The sleepy child

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Healthy sleep is essential for your child’s health

By Phil Noe, Pediatric Nurse Practitioner

School is back in session, and this is the time of year when sleep problems in children most commonly become evident. With the pressure of early morning awakenings, the once happy and content child now appears like two of the seven dwarfs: grumpy and sleepy. While irritability and sleepiness can affect the child’s overall mood and level of happiness, inadequate sleep can have even more serious consequences such as difficulty focusing, poor learning, and an increased risk of accidents. There are two key ingredients to effectively dealing with this issue: establishing a healthy sleep environment and looking for clues that a sleep problem exists.

For the majority of children, adjusting their sleep time and environment will result in a well-rested child.  There are several keys to establishing this appropriate sleep environment. These keys are critical to helping a child fall asleep, stay asleep, and achieve restful sleep. These keys include:

  • A quiet bedroom – no noisemakers in the room such as a television, computer, radio, I pod, video game or cell phone.
  • Falling asleep independently – A child should fall asleep on their own with no one else in the room or in the bed with them.
  • Nightlights are acceptable – otherwise, the room should be dark.
  • Keep the bedroom at a comfortable temperature (70-72 degrees) – avoid an overly hot room.

The next step is to make sure your child is getting enough sleep. Most 6-12 year old children need 10 – 11 hours of sleep each night. In addition, most children take around 15 minutes to fall asleep. When these two facts are combined, it is easy to see that 6-12 year olds need roughly 11 hours in bed each night. To determine an appropriate bedtime, simply subtract 11 hours from the time the child needs to get up in the morning for school. If morning wakeup time is 7 a.m., the appropriate bedtime is 8 p.m. Children who start their day at 6 a.m. should go to bed at 7 p.m. This practice will provide an opportunity for your child to obtain an adequate amount of sleep each night.

“For the majority of children, adjusting their sleep time and environment will result in a well-rested child.”

If your child continues to experience excessive daytime sleepiness despite an appropriate sleep environment and an adequate amount of sleep, the next step is to consider that your child might have a sleep problem. There are several sleep problems that can exist during childhood, which include:

Insomnia

Insomnia is difficulty falling asleep or staying asleep during the night. Many people experience occasional insomnia, but if it becomes frequent or prolonged it can lead to problems associated with inadequate sleep. The most common cause of insomnia is stress, but many things can lead to insomnia, including physical discomfort (the stuffy nose of a cold or the pain of a headache), emotional troubles (like family problems or relationship difficulties) or even an uncomfortable sleeping environment (a room that’s too hot, cold or noisy). It’s common for children to occasionally have insomnia but if insomnia lasts for one month or longer, the child should be evaluated by their health Care provider to determine the cause and most effective treatment to restore adequate restful sleep.

Narcolepsy

Children with narcolepsy are very sleepy during the day and may have sleep “attacks” during the day that may make them suddenly fall asleep or lose muscle control.  These children also report vivid dreamlike images while dozing off or waking up. Nighttime sleep also may be disrupted, with frequent awakenings throughout the night.  Characteristically, children with narcolepsy fall asleep frequently and at unusual times, such as on the playground, in the lunchroom or in the middle of a conversation.  This is not a common cause of sleepiness in children; in fact, most cases of narcolepsy are not diagnosed until adulthood.  People usually begin to have symptoms between the ages of 10 and 25 but might not be properly diagnosed until 10-15 years later. Doctors usually treat narcolepsy with medications and lifestyle changes.

What to do if you suspect a sleep problem

If your child seems to be getting enough rest at night but is still feeling tired during the day, it’s a good idea to visit your health care provider. Excessive tiredness can be caused by a wide variety of health problems, not just difficulties with sleep. If a sleep problem is suspected, your health care provider will evaluate your child’s overall health and sleep habits. In addition to doing a physical examination, your provider will take a medical history by asking about any concerns and symptoms your child has and about his or her past health, your family’s health and any medications your child is taking. The provider also may do tests such as a sleep study to find out whether there is a medical condition affecting your child’s health. Your provider may even refer you to a specialist such as the Pediatric Pulmonology & Sleep Medicine Center at Children’s Hospital.

Healthy sleep is an essential part of your child’s overall health. Monitoring your child’s sleep and ensuring an adequate amount and quality of sleep is extremely important in keeping your child physically and emotionally healthy.

Read The Sleepy Child, Part two in the September issue of Knoxville Parent and learn about Obstructive Sleep Apnea and Restless Leg Syndrome.

Phil Noe has been a Pediatric Nurse Practitioner with the Pediatric Pulmonology and Sleep Medicine Center at East Tennessee Children’s Hospital for the past 15 years. He works with a variety of sleep-related medical problems from newborns to young adults.

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