Monday, February 20th, 2012
When you are dealing with an infant or toddler, the most pressing sleep issue is usually finding the right sleep method that gets your child to go to sleep, and stay asleep. When you are dealing with school-age kids (from kindergarten through high school), the challenge shifts to making sure that your child’s sleep is regulated nightly and that they are getting the right amount of sleep. Given the ongoing debate about how sleep recommendations are made – and what should be followed – I’m providing my take on the key guidelines, warning signs, and next steps as they apply to school-age kids, all in the service of providing information so that you can become the sleep expert for your own child.
GUIDELINES: Much of the recent debate concerns how the current guidelines have been generated – and the extent to which we need more science to make them more precise. While it would be terrific to have new research on this topic, the fact is the current recommendations offer pretty reasonable – though somewhat fuzzy – numbers to shoot for. Here are some tables listing the average (meaning kids can get more or less) amount of sleep that is recommended by age that I am pulling from a source that I find very helpful – the University of Michigan Health System. (Do note that different recommendations are made by the National Sleep Foundation - for example, the recommendation there for preschoolers is 11 – 13 hours per day – and the lack of universal guidelines are part of the reason that there is debate going on between experts). But as an illustration of how sleep changes with age, let’s stick with the University of Michigan guidelines and start with the transition in sleep requirements from age 3 to age 5.
|3 years||10.5||1.5 (1 nap)||12|
The big changes here are that naps are typically no longer needed by age 5 (this source does not put in a nap time at age 4, though it is noted that many 4-year-olds still nap), and the amount of required total sleep declines with age (from 12 hours at age 3 to 11 hours by age 5). If you look closely at this table, though, you will also see that the amount of nighttime sleep at age 4 and 5 may be more than that required at age 3 because naps are no longer taken. Of course, these are averages, so your child may deviate greatly from them – I’ll get to this point shortly so stick with me. So let’s move on to look at how sleep recommendations continue to change by age by considering ages 6 – 8.
The only change here (on average) is that less sleep may be required at age 8. How about ages 9 – 11?
Now we see the trend – between 7 and 11 years of age the shift is from 11 hours a night to 10 hours a night. Moving on to the transition to adolescence we find the following:
|12 years||9.5 – 10||0||9.5 – 10|
|13 years||9.5 – 10||0||9.5 – 10|
So another small shift is seen entering the teen years – the total nighttime sleep has gone down to settle at an average of 9.5 by age 14.
WARNING SIGNS: Okay, so now we have some rough guidelines. As I anticipated earlier, many of you are noticing that your child deviates from these – sometimes substantially. And that’s the biggest challenge to interpreting these kinds of guidelines – because every recommendation I encounter simply notes that children differ without telling you why they differ and if it’s problematic. Given that, we need to consider some warning signs that your child may not be getting enough sleep so that you can determine if you need to change their sleep schedule. I suggest you first determine if your child’s sleep patterns are regular. Regular sleep patterns are important physically for your child – recent research suggests that highly irregular sleep schedules during the school years are associated with a number of physiological changes that could signal the start of risk for metabolic conditions (including those that predict risk for diabetes). So if your child’s sleep varies greatly from night to night, that is, in and of itself, a signal that they are not regulated. By “varies greatly,” I would be conservative and say that it shouldn’t differ by more than 15 – 20 minutes from night to night (given that some nights might go later because of activities or homework requirements) – and in fact should be about the same.
Next, you can use some easily collected information about getting to sleep, and waking up. Does your child fall asleep pretty easily – meaning somewhere between 15 -30 minutes after the lights are off and it’s time for sleep? If not, this is sign that the sleep cycle is not sufficiently regulated. Similarly, is it hard to get your child up in the morning at the designated wake-up time? By “hard,” I mean a struggle. School age kids should be either waking up themselves or waking up easily to an alarm or your gentle way of letting them know it’s morning. And they should be alert pretty quickly. So if they aren’t getting up easily or seem groggy for a while, then it’s time to consider that you may need to adjust the amount of sleep they are getting.
Information collected throuhgout the day is valuable as well. They should not be sleepy during the day. They shouldn’t be dragging and yawning during school – and teachers shouldn’t be noticing this on a regular basis. (Signs of sleep deprivation in school are clearly associated with reductions in learning and classroom performance). They shouldn’t look tired after school. They shouldn’t look tired when they are in the car. They shouldn’t be yawning through dinner. And they shouldn’t be showing signs of fatigue while they are doing their homework. If any of these things are happening, it’s a good bet that they need more sleep.
You will often times see other indicators noted, like being cranky, irritable, etc. I don’t find these to be as helpful – unless they are happening along with some of the other signs I have just noted. Then you can be pretty darn sure there is a sleep problem.
NEXT STEPS: To be clear, what’s most important for you to determine is not so much how much sleep your child is getting – but the quality of it. If you aren’t seeing any signs of sleep deprivation, you can probably ignore the charts and figure that what you are doing is working just fine. But any sign of sleep deprivation noted above should be taken seriously and spur you to examine your child’s sleep patterns more closely. And a good place to start is to focus on what’s happening before bedtime – many sleep issues can be solved by changing the activities that happen before sleep. There are the electronic culprits that interfere with sleep on a more frequent basis these days – extended time devoted to TV, DVDs, social media, texting, and video games can mess up the required sleep cycle. These things are infiltrating kids’ space and time and some strict rules may need to be put in place, especially later in the night – and particularly if they are available in your kid’s room (you may think they are sleeping but they may not be). Outside activities can be wonderful but an intrusion on your kid’s schedule – you will need to figure this out and see if hard decisions need to be made (like not doing a given activity because it takes up too much time or gets your kid home too late). Homework can become an increasing time management issue as kids get older – especially in the middle school/upper division years and high school. If it is keeping your kid up later than you think is right for them, you will need to bring this to the school’s attention (many parents do these days, as parents and schools partner to find the right balance). All of these things should be considered to help define a regular bedtime that can work night after night. And, that said, since your kid’s wake-up time is probably pretty fixed (you know how much time they need to get ready, have a good breakfast, etc), you will need to adjust their bedtime. This is best done in small increments. Try adjusting the bedtime by getting your kid settled in for sleep 15 minutes earlier than you have been doing and stick with this for at least a week. Then if necessary try adding on another 15 minutes the following week (so that now they are going to sleep 30 minutes earlier than they used to). See if this results in a reduction in any of the signs of sleep deprivation.
All of this sounds like a lot. And it is. Regulating sleep in the school years is not an easy process. And if nothing is working – talk to your pediatrician about a referral to a pediatric sleep clinic. Simply put, getting your child the right amount of sleep is one of the best things you can do for school-age kids.