More and more children are using iPads and gadgets as a source of entertainment and learning. Sharyn Timerman from theparentingtoolbox.ca and Child Development Specialist for the Family Sleep Institute looks into how technology affects kids’ conduct and manners and shares a few tips to tackle this issue.
FSI graduate, Erin Meckfessel, is featured on the Wise Baby, and discusses a case study and sleep plan to help a family.
We’ve had two great posts from Erin at Pickles & Ice Cream Consultants but today’s is my favorite. Last month we talked about why you should hire a sleep consultant but with this months post Erin gets into why people really hire a sleep consultant by letting us into the lives of one family she has worked with. This post is so great we breaking it up into two posts – installment one today and two next month. I hope you enjoy this post as much and remember Erin is available via Skype and email to help if needed!
“Are you expecting a little bundle of joy and looking for advice in planning your nursery? Or perhaps you are looking to revamp your child’s room to create the optimal sleep environment? Here are some tips to have everything in place so your baby’s room can be all you dreamed it would be:
- Think Cave Like
Hmmm cave and newborn, two words that don’t really work together. They do when it comes to sleep! A baby sleeps best in a dark, cool and damp room. Well not damp exactly, but its great to run a humidifier especially during winter months. The ideal sleep temperature for your baby’s room is somewhere between 65-70 degrees. I suggest shooting for 68 degrees. Also, make sure to include black out curtains on your windows. The darker the better…”
Diagnosing the Wrong Deficit – New York Time Sunday Review 4/27/13 - VATSAL G. THAKKAR
Find Original Source Here: http://www.nytimes.com/2013/04/28/opinion/sunday/diagnosing-the-wrong-deficit.html?pagewanted=all&_r=2&
By VATSAL G. THAKKAR
Published: April 27, 2013
IN the spring of 2010, a new patient came to see me to find out if he had attention-deficit hyperactivity disorder. He had all the classic symptoms: procrastination, forgetfulness, a propensity to lose things and, of course, the inability to pay attention consistently. But one thing was unusual. His symptoms had started only two years earlier, when he was 31.
Though I treat a lot of adults for attention-deficit hyperactivity disorder, the presentation of this case was a violation of an important diagnostic criterion: symptoms must date back to childhood. It turned out he first started having these problems the month he began his most recent job, one that required him to rise at 5 a.m., despite the fact that he was a night owl.
The patient didn’t have A.D.H.D., I realized, but a chronic sleep deficit. I suggested some techniques to help him fall asleep at night, like relaxing for 90 minutes before getting in bed at 10 p.m. If necessary, he could take a small amount of melatonin. When he returned to see me two weeks later, his symptoms were almost gone. I suggested he call if they recurred. I never heard from him again.
Many theories are thrown around to explain the rise in the diagnosis and treatment of A.D.H.D. in children and adults. According to the Centers for Disease Control and Prevention, 11 percent of school-age children have now received a diagnosis of the condition. I don’t doubt that many people do, in fact, have A.D.H.D.; I regularly diagnose and treat it in adults. But what if a substantial proportion of cases are really sleep disorders in disguise?
For some people — especially children — sleep deprivation does not necessarily cause lethargy; instead they become hyperactive and unfocused. Researchers and reporters are increasingly seeing connections between dysfunctional sleep and what looks like A.D.H.D., but those links are taking a long time to be understood by parents and doctors.
We all get less sleep than we used to. The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago. And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses.
A number of studies have shown that a huge proportion of children with an A.D.H.D. diagnosis also have sleep-disordered breathing like apnea or snoring, restless leg syndrome or non-restorative sleep, in which delta sleep is frequently interrupted.
One study, published in 2004 in the journal Sleep, looked at 34 children with A.D.H.D. Every one of them showed a deficit of delta sleep, compared with only a handful of the 32 control subjects.
A 2006 study in the journal Pediatrics showed something similar, from the perspective of a surgery clinic. This study included 105 children between ages 5 and 12. Seventy-eight of them were scheduled to have their tonsils removed because they had problems breathing in their sleep, while 27 children scheduled for other operations served as a control group. Researchers measured the participants’ sleep patterns and tested for hyperactivity and inattentiveness, consistent with standard protocols for validating an A.D.H.D. diagnosis.
Of the 78 children getting the tonsillectomies, 28 percent were found to have A.D.H.D., compared with only 7 percent of the control group.
Even more stunning was what the study’s authors found a year after the surgeries, when they followed up with the children. A full half of the original A.D.H.D. group who received tonsillectomies — 11 of 22 children — no longer met the criteria for the condition. In other words, what had appeared to be A.D.H.D. had been resolved by treating a sleeping problem.
But it’s also possible that A.D.H.D.-like symptoms can persist even after a sleeping problem is resolved. Consider a long-term study of more than 11,000 children in Britain published last year, also in Pediatrics. Mothers were asked about symptoms of sleep-disordered breathing in their infants when they were 6 months old. Then, when the children were 4 and 7 years old, the mothers completed a behavioral questionnaire to gauge their children’s levels of inattention, hyperactivity, anxiety, depression and problems with peers, conduct and social skills.
The study found that children who suffered from sleep-disordered breathing in infancy were more likely to have behavioral difficulties later in life — they were 20 to 60 percent more likely to have behavioral problems at age 4, and 40 to 100 percent more likely to have such problems at age 7. Interestingly, these problems occurred even if the disordered breathing had abated, implying that an infant breathing problem might cause some kind of potentially irreversible neurological injury.
CLEARLY there is more going on in the nocturnal lives of our children than any of us have realized. Typically, we see and diagnose only their downstream, daytime symptoms.
There has been less research into sleep and A.D.H.D. outside of childhood. But a team from Massachusetts General Hospital found, in one of the only studies of its kind, that sleep dysfunction in adults with A.D.H.D. closely mimics the sleep dysfunction in children with A.D.H.D.
There is also some promising research being done on sleep in adults, relating to focus, memory and cognitive performance. A study published in February in the journal Nature Neuroscience found that the amount of delta sleep in seniors correlates with performance on memory tests. And a study published three years ago in Sleep found that while subjects who were deprived of sleep didn’t necessarily report feeling sleepier, their cognitive performance declined in proportion to their sleep deprivation and continued to worsen over five nights of sleep restriction.
As it happens, “moves about excessively during sleep” was once listed as a symptom of attention-deficit disorder in the Diagnostic and Statistical Manual of Mental Disorders. That version of the manual, published in 1980, was the first to name the disorder. When the term A.D.H.D., reflecting the addition of hyperactivity, appeared in 1987, the diagnostic criteria no longer included trouble sleeping. The authors said there was not enough evidence to support keeping it in.
But what if doctors, before diagnosing A.D.H.D. in their patients, did have to find evidence of a sleep disorder? Psychiatric researchers typically don’t have access to the equipment or expertise needed to evaluate sleep issues. It’s tricky to ask patients to keep sleep logs or to send them for expensive overnight sleep studies, which can involve complicated equipment like surface electrodes to measure brain and muscle activity; abdominal belts to record breathing; “pulse oximeters” to measure blood oxygen levels; even snore microphones. (And getting a sleep study approved by an insurance company is by no means guaranteed.) As it stands, A.D.H.D. can be diagnosed with only an office interview.
Sometimes my patients have resisted my referrals for sleep testing, since everything they have read (often through direct-to-consumer marketing by drug companies) identifies A.D.H.D. as the culprit. People don’t like to hear that they may have a different, stranger-sounding problem that can’t be fixed with a pill — though this often changes once patients see the results of their sleep studies.
Beyond my day job, I have a personal interest in A.D.H.D. and sleep disorders. Beginning in college and for nearly a decade, I struggled with profound cognitive lethargy and difficulty focusing, a daily nap habit and weekend sleep addiction. I got through my medical school exams only by the grace of good memorization skills and the fact that ephedra was still a legal supplement.
I was misdiagnosed with various maladies, including A.D.H.D. Then I underwent two sleep studies and, finally, was found to have an atypical form of narcolepsy. This was a shock to me, because I had never fallen asleep while eating or talking. But, it turned out, over 40 percent of my night was spent in REM sleep — or “dreaming sleep,” which normally occurs only intermittently throughout the night — while just 5 percent was spent in delta sleep, the rejuvenating kind. I was sleeping 8 to 10 hours a night, but I still had a profound delta sleep deficit.
It took some trial and error, but with the proper treatment, my cognitive problems came to an end. Today I eat well and respect my unique sleep needs instead of trying to suppress them. I also take two medications: a stimulant for narcolepsy and, at bedtime, an S.N.R.I. (or serotonin-norepinephrine reuptake inhibitor) antidepressant — an off-label treatment that curtails REM sleep and helps increase delta sleep. Now I wake up without an alarm, and my daytime focus is remarkably improved. My recovery has been amazing (though my wife would argue that weekend mornings are still tough — she picks up the slack with our two kids).
Attention-deficit problems are far from the only reasons to take our lack of quality sleep seriously. Laboratory animals die when they are deprived of delta sleep. Chronic delta sleep deficits in humans are implicated in many diseases, including depression, heart disease, hypertension, obesity, chronic pain, diabetes and cancer, not to mention thousands of fatigue-related car accidents each year.
Sleep disorders are so prevalent that every internist, pediatrician and psychiatrist should routinely screen for them. And we need far more research into this issue. Every year billions of dollars are poured into researching cancer, depression and heart disease, but how much money goes into sleep?
The National Institutes of Health will spend only $240 million on sleep research this year. One of the problems is that the research establishment exists as mini-fiefdoms — money given to one sector, like cardiology or psychiatry, rarely makes it into another, like sleep medicine, even if they are intimately connected.
But we can’t wait any longer to pay attention to the connection between delta sleep and A.D.H.D. If you’re not already convinced, consider the drug clonidine. It started life as a hypertension treatment, but has been approved by the Food and Drug Administration to treat A.D.H.D. Studies show that when it is taken only at bedtime, symptoms improve during the day. For psychiatrists, it is one of these “oh-we-don’t-know-how-it-works” drugs. But here is a little-known fact about clonidine: it can be a potent delta sleep enhancer.
Vatsal G. Thakkar is a clinical assistant professor of psychiatry at the N.Y.U. School of Medicine.
A version of this op-ed appeared in print on April 28, 2013, on page SR1 of the New York edition with the headline: Diagnosing The Wrong Deficit.
If your kids are getting out of bed, coming to sleep in your room or maybe just not going to bed on time, we have a local expert who says she can help.
Tiffany Larson is a certified sleep expert and she stopped by the “Everyday” show to tell us how she gives sleep-deprived parents relief.
GOOD BYE CRIB, HELLO BED?
Is your climbing toddler ready for the leap to a big kid bed? It’s a question that I receive regularly from parents whose kids have recently started escaping their crib. Safety is our number one priority and it is our goal to make sure your children’s sleep environment is as safe as possible. If your child is climbing out of his crib, a change is definitely needed. Our second priority….making sure your child and you get the sleep you need! My first suggestion is to make sure your child is 100% ready for this transition. This one is a big deal as it affects your child emotionally, physically and mentally. My advice is to keep your toddler in a crib as long as possible (we recommend waiting until your child is as close to 3 years old as possible). So before you take the leap to a big kid bed, you want to make sure that your child is really ready for this transition. If they are not quite there yet, we want to see if we can safely modify their sleep environment to keep them in their crib until they are ready.
How do you know if your child is ready?
- They have been consistently climbing out of their crib (and the modifications listed below did not remedy the situation).
- They understand boundaries and can follow directions.
- They actually ask for a big kid bed.
- They are 3 years old!
If your child is not quite ready – check out these changes to see if you can delay the move:
- Remove The Bumper – If your child’s crib has a bumper in place, remove the bumper. If your little monkey is making his great escape by hoisting himself up with the help of his bumper, this usually solves the problem. Without the added height of pushing off the bumper it will be much harder to climb out.
- The Sleep Sack – Put your child to sleep with a sleep sack over their pj’s! This is such an easy modification, yet it is so effective. Most kids cannot climb out of their crib while wearing a sleep sack because it does not allow them to lift up their little legs. You can make it seem like a fun and exciting change to your toddler. Take them shopping and allow them to pick out the color or print themselves. You may need to modify your child’s pajamas to a lighter weight or lower the temperature slightly so they do not become hot in their sleep sack, but these changes are well worth it if the sack safely keeps them in their crib.
- Catch Him in the Act – If he is only climbing out at bedtime or at naptime and you own a video monitor, this tactic is extremely effective. Position yourself near your child’s bedroom door video monitor in hand. The very second he starts to attempt to climb out, you quickly open his door and firmly say “NO”. Without further conversation (you don’t want to give him any added attention as that will just make him want to do it again), you lay him down and leave the room. For most kids, they are so shocked that they got caught that it just takes this reprimand one time to work. However, you will want to watch for a few days and repeat as necessary. If you are 100% consistent with your reaction, the climbing will cease to occur ever again.
If your child cannot stay in their crib safely or you feel that they are ready for the big move, here’s what you do:
- Do Some Prep Work: Get your child involved so they feel in control of the situation and also excited about the new change. If your child is going to stay in their crib converted into a big kid bed, allow them to pick out some new sheets or a new big kid blanket. If they are going to go into a completely new bed, allow your child to be part of picking out the new bed. Pick up a book or two about the transition to help them understand what will happen and to ease any fears. Talk about the transition with them and explain that bedtime will remain the same, they will just be sleeping in new big kid bed.
- Keep your current routine in place: By this time you should have a solid bedtime routine in place. Children count on consistency as it makes them feel safe and helps them to understand what to expect. Keep your pre-bedtime routine as consistent as possible as this will just help things go more smoothly.
- Implement a Set of Sleep rules for the New Bed: Before you make the switch make sure your child understands that they are expected to stay in their bed until the next morning. Expect your child to wander out of their bed the first few nights. Make sure you have a plan in place to deal with this a head of time.
- Make sure Their new Found Freedom doesn’t Spiral Out of Control: With all of this excitement, your child will likely try to get out of their bed during the night at some point in the first few days. When this happens, you need to deal with it quickly and consistently. Every time your child gets out of the bed you will immediately take them by the hand and walk them back to the bed. During this time, you will not acknowledge them by talking or making eye contact. You need to remain completely silent. If you talk to them you are reinforcing the reason why they are getting out of bed in the first place – attention. If there is no communication, the novelty wears off pretty quickly. Our children are quick learners.
- Be Firm & Consistent: While it is easy to cave at 3am and allow your little one to crawl into bed with you, be consistent and stick to your plan. With just a few days of absolute consistency your child will understand the rules and stay in their bed.
Here are some additional tips:
- Purchase a sleep clock; this is helpful for your child to understand when it is ok to get out of bed in the morning.
- If possible, try to make the transition while your child is in a well-rested state.
- Make sure your child is not over-tired by allowing for an earlier bedtime if necessary.
- Avoid making the switch when there are others changes going on in your toddler’s life – a new baby, potty training, a move etc.
Good luck with this transition, please visit us at wellrestedbaby.com for further information about infant and toddler sleep.
Amy Lage is a Family Sleep Institute certified Child Sleep Consultant. She is co-owner of Well Rested Baby. She offers a host of services including in person, phone, email and Skype/FaceTime consultations that can be tailored to meet any family’s needs and schedule. Please email her firstname.lastname@example.org with any questions.
There was breast versus bottle. Then crib-sleeping versus co-sleeping. Now the latest infant-rearing technique to stir controversy and confuse even the most confident BabyBjorn-clad parents is swaddling.
For the uninitiated, swaddling involves snugly wrapping infants in a blanket to restrict movement. It’s been around for thousands of years (see Bible, Jesus), but it has grown steadily in popularity even in the past decade.
Swaddled babies, according to proponents of the technique, sleep longer, fuss less and have a lower risk of Sudden Infant Death Syndrome (SIDS).
As the practice gains a bigger following, however, questions about safety are prompting some hospitals to speak out against it and are causing many converts to have second thoughts.
“Really, [parents] shouldn’t be doing this,” said Maureen Luther, a pediatric physiotherapist at Sunnybrook Health Sciences Centre in Toronto. “[Swaddling] is really not that beneficial.”
Few, if any, Canadian institutions endorse or recommend the practice and some of the country’s largest maternity hospitals, including Mount Sinai Hospital and Sunnybrook Health Sciences Centre in Toronto, as well as the agency that oversees perinatal services in the province of B.C., are moving away from swaddling healthy newborns. (In most institutions, it is still recommended that premature infants or those exposed to drugs in utero be swaddled to provide comfort.)
Several studies have linked swaddling to a higher risk of respiratory infections and, if done improperly, hip dysplasia. Swaddled babies may overheat, especially if their heads are partially covered, which can cause hyperthermia and even death. There is ongoing debate over whether swaddling prevents infants from waking easily, hinders weight gain or, most troubling, increases the chance of SIDS.
There’s also a fundamental question of whether the very function of swaddling – keeping the movements of infants restricted in order to soothe – is good for babies, or is just good for parents.
“To have them pinned down by a tight blanket doesn’t make a lot of sense,” said Susan Guest, a clinical nurse specialist in Maternal Newborn Care at Mount Sinai. “You need to know that, developmentally, they need to move, they need to be able to put their hand in their mouth.”
One of the factors complicating the issue, according to medical experts, is not enough quality research into swaddling has been done.
The rise of the “Back to Sleep” campaign in the 1990s, which advised parents to place babies on their backs when sleeping to prevent SIDS, set the stage for the increase in swaddling. Many parents found their babies had a difficult time sleeping on their backs or would startle themselves into waking up, so they turned to swaddling.
In 2002, pediatrician Harvey Karp published the bestseller The Happiest Baby on the Block that tells parents swaddling is key to reducing crying and helping babies sleep on their backs.
“That’s why I recommend [swaddling] for all babies,” Karp said in a recent interview. “Even a calm baby will sleep longer and be calmer.”
Many other doctors and parents agree with Karp’s thesis, that the benefits of swaddling outweigh the potential risks. “If the swaddling is done properly, there seems to be an additional benefit of better sleep,” said Denis Leduc, past-president of the Canadian Paediatric Society.
Heather Lochner, who lives in Etobicoke, Ont., swaddled her son and, later, her daughter, even though a sleep consultant told her that infants need to learn to sleep without swaddling. “I had to trust my instincts,” she said, “and trust that I knew what was best.”
There is some research that links swaddling to better sleep and less crying. But despite what proponents say, the results aren’t conclusive. One 2006 study published in the Journal of Pediatrics, for instance, found the difference in crying time between swaddled and unswaddled infants was 10 minutes.
Many believe swaddling should prevent SIDS because it encourages parents to put babies on their backs. But some pediatric experts are concerned that swaddled infants can overheat, end up with a blanket over their faces or have a difficult time rousing – all SIDS risk factors.
A growing segment of the pediatric medical community sees swaddling as a crutch for parents, even though it might not be what’s best for the baby. And similar to driving around the block until baby falls asleep, once swaddling becomes part of the routine, it’s difficult to stop.
Yoni Freedhoff, an Ottawa doctor, had a “very long transition” to get his firstborn daughter unswaddled. He and his wife only swaddled their second for about a month and didn’t at all with their third – and found they had no major sleep issues. “The more requirements, I think, that you give a child in order for them to be able to fall asleep, the more things can go wrong in terms of your child not falling asleep,” he said.
One major concern revolves around a supposed benefit of swaddling. When babies’ limbs are confined, they’re less likely to startle themselves awake, a natural reflex found in all infants. “Are you really supposed to be preventing the [startle reflex]? Is it not there as a protective mechanism?” Luther asked. “It keeps the engine going.”
Aside from safety, some pediatric experts say swaddling prevents babies from moving around, an important part of development. “I don’t think [swaddling] is anything that we’ve dealt with or would cross our minds or think of recommending for a healthy baby,” said Aideen Moore, a neonatologist at Toronto’s Hospital for Sick Children. “It’s almost a form of restraint.”
However, the practice is unlikely to become less common, in part because there are few definitive recommendations, pro or con. Even the Canadian Paediatric Society hasn’t taken a stance. Meanwhile, many nurses still show parents how to swaddle their newborns. “We just need to change old practice,” Guest said. “Those changes take years and years.”
One Canadian organization, Perinatal Services B.C., published guidelines last year that warn against swaddling because of the potential risks. There has since been a noted decline in the popularity of swaddling in B.C., according to executive director Kim Williams.
But across the country, few parents are hearing that message. Betsy Hilton, whose son, Theo, was born Aug. 31, was taught to swaddle in the hospital. It helps her son sleep up to three hours at a stretch.
“My feeling on swaddling is this is really working,” Hilton said. “I’m very reluctant to mess with a good thing.”
“Three Misunderstood Elements of Sleep For Children and Teens” by Natalie Willes of The Baby Sleep Trainer 4/11/13
Three Misunderstood Elements of Sleep for Children and Teens
by Natalie Willes – In the Scoop San Diego, Click this Link to see the original story http://scoopsandiego.com/news/local/three-misunderstood-elements-of-sleep-for-children-and-teens/article_a02c1838-a2f7-11e2-a236-0019bb30f31a.html
Here are three misunderstood elements of sleep for infants and children age 5-18:
1. Brain development - A study released recently by Dr. Gravin, M.D. and Dr. Brown, Ph.D. demonstrated that proper sleep cycles are necessary for the development of neurosensory and motor systems in fetus, newborns, children and teenagers. This means that repeated cycling through all the stages of sleep is essential for the body’s nervous system to develop properly. Furthermore, since babies develop so many motor skills throughout the first year of their life, sleep is essential in order to allow the body to reach it’s optimum potential in terms of rolling, sitting, crawling and walking. Infant sleep cycles need to be longer than 45 minutes in order for a full, restorative cycle to be completed. If one has a poor napper, that is all the more reason to address night sleep as soon as possible so that the infant or child is at least getting some chance to develop their nervous system and motor skills properly.
2. Muscle Development - Muscle development happens almost exclusively during sleep! And this doesn’t just matter if you’re trying to bulk up – children spend a lot of their time growing and lengthening, turning baby fat into muscles. If infants and children are not sleeping properly, their muscles are not developing properly!
3. Lack of Sleep Contributes to Hyperactivity and Problematic Behavioral Issues - The New England Center for Pediatric Psychology has coined the term Faux ADHD to describe children who have been diagnosed with ADHD, but whose behaviors are in fact directly linked to two detrimental sleep behaviors:
First children who did not sleep in their own bed display ADHD-like behaviors 7 times more often than children who sleep on their own, and second, children who did not have a consistent bedtime were 8 times more likely to display ADHD-like behaviors than children who have a consistent nightly bedtime.
If one is struggling with a child who displays ADHD-like behaviors, make sure sleep is ruled out as an issue first, especially if the child is not responding well to medications.
Natalie Willes is not a medical doctor and this press release is not intended to give medical advice.
Natalie Willes, coined as the “Sleep Training Guru”, is a certified child sleep consultant in Los Angeles, who has helped parents across the country teach their children to develop healthy sleep habits. Natalie has experience with newborns, toddlers, children over five, teens and even ends up helping parents too.
By: Amy Lage, Owner of Well Rested Baby
“Is your climbing toddler ready for the leap to a big kid bed? It’s a question that I receive regularly from parents whose kids have recently started escaping their crib. Safety is our number one priority and it is our goal to make sure your children’s sleep environment is as safe as possible. If your child is climbing out of his crib, a change is definitely needed. Our second priority….making sure your child and you get the sleep you need! My first suggestion is to make sure your child is 100% ready for this transition. This one is a big deal as it affects your child emotionally, physically and mentally. My advice is to keep your toddler in a crib as long as possible (we recommend waiting until your child is as close to 3 years old as possible). So before you take the leap to a big kid bed, you want to make sure that your child is really ready for this transition. If they are not quite there yet, we want to see if we can safely modify their sleep environment to keep them in their crib until they are ready…”