain medical conditions can cause or contribute to disrupted sleep, including anxiety, untreated allergies, gastroesophageal reflux and sleep apnea.

Sleep apnea is one of the easier ones to detect since the breathing disorder is often accompanied by loud snoring. Even so, says Nieman, “parents don’t always know. Sometimes they don’t find out until the family shares a hotel room or they are told to videotape or tape-record their child while asleep.” Some studies have found a link between hyperactive behaviour and apnea in children.

Diagnosing a problem
In assessing whether your child is sleep deprived, the starting point is not: Is my child getting as much sleep as experts recommend? Rather, parents should ask themselves, what exactly is the problem — is there a problem? Is Jessica always cranky late in the day? Is she often drowsy? Is she difficult to awaken? “In many ways,” says Owens, “the definition of childhood sleep problems is that the parents are having a problem of some kind related to the child’s sleeping patterns or behaviour.”

A suspected sleep problem requires a thorough medical assessment. Unfortunately, according to both Nieman and Owens, many doctors do not talk to their patients about sleep, or do so ineffectively.

Anita Sutton* has two daughters who are, by any standard, both miserable sleepers. Seven-year-old Quinn goes to bed around 8 p.m., but is seldom asleep before 11, and usually wakes each night. Her three-year-old sister, Angi, wakes frequently (10 times is the record) and rises very early — 5 a.m. some days. “I’d say that on most nights, Quinn gets no more than six hours of real sleep,” says Sutton, who lives in southwestern Ontario. “Angi [who] usually gets less, closer to five hours.”

Even a cursory glance at such a story should raise alarm bells, yet Sutton can’t get doctors to take her problems seriously.
“My doctor thought I was exaggerating,” she says. “He told me that interrupted sleep was part of parenting.” Eventually she wheedled her way into a paediatrician’s office. His response was similar. “Don’t worry. Pretty soon you won’t be able to get them out of bed,” he said.

Though he won’t comment on another doctor’s case, Nieman says that when parents report sleep problems, doctors should take them seriously and investigate the cause.

Help for bad sleepers
Medical problems require appropriate diagnosis and treatment. The possibility that hidden interruptions, such as those listed above, may be costing a child sleep should at least be ruled out. However, most sleep problems are not medical, says Nieman.

A big reason that some children go short of sleep is — to risk stating the obvious — late bedtimes. These days many preschoolers must get up early and eat dinner late due to the schedules of their working parents. Older children have more homework and lots of commitments to after-school and evening activities. Add to that electronic enticements like TV, video games and instant messaging, and it’s easy to see why some kids have busier evenings, later bedtimes and more difficulty settling down for sleep.

Since wake-up time is often non-negotiable, the only option for increasing a child’s daily sleep is an earlier bedtime. Most experts recommend altering bedtimes gradually, say 15 minutes at a time. The key is restructuring the family’s evening; Nieman suggests we think of it like a hot- air balloon that is too heavy. “You have to throw something overboard to make the balloon lighter,” he says. Whether that means dropping soccer or instituting a no-TV rule, a less hectic evening is critical to creating an unhurried, consistent routine to help the child wind down.

Adolescents are a different breed
“Children’s circadian rhythms — the times when they feel ready for sleep and ready to wake up for the day — change during adolescence,” says Judith Owens, of Hasbro Children’s Hospital in Providence, RI. This can start as young as 12, and may explain why teens find it so hard to get up for school, love to sleep in weekends and often don’t seem to be tired when we think they should be. In fact, some experts have argued that high school start times, which in the US can be as early as 7:15 a.m., are developmentally inappropriate for adolescents. Since most high school schedules are unlikely to change, parents are left with a dilemma. You can try to make your teen stick to “good sleep hygiene,” as experts call it, by keeping regular hours; that means going to bed and getting up at the same time seven days a week. Or you can let him sleep in generously on weekends. While experts would call this bad sleep hygiene, for many parents it’s clearly the lesser of two evils.

Yeah, but...
Still, a stricter commitment to bedtime isn’t going to do it for every family. Nieman knows this from both professional and personal experience with his own four kids. “I think a certain percentage of children are simply born bad sleepers,” he says. “The parents have read every book and tried every technique, but still the child fights bedtime or calls out in the night, or wakes up too early, or seems to resist falling asleep with every ounce of her being. If I had the one answer, I’d be a millionaire.”

Parents struggling with persistent sleep problems need two things. One is short-term coping strategies. That might mean taking turns on the middle of the night or early morning shift, or, in some cases, farming the child out to an understanding relative for the occasional “sleepover.” Sutton sometimes sends Quinn to Grandma’s house where, interestingly, she usually sleeps better.

Secondly, parents need strategies to try, something — anything! — that has a possibility of altering the status quo. Nieman says the best place to start is by asking if there’s anything that helps right now. “For most of these families, there’s usually something that works, and often it’s having the parent sleep with the child,” he observes. Historically, doctors, including Nieman, have tended not to recommend co-sleeping, but he acknowledges that it may make sense in some cases. “You want to establish some stability in the child’s sleeping,” he says. Then parents can look for the next step towards the ultimate goal of having their child sleep well independently — or at least in a way that ensures that both parent and child get more undisturbed sleep.

Another sensible starting point: If what you’re doing doesn’t work, try something else. At least you stand a chance of interrupting whatever negative pattern you and your child have gotten into. Perhaps a child will fall asleep on her own listening to music or a story on a CD player. For some kids, a later bedtime might cut down on the time they lie awake. If Mom does all the bedtimes and is getting resistance, maybe she should bow out for a while and see if Dad can do better. If a child awakes and needs reassurance in the night, will sitting on her bed (as opposed to taking her into yours) do the trick? Older children may respond to an incentive — otherwise known as the much frowned-upon (but often used) bribe. “If you stay in your own bed all night for seven nights, we’ll buy you a Barbie sports car.” (As parents can attest who have tried it, however, bribery usually only works as a temporary measure, when a child is ready and willing to change his behaviour.)

Nieman doesn’t necessarily endorse all of these tactics and he acknowledges that you might try them all and still not solve your problem. “But parents need options,” he says. “Trying something new might break a negative pattern or, if nothing else, make you feel a little less helpless in the face of your problems.” Sleep problems are one of the greatest tests of parental patience, he says. “Keep trying and look for small improvements. Most of the time, these sorts of problems resolve very gradually. But usually, they do resolve eventually.”

*Name changed by request.

This article was originally published on Apr 04, 2005

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