When your child is not sleeping well

  • Children
  • Thursday, 11 Jun 2020

Getting sufficient good quality sleep is essential for a child’s growth, immune system and brain function, among other things. — Photos: TNS

A child spends about 40% of his or her childhood sleeping.

This is an essential activity as sleep is crucial for children to grow and learn, stay healthy, and function well.

It is also essential in the regulation of emotion, behaviour, memory and attention in children.

The circadian rhythm, commonly known as the sleep-wake cycle, is regulated by the light and dark phases of the day.

The sleep-wake cycle starts to develop in newborns, and by three to six months of age, most infants would have acquired a regular sleep-wake pattern.

Sleep requirements depend on a child’s age.

The US National Sleep Foundation recommends that pre-school children (aged three to five years old) need 11 to 13 hours of sleep and school-going children (aged six to 13 years old) need nine to 11 hours of sleep.

However, these recommendations merely serve as a guideline as every child is different, including their sleep requirements.

So do take some time to understand your child and figure out what works best for him.

In recent years, the topic of sleep patterns in children and adolescents have caught the attention of many researchers and policymakers.

The total sleep time for children and adolescents has reduced over the decades.

Children in this modern era are getting less sleep, compared to those in previous generations.

Sleep loss in children is an alarming trend and is now recognised as a major public health issue.

A vicious cycle

Children respond differently to sleep loss, compared to adults, as the developing brains in children are more sensitive to it.

The long-term effects of insufficient sleep are poor memory and concentration, which leads to poor academic performance.

Children with sleep deprivation may also exhibit change in behaviour, act impulsively and have rapid mood swings.

The relationship between sleep loss and behavioural changes is a vicious cycle, where problems with sleep lead to behavioural issues and behavioural issues lead to sleep problems.

For example, a child who has sleep loss the night before and is exhausted, will try to fight off feelings of fatigue.

In response, her body will produce the hormone adrenaline in excess, allowing her to stay alert and active, but still deeply exhausted.

So, a tired child may initially look alert and active, but irritability and crankiness will soon set in.

By then, the child will not be able to concentrate, stay calm and learn.

In such cases with a school-going child, increasing their sleep by 30 minutes to an hour daily may help to improve their school performance.

Sleep also helps strengthen the immune system and promotes healthy growth in children.

Although sleep loss for a single night will not stunt growth, children need consistent good quality sleep in order to thrive.

That is because the growth hormone is typically released during sleep.

With sleep loss, our body is also unable to make cytokines, an immune system protein that is effective at combating infections and inflammation.

The immune system is therefore weakened with sleep deprivation.

But why are children in this generation getting less sleep?

Several potential reasons include busy daily schedules, school and social activities, and the use of electronic devices.

So, what can we do to reverse this unwanted trend?

Switch off the screens

TV viewing and tablet or smartphone screen time should be limited, especially in the evenings before bedtime.

Increased TV viewing in a day could contribute to difficulty in falling asleep in children aged four to six years old.

In comparison to children who watch less than two hours of TV in a day, those with increased viewing time have a higher chance of difficulty in falling asleep and are likely to experience sleep disturbances.

Some studies have found that the use of TVs is associated with delayed bedtime, later wake-up time and a shorter time in bed, both during weekdays and weekends.

The use of electronic gadgets in the late evening has also been reported to harm a child’s sleep.

Violent electronic games and activities near bedtime put the body in a stressful state and can impair the onset of sleep.

The hormone that promotes sleep, melatonin, is suppressed by light exposure, including exposure to LED lights.

So, to promote a night of good sleep, TV, computer and electronic gadget screens should be switched off, preferably long before bedtime.

There should also be a regular sleep routine, where the child goes to sleep at about the same time everyday, plus or minus 15 minutes.

This routine should include a period to allow children to calm down and relax.

We live in a 24/7, fast-paced society where children are so caught up with their daily routine that they do not have a substantial time to wind down and relax.

Children are mostly rushed through the evenings when they reach home, and before long, they are asked to get ready for bed.

In a situation like this, which is a norm for many families, some children are not able to cope with the expectation that they should fall asleep soon after they are put in bed.

Room lights should be dimmed to help a child to relax and to promote sleep.

Relaxing activities such as light reading or singing lullabies, are helpful to promote good sleep.

Bed-wetting is one of the reasons a child may naturally wake up at night. Most children will outgrow this phase without the need for medical attention by the time they reach adolescence.Bed-wetting is one of the reasons a child may naturally wake up at night. Most children will outgrow this phase without the need for medical attention by the time they reach adolescence.

A medical problem

However, sometimes a child might find it difficult to fall asleep or to stay asleep throughout the night because of a medical condition.

Examples of some common sleep-related conditions are sleep-related breathing disorders, allergic conditions causing a stuffy nose or itchy skin that disturb sleep, and pain due to other diseases.

Sleep deprivation and pre-existing medical conditions often exist in a reciprocal cause-and-effect relationship.

One condition triggers the other, and the pattern revolves repetitively in a vicious cycle.

Sleep apnoea is an example of a sleep-related breathing disorder.

This is a condition that occurs during sleep where sufferers have multiple brief involuntary pauses in their breathing.

These breathing pauses cause them to wake up multiple times at night due to lack of oxygen, and are disruptive to a good, restorative sleep.

Obesity is one risk factor for sleep apnoea, and thus, sleep loss; however, sleep loss is also linked to obesity.

The loss of sleep alters eating behaviour and increases the desire for food.

Altered or delayed sleeping time influences snacking behaviour, as well as increasing one’s craving for sugary food.

Another phenomenon seen in sleep deprivation is insulin insensitivity, a condition that makes it difficult for the body to process glucose properly and is another cause for obesity.

The lack of sleep also results in tiredness, and subsequently, a reduction in physical activity, which promotes weight gain.

Excessive daytime sleepiness (EDS) is a consequence of long-term sleep fragmentation and sleep deprivation.

EDS contributes to poor daytime cognitive function and many other unwanted psychosocial problems.

Night awakenings

However, sometimes, it is inevitable that our children’s bedtimes are delayed, e.g. when there is a special family or social occasion, or when we are on holiday.

It is acceptable to delay bedtime once in a while, but it is very important that the daily sleep routine is restored as soon as possible to allow for adequate recovery and rest.

There are also times when a child may naturally wake up in the middle of the night, disrupting their sleep.

Reasons for this include the need to use the toilet, bedwetting, a scary nightmare or sleepwalking.

Attend to your child’s needs, then walk them back to their bedroom without creating any fuss.

Try to comfort and settle him back to sleep as soon as possible.

However, if your child frequently wakes up during the night, do go and see your family doctor as they might be suffering from a medical condition like those mentioned above.

In a family, a consistent bedtime routine is essential to ensure good quality sleep.

Children must follow a regular sleep routine and parents should set a good example for them.

Their bedroom should be cool, quiet and dark, without TV, computers or other electronic gadgets to distract them.

The bedtime routine should be a relaxing one, like taking a warm shower before bed.

Maintaining good sleep hygiene is essential to prevent the ill effects of sleep loss.

We have to safeguard our children’s sleep as much as we take care of their food intake and safety. For a healthier family, make sleep a priority!

Associate Professor Dr Christina Liew Siaw Cheok is the academic lead in Clinical Competencies and Assoc Prof Dr Thidar Aung is with the Department of Biochemistry/Immunology at the Perdana University-Royal College of Surgeons in Ireland. This article is courtesy of Perdana University. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Child health , sleep


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