7 Tips to Help your Child Sleep Better

By Dr. Reshmi Basu, a CHOC Children’s pediatrician

All parents have been there― it’s late at night, you’ve had a long day, and you’re struggling to get your child to go to sleep. I’m also a mom, and I’ve had plenty of those nights in my household too. Here’s my best advice as a pediatrician on getting your child to go to sleep.

  1. Know how much sleep your child should be getting

Sleep requirements change with age, so it is important to know what is appropriate as your child grows. However, remember these are ranges and each child is different. Talk to your pediatrician about how much sleep your child needs.

These are ranges for hours of sleep in a 24-hour period, including naps.

  • 0-2 months: 9-18 hours
  • 2-12 months: 12-13 hours
  • 12 months-3 years: 11-13 hours
  • 3-5 years: 11.5-12 hours
  • 6-12 years: 9-10 hours
  • 12-18 years: 8.5-9.5 hours

Behavioral problems can often be associated with inadequate sleep. And sleep can even affect weight. One study showed that putting preschoolers to bed early is associated with lower risk for adolescent obesity.

  1. Stick with a routine

A consistent routine is important no matter the age of your child. If possible, keep the same routine on weekdays and weekends, with a similar bedtime and wake time—even if they don’thave to get up early for school the next day. This may become a challenge in the teen years where teenagers will try to catch up on sleep on weekends, that can actually cause other problems such as insomnia.

In younger kids, naps are essential.However, it’s best to avoid naps late in the day that can interfere with bedtime. And although short naps, like a quick snooze in the car, can restore alertness for a short time, it is the longer naps that have a more long-term restorative function. Do your best to schedule naptime in the early afternoon even on busy weekends.

  1. Reduce stimulation prior to bedtime

Try to encourage calming and relaxing activities prior to bedtime. Limit very active play just prior to bed. Do your best to limit screen use before bedtime. This includes limiting screens in the evening and keeping all media devices out of the bedroom, especially after lights out. Never use electronics as a sleep aid.

  1. Be careful of sleep associations

As infants get older, avoid activities such as nursing or rocking to sleep because they may require the same during nighttime awakenings instead of being able to soothe themselves back to sleep. Studies have found that gradually delaying infant’s bedtime or parents’ response to infant’s crying improves sleep and is not associated with increased stress or emotional problems. School-aged children who require a parent to be present at sleep onset are more likely to wake up during the night. Some sleep associations, however, can be helpful and do not require parental intervention, such as a favorite teddy bear or blanket.

  1. Watch out for sleep disorders

Sleep disorders in children and adolescents include obstructive sleep apnea, sleepwalking, sleep talking, night terrors and insomnia. These may lead to excessive daytime sleepiness, irritability and even learning difficulties in school. If your school-aged child is napping, dozing off on short car rides or while watching TV, then tell her doctor. Loud snoring or restless sleep can also be a problem and should be discussed with your child’s doctor.

  1. Create an ideal sleep environment

Your child’s bedroom should be kept cool, dark and quiet. Consider blackout curtains to avoid direct light exposure in the bedroom during the night. A night light may help your school-aged child with nighttime fears. Remember crib safety for your infant and that it is not safe to continue swaddling after 4-6 months or earlier if the baby is trying to turn over. For teenagers, encourage them not to use their bed for activities other than sleeping (i.e. watching TV or using electronic devices).

  1. Remember good habits during the day

Healthy habits during the day will translate to healthy sleep at night. This includes adequate stimulation for infants and regular exercise for older children. Avoid skipping meals—especially breakfast―offer healthy snacks and avoid large meals just before bed.

Find a CHOC pediatrician near you

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Meet Dr. Anjalee Warrier Galion

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Anjalee Warrier Galion, a pediatric neurologist and sleep specialist.

Dr. Anjalee Warrier Galion
Dr. Anjalee Warrier Galion

Q: What is your education and training?
A: I attended the University of Medicine and Dentistry of New Jersey- New Jersey Medical School, and completed my residency in pediatrics at University of San Francisco, Fresno.  During my academic year, I worked for Walter Reed Army Institute of Research to help identify a vaccine for malaria. My second day was September 11, 2011, and it was an amazing, humbling, and scary experience to be a part of the military for this day. My first fellowship was in pediatric neurology at the University of California, Irvine (UCI), and my second fellowship was in sleep medicine at the University of California Los Angeles- Cedars Sinai Sleep Medicine Fellowship.

Q: What are your administrative appointments?
A: Assistant clinical professor at UCI, assistant program director for the UCI child neurology residency program, chair of the junior faculty leadership council, and co-chair of the sleep workgroup for the National Autism Treatment Network.

Q: What are your special clinical interests?
A: Sleep disorders in children with neurologic diseases such as epilepsy and autism, as well as sleep and cognition.

Q: Are you involved in any current research?

A: Evaluation of efficacy of specific sedative hypnotics in children with Autism spectrum disorder, and Identification of sleep architecture and pathology in children with epilepsy.

Q: How long have you been on staff at CHOC?
A: Four years.

Q: What are some new programs or developments within your specialty?
A: CHOC is one of the few, if only, hospitals in the country doing combined long-term video EEG as well as polysomnography (sleep study).  This allows us a very unique opportunity to look at the brain activity and pathology in sleep. Multidisciplinary sleep clinics involving psychology and pulmonology are also unique. Also, identification and treatment of a variety of pediatric sleep disorders including all types of insomnia, narcolepsy and parasomnias, such as sleepwalking, sleep talking and night terrors.

Q: What are your most common diagnoses?
A: Insomnia, narcolepsy, sleepwalking (or somnambulism).

Q: What would you most like patients and families to know about you or your division at CHOC?
A: We treat all types of sleep-related disorders and are providing state-of-the-art care for children with sleep disorders. It is estimated that more than 30 percent of children have sleep-related disorders, and improvement in sleep is essential for learning and cognition. Research suggests improved sleep supports optimal athletic performance as well. If there is any concern for a sleep-related disorder we are happy to help evaluate these children.

Q:  What inspires you most about the care being delivered here at CHOC?
A: We treat every child with the highest level of care and the physicians genuinely care for the patients and our community.

Q: Why did you decide to become a doctor?
A: I had been interested in neuroscience since I was a Howard Hughes fellow at the University of Maryland, having done work in spinal cord regeneration. I heard a talk in my first year of medical school about pediatric neurology and haven’t looked back since.

Q: If you weren’t a physician, what would you be and why?
A: If I was not a physician I would mostly likely be a PhD working in the field of neurobiology and sleep medicine. Both my parents were PhDs and I grew up hearing about fascinating advances in the world of science, so I have been drawn to science and research from a young age. For quite a few years I was strongly considering becoming a professional flute player. I was fortunate enough to travel through Italy with my youth symphony and performed around the country in orchestras, but science drew me in by the time I was in college.

Q: What are your hobbies/interests outside of work?
A: I enjoy hosting parties and events for family and friends. Our family enjoys traveling and spending time together.

Q: What have you learned from your patients?
A: The best part about working with pediatric patients is that you are constantly reminded to enjoy life and be grateful for every day. The smallest things can make a child happy, like playing with a light-up toy or seeing bubbles, and it is a great reminder to take pleasure in all the simple things around us every day.

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Does My Child Have a Sleep Disorder?

Healthy sleep is critical for children and teens. Sleep disorders, such as problems falling asleep and sleep apnea, affect your child’s ability to get the sleep needed for good growth, development and overall health. Even infants may have sleep disorders. However, a pediatric sleep disorder can be treated with the help of a sleep specialist.

In this episode of CHOC Radio, Dr. Neal Nakra, a pediatric pulmonologist and sleep specialist, and Dr. Marni Nagel, a psychologist, discuss:

  • The difference between medical and behavioral sleep problems and how to recognize them
  • When it may necessary to see a sleep specialist
  • How many hours of sleep your child needs
  • How sleep problems can affect health
  • The importance of sleep for teens and school start times

Hear more from CHOC experts in this podcast.

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Time to Re-Think the “All-Nighter”

CHOC Children's Sleep Disorder CenterOne of the most important investments you can make in your teen’s academic success won’t cost a dime. A good night’s sleep is essential to concentration, learning, memory-retention and problem-solving skills.

Despite the best intentions, students who regularly burn the midnight oil are actually undermining themselves. That’s because the brain needs enough hours of quality sleep in order to perform the essential functions related to learning.

“Studies have shown that people who are sleep-deprived have poor memory retention, and this is essentially what students are doing when they stay up past midnight cramming for a test the next day” said Dr. Neal Nakra, medical director of the CHOC Children’s Sleep Disorder Center. “Deep sleep, particularly Stage III (slow-wave sleep), helps the brain solidify the learning that took place that day.”

The average high-school student needs between eight to 10 hours of sleep every night. That means lights out by 10:15 p.m. for the student who gets up around 6:45 a.m. That’s a minimum eight hours, plus the 30 minutes needed to actually fall asleep.

But it may feel as though there are not enough hours in the day for teens balancing demanding college prep courses with a full slate of after-school activities. Dr. Nakra said he often sees chronic sleep deprivation in teens, particularly in high-achieving students.

Another common cause of poor sleep quality is the use of electronic devices right before bedtime. The light from phones, tablets, computers and electronic games actually stimulates the part of the retina that increases wakefulness.

For a Better Night’s Sleep
Dr. Nakra said the following steps will allow for a good night’s sleep without the need for medication in the vast majority of students:
• Review your teen’s academic and extracurricular schedule — is it simply too much?
• Discuss the importance of healthy sleep with your teen, and support him or her in making the tough decisions about which activities may need to be dropped.
• Set a consistent bedtime schedule, with time to relax before turning out the light.
• Remove all electronic devices from the bedroom.
• Turn off all electronics an hour or two before bedtime.
• Keep the bedroom quiet and cool, not too warm or chilly.
• Avoid caffeine or heavy meals two to three hours before bedtime.
• Be sure your teen gets daily exercise.

Daytime sleepiness, concentration difficulties and dropping grades are clear signs a teen may need more sleep. Moodiness, irritability, depression and even weight gain could also be clues.

School-age children require between nine and 11 hours every night. Dr. Nakra added that in this age group, symptoms of hyperactivity may be related to inadequate sleep. Hyperactivity or excessive daytime sleepiness may also indicate poor sleep quality, especially if associated with other symptoms including loud snoring, mouth breathing, frequent night awakenings or bedwetting.

“These may be symptoms of sleep apnea, which is a treatable sleep disorder,” Dr. Nakra said. “Excessive daytime sleepiness also needs medical attention.”

The CHOC Sleep Disorder Center provides clinical care and testing, including sleep studies, for pediatric sleep problems. Services are available at both our Orange and Mission Viejo hospital campuses. For more information, please call 714-509-8651.

Learn more about CHOC’s Sleep Disorder Center: http://www.choc.org/neuroscience/sleep-disorder-center/

CHOC Children’s at Mission Hospital Opens State-of-the-Art Sleep Center

IMG_4614Families in South Orange County now have access to a state-of-the-art Sleep Center for children who need overnight monitoring to diagnose problems related to sleep.

The new three-room unit at CHOC Children’s at Mission Hospital offers private, comfortable accommodations and the latest technology for routine polysomnograms (sleep studies). CHOC already performs more than 750 sleep studies a year at its three-bed Sleep Disorder Center in Orange.

A sleep study is used to diagnose sleep disorders such as apnea and narcolepsy, as well as sleep problems that may be caused by other health conditions, including enlarged tonsils, obesity, muscular dystrophy and Down syndrome. Most sleep studies are prescribed by a child’s pediatrician or referring physician and are done on an outpatient basis.

Each Sleep Center room includes custom light control, a flat-screen TV, a fold-out bed for mom or dad, and unique artwork that showcases Southern California beaches to promote a soothing, calm environment. Families are encouraged to bring familiar toys, books and blankets to help a child feel at home.

The Sleep Center is equipped with live video monitoring and electroencephalogram (EEG), electrocardiogram (EKG), electrooculogram (EOG), electromyogram (EMG), thermistor, pulse oximeter and piezo crystal monitoring systems, allowing technologists to track every child’s breath, brainwave and movement during sleep. Patients are hooked up to the equipment with small, painless electrode stickers and a lightweight belt around the chest. A child’s dedicated technologist is always in the next room to monitor the data through the night, and they are available to provide assistance to families when needed.

In addition to registered sleep technologists, CHOC’s multidisciplinary sleep team includes a board-certified pediatric neurologist fellowship trained in sleep medicine, board-certified pediatric pulmonologists and psychologists. Depending on the results of a study sleep, a child will have a follow-up appointment with his or her doctor, or be referred to a CHOC specialist.

Click here to learn more about the sleep conditions that affect children.

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