Is your school-age child irritable or inattentive? Not doing well academically, or as well as he could be? What about weight? Is this an issue? If you answered yes to any of the above, it might help to know that the cause of these and other common concerns could be nothing more than a lack of sleep. And if that’s the case, there’s an obvious fix: more sleep.
Unfortunately, many kids aren’t getting it says Hoi See Tsao, MD, FAAP, a pediatric emergency fellow at Hasbro Children's Hospital in Providence, R.I.
In fact, says Tsao, a former middle school teacher who recently completed a study on the topic, sleep deprivation has become epidemic and now affects about a third of U.S. school-age children. It’s become “a serious public health problem and is associated with a number of physical and mental health issues,” she said. To remedy this, “increased efforts are needed.”
That’s easier said than done, though, especially with so much else competing for our kids’ attention. But when we consider what can happen when kids don’t get the recommended amount of sleep, the importance of taking action is clear.
Impact on physical and mental development
One of the most compelling arguments for ensuring that kids sleep enough is the fact that when they don’t, there may be potentially irreversible consequences. This is especially true for younger children, says pediatric sleep psychologist W. David Brown of Children’s Health in Texas.
Researchers have recently theorized that childhood sleep deprivation can fundamentally change the way our brains are wired, which can affect us for the rest of our lives, he said. And he agrees that the effect can be huge. “Little children learn at a rate that will never again be achieved in the rest of the life cycle … and if they’re not getting an adequate amount of sleep, they simply cannot learn up to that par.”
A lack of sleep can also impact a child’s size, Brown added. They may be smaller or not grow as well.
The link between sleep and obesity
Another issue that can be a wakeup call for anyone who underestimates sleep’s importance is childhood obesity, which has more than tripled in the United States since the 1970s.
According to sleep experts, it’s been well established that sleep and weight gain are closely related. Although other things can contribute to obesity, like fast food and insufficient exercise, lack of sleep is often a key factor.
That’s because it directly affects hormones that control appetite — ghrelin, which increases it, and leptin, which decreases it. When we’re sleep deprived, our ghrelin level rises and our leptin level falls and we become hungrier.
Symptoms can mimic ADHD
Sleep deprivation can also mimic symptoms of ADHD, like mood swings, irritability and an inability to focus. But some believe that what’s thought to be ADHD could, in some cases, be nothing more than a sleep issue.
“I think a lot of parents don’t get that, and teachers, and everyone else involved,” says Terry Cralle, a registered nurse and clinical sleep educator based in Washington. “We see this as hyperactivity that occurs when children are completely exhausted … it’s sort of the opposite of what you’d think would happen, but that’s what happens when you’re sleep deprived.”
“Short sleep or disrupted sleep makes kids look like they have ADHD,” agrees pediatric sleep physician Craig Canapari, associate professor of pediatrics at Yale University and director of Yale’s Pediatric Sleep Center. All of us, if we’re sleep deprived enough, look like we have it, he said.
He suggests that a “worthwhile first step” for parents who suspect this in a sleep-deprived child would be to try to resolve the sleep issues before consulting a pediatrician.
Other issues caused by lack of sleep
As noted, sleep deprivation can also contribute to anxiety, depression and forgetfulness. In addition, say experts, it can impact the immune system, leading to more colds and infections, and is linked to higher blood pressure. Kids who are tired are also more accident prone, and those who drive are more likely to fall asleep at the wheel.
How to revamp your child's sleep routine
Although changing sleep habits doesn’t happen overnight, there are steps parents can take to gradually bring about change. These include ensuring that kids get enough natural light and exercise during the day, limiting their screen time, creating the right sleep environment, and establishing good bedtime routines.
There are also things to avoid: negotiating bedtime, using it as a punishment (or staying up late as a reward), and allowing kids to consume anything sugary or caffeinated late in the day.
1. Create the right environment
One of the easiest ways to promote better sleep is to create the optimal environment: a bedroom that’s dark or dimly lit (use blackout shades if needed), not too hot or cold, and quiet. If the latter is impossible, white noise machines can help. Also, the mattress and pillow should be comfortable, and the right size, and there shouldn’t be too many or too few blankets.
It’s also a good idea to encourage a child’s input when making changes says Cralle, so that they feel they have choices. Although parents should make it clear that bedtime itself is non-negotiable, other things can be. Kids can pick out new pajamas, for example, or help select a new pillow.
“If we approach it this way, it empowers kids to take ownership of their sleep,” Cralle said. “They’re much more likely to do it and feel good about it.”
2. Set a digital curfew
One of the biggest obstacles to getting enough sleep — for all of us — is screen time. According to The National Sleep Foundation, using electronic devices before bed, especially small screens that are held close to the face, interferes with the release of melatonin, the hormone that helps us sleep. This is largely due to the blue light they emit, which Brown equates with caffeine.
“Kids that are on their phones or on their tablets or computers or television are getting exposed to a lot … which is similar to saying, why don’t you have a cup of coffee and go to bed,” he said. “Parents would never do that, but they don’t realize that they’re doing a very similar thing by letting them be on electronics up until bedtime.”
Although it may be hard to avoid screens entirely, it’s recommended that parents give kids a digital curfew (an hour or two before bedtime), and ban devices from the bedroom while sleeping. If the phone has been used to wake up, an alarm clock can be substituted.
3. Establish nighttime routines
Good bedtime routines are also quite helpful, as they help us wind down and tell our bodies it’s time to sleep. For many kids, these routines include a bath or shower, bedtime reading (though not on an electronic device), and/or listening to relaxing music.
Cralle also suggests that kids be encouraged to discuss the positive things that happened that day. “Anything to end the day and associate bedtime with positivity would be wonderful,” she said. “It would really change our collective perspective on the whole sleep-going to bed kind of thing.”
Experts further recommend sticking to the same bedtime every night, at least within an hour, even if it’s not a school night. This keeps our internal clocks where they should be so that our bodies are ready to sleep when we are.
4. Lead by example and be an advocate for better sleep
In addition to the above, parents who want their kids to sleep well should lead by example says Canapari. “Showing good sleep hygiene, keeping their devices out of their rooms, and talking about how important good sleep is to them, in terms of their functioning and their success, is really valuable,” he said.
Parents should also check with their child’s pediatrician or a sleep expert if they suspect a sleep disorder, he added, although he believes these are relatively rare. “I’d say that on average, less than five percent of kids would have a diagnosable disorder.”
On a broader level, there are other things parents can do as well, like advocating for their kids if they’re getting too much homework or too many early morning sports practices.
Beyond this, parents — and the rest of us — can support later school start times for older kids in areas that haven’t implemented these. This, a trend that’s gained traction in recent years, is based on the fact that adolescents are biologically wired to stay up later than other age groups and must therefore sleep later. (Some say this is because they once needed to serve as sentinels.)
“It’s not just a matter of letting our kids sleep in because they’re lazy,” says Brown. “It’s based on their physiology, and will enhance their academic performance … schools that do this find increased attendance, decreased tardiness, and increased standardized test scores.”
“It’s a difficult thing to do,” he adds, “but I think it’s well worth looking into.”
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