Sleep Baby Sleep

“Sleep is life's nurse, sent from heaven to create us anew day by day.”
- CHARLES READE

We have always thought of sleep as the time when mind and body relax. This is true, because one feels refreshed after a good sleep.  In reality, sleep allows the brain to be active continuously.  In the developing brain, sleep allows the brain to grow, differentiate and strengthen  neural connections and development of neural pathways.  It has an active role in learning since it allows daytime learning to be consolidated and integrate memories.

How Much Sleep Does The Child Need?

To  allow the brain  to function at its optimum, we must ensure that the child gets the proper hours of sleep.  American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents. This was endorsed by the American Academy of Pediatrics.

• Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) 
• Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) 
• Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) 
• Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours 
• Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours

Sleep Disorders

Most children will sleep peacefully.  However, approximately 20-25% experience some type of sleep disturbances.  Some common sleep disorders are:

1. Nightmares –occur typically early in the morning and most common in primary school age children.  Remembered on waking.
2. Partial Arousal Parasomnias - occur early in the night.  Do not remember episodes in the morning.  Examples are night terrors which is most common in the 4-12 year old group;  sleep walking – typically starts 4-6 years old and peaks 8-10 years old

Impact

Adequate duration and quality of sleep have a positive impact on overall well-being, on emotional, behavioural and cognitive functioning and future health. Lack of sleep may lead to negative mood changes, such as hyperactive and disruptive behaviors as well as low mood. It may lead to difficulties with focused attention, vigilance, reaction time, executive function and memory. It also negatively affects academic work since it affects attention, decision making and cognitive flexibility, making it harder to learn. Some children who start acting up or lose focus may be due to lack of sleep.

There is also an association between short sleep and later body composition. Cross-sectional studies from around the world show a consistent increased risk of obesity amongst short sleepers in children and adults. Short sleep is associated with reciprocal changes in leptin and ghrelin. This in turn would increase appetite and contribute to the development of obesity. The association between the number of sleep problems with the usage of screen devices and consumption of sugar-sweetened beverages could suggest that these factors might influence children’s weight statuses via the sleep-obesity nexus. And in prepubertal children with short sleep, there is an increased odds ratio for obesity of around 1.6.

Children can usually be assured of good sleep and this can be achieved by some simple practices.   This means modifying environment and behaviour to promote good sleep.

1. Consistent bedtime routine.  This provides external clues that sleep is coming and assists children to prepare for sleep mentally by being both predictable and calming. 
2. Limiting access to electronic gadgets in the bedroom.  Light emission from display screens suppresses natural melatonin release and in turn sleep onset.  This also avoid stimulating activity before bedtime.  
3. Let children settle and sleep independently. This way, they can self-soothe back to sleep after natural night wakenings.  

Sleep can have significant impact on child and family health.  Simple questions on sleep should be part of a well-child visit. This can lead to establishing better long-term healthy sleep patterns and  avoiding ill consequences of sleep problems.

Reference

1. Allen SL, Howlett MD,Coulombe JA, Penny V. Corkum etal. ABCs of SLEEPING: A review of the Evidence behind Pediatric Sleep Practice Recommendations.  Sleep Medicine Reviews 29 (2016) 1e14
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3. Cappuccio FP, Taggart FM; Kandala NB, Currie A, Peile E; Stranges S, Miller M. Meta-Analysis of Short Sleep Duration and Obesity in Children and Adults.  SLEEP, Vol. 31, No. 5, 2008
4. Hill, C and Everitt H.  Assessment and initial management of suspected behavioural insomnia in pre-adolescent children.  BMJ 2018; 363:k3797
5. Mindell JA, Owens, JA and Carskadon MA.  Development Features of Sleep.  Child and Adolescent Psychiatric Clinics of North America 1999; 8:4
6. Morrissey B, Allender S and  Strugnell S. Dietary and Activity Factors Influence Poor Sleep and the Sleep-Obesity Nexus among Children. Int. J. Environ. Res. Public Health 2019, 16, 1778 
7. Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016;12(6):785–786.