Healthy Sleep For Children
Gary Feldman (Medical Director, Stramski Disorders Center, Miller Children's Hospital ) gives expert video advice on: What are the benefits of sleep for children?; What is a normal sleep pattern?; How much sleep does my child need every day? and more...
What is "sleep"?
Sleep is something that is really necessary for all of us. Often we think well perhaps we just laid on the bed and closed our eyes for 8 hours we would be fine. We could get up in the morning or get up whenever and be refreshed, but we're not. Our body actually needs sleep and we need sleep for a number of reasons. It's not really just to rest your body physically but it is important for your brain. When we say important for the brain, it's important for things like memory development or memory consolidation. So the kind of experiences you had in the day, when you sleep you kind of reorganize it. It is kind of like packing a suitcase. When you have been on vacation and your suitcase is a mess, and you are ready to go home you have to put all your clothes in there. You have got to pack it. So in a sense when you sleep you are kind of packing and rearranging the events of the day so it is easier to retrieve later on.
What are the benefits of sleep for children?
For children, sleep is important because that's when your brain does a lot of growing and when a lot of your neural connections take place. Sleep is important for daytime functioning too. It affects your mood. It affects your executive functioning and how you organize your life and how you make decisions. In children, sleep is also necessary for physical growth because there's a hormone that's released particularly during sleep, and lack of sleep can impact the release of growth hormone.
What are "sleep patterns" or "sleep stages"?
When we say "sleep patterns", its synonymous with "sleep stages" because as you sleep through the night you go through these different stages and the pattern that you see is what we call "ultradium rhythm". It's kind of like a map of the different stages that you've gone through in the night and when you do a sleep study, you can measure the brain waves. It gives you this ultradium rhythm, which gives you a pattern and if you look at this ultradium rhythm, or pattern, you can identify what a normal looking sleep pattern for the night is and what is abnormal.
What is a normal sleep pattern?
I think the definition of normal sleep is the effects of sleep. In other words, how it affects your behavior. For instance, if you have abnormal sleep, it will affect your performance, and it's going to affect how you perform in the daytime. I guess it's kind of a reverse definition, because you only had abnormal sleep because your lifestyle or quality of life is affected. For instance, the child who is not sleeping well or has abnormal sleep for whatever reason will have some kind of behavioral manifestations during the day. They'll be cranky, if they're older, they won't be able to concentrate at school, and may be labeled ADD. They may be excessively sleepy and fall asleep, whatever they're doing. When kids have sleep problems, they're sleep patterns are not necessarily broken. It's primarily behavioral or if it's not behavioral, it may be problems with breathing and sleeptime; it's not something seriously wrong with the child. A lot of families think that might be the case, and that might prevent them from coming forward and asking for help. It's embarrasing. For me personally, if my kids have sleep problems, do you think I'm going to tell anybody? Not really, I mean it's embarrasing, especially if you purport to have knowledge about it.
What is our body's "internal clock"?
The body's internal clock is an innate system allowing you to realise subconciously when it is night and day. There are certain things that keep your internal clock syncronized. For instance if you took an individual and put them in a room without outside stimulation and you kept the light on indefinitely, you'll find that the body's internal clock letting you know when you feel tired and when you wake up naturally, will be around 25 hours and will progressively increase. So if you left someone in a room for a number of days, you would find in fact that after a few days they would actually want to sleep in what would be the day time and would want to be awake in what would be the night time, and then given enough time it would cycle back through to night time. So the factors that help you synchronize your internal clock, what we call the Circadian rhythm, are basically: exposure to light, regular meals, and activity. And these things are really what keeps our clock on schedule.
What is "sleep homeostasis"?
Sleep homeostasis is best explained like this: Besides that internal clock (our day-night Circadian rhythmic clock that helps us regulate our sleep cycle), we also have sleep homeostasis which is like a "sleep drive."During the day, as you progress during the day, you accumulate an increasing need to sleep so that by the time nightfall comes and your body starts to produce a particular hormone called melatonin, which is your sleep hormone, you have developed sufficient sleep drive and need to sleep at that time, which will then make you feel sleepy so that you fall asleep. That is homeostasis.
What is a "sleep habit" or a "sleep onset association"?
Whether we're children or adults, we actually all have habits when we sleep. Let me talk about adults quickly and then I'll relate it to children. As adults, when we're serious about going to sleep we may have a favourite position that we adopt; we may take our pillow and do something with it, we may have a habit that we always use when we're serious about falling asleep. That's for why some people, when they go to sleepovers, to a hotel, or they're sleeping overnight somewhere and don't have their favourite pillow, it's just not right; it's harder for them to fall asleep because it's not what they're used to. So, in essence, we all have something we're used to; now children are the same and we call these habits, these things that we're used to, 'sleep onset associations'; we always associate something with going to sleep. The habit could be whatever the child is used to, for instance if the baby is used to sleeping with a parent and going to sleep with a parent, then that becomes the habit and they cannot fall asleep without that. If they're used to having a pacifier, if they're used to having their teddy bear, if they're used to having music played or the TV on, or a combination of all of those things. Some of them can be really complex. You can have a parent have to lie with you and you may have to drink a bottle, you may have to have music, you may have to have a teddy bear, you may have to have a blanket, you may have to have the TV on as well, and these things all become entrenched as habits. Now, it's important to understand that when we go back to these sleep patterns, when we go through our sleep patterns and we move from a deep state of sleep to a light state of sleep, we all naturally have moments where we wake up spontaneously. It's normal; it's normal to wake up in the night, it's just part of our sleep pattern. The question is, depending on our habit, when we wake up naturally in the middle of the night, for most of us as adults, we kind of may roll over, we may move the pillow, we may do something again, or we may kind of recreate the habit that we had when we went to sleep initially and we put ourselves back to sleep. Now for a child, if their sleep habit is say drinking a bottle or nursing, or having the TV on, and they wake up naturally (which can happen multiple times in the night), they wake up and they see that Mummy's not with them anymore, and where's the bottle that they were used to? They actually cannot put themselves back to sleep without having those additional sleep onset associations, and so that's when it can become a problem, because when naturally waking up in the night, the child is unable to put themselves back to sleep because they don't have all of those additional, peripheral things which they were used to.
How much sleep does my child need every day?
So the amount of sleep your child needs varies according to their age. As you get older, you need less and less sleep. So, for example, a baby that's under two weeks of age needs about sixteen hours of sleep in twenty-four hours. From about six months of age, you need about fourteen hours of sleep and of course you've got to figure out when you say fourteen hours of sleep in twenty-four hours that includes nap time, of course. Between six months and two years about thirteen hours of sleep. When you get to about two years of age you need about twelve hours of sleep. Between three and five years you're down to about eleven. From about five to nine years about ten and a half hours of sleep. Then it kind of starts to change. Just about before you get to adolescence, you may get by, so in your middle school years on ten hours of sleep. Then we think, well we're teenagers, teenagers are notorious for not getting enough sleep and teenagers think that they can live without sleep. Most teenagers are getting, maybe if we're lucky, depending on how early they start school, six, maybe sometimes seven hours of sleep. Surprising thing is that teenagers need about nine and a quarter hours of sleep because their body physiologically actually requires more sleep than you need as an adult. Now even when I say teenagers I mean including seventeen, eighteen year olds even nineteen years olds need about nine and a quarter hours of sleep and we all know they are getting a lot less than that.
What is a "sleep debt"?
We do accumulate what we call "sleep debt". So for instance if we have a bad night and we don't sleep well, we have a debt that we have to pay back, nd that debt doesn't go away. It will never go away unless you sleep. Sleep debt does not diffuse away with activity, with living. At some point, you have to pay sleep-debt back. So, if a child has not had a good sleep, or you've been traveling, whatever the case is, you can anticipate that that child is going to need to catch up. That may be in the form of either a longer nighttime sleep the following night, or maybe longer naps or more frequent naps the subsequent morning.