What You Need to Know About Kids and Sleep

Does your child have a tough time waking up in the morning? If he does, he's not alone. Children in all age groups from infancy through fifth grade aren't getting enough shut-eye, falling short of even the low end of the recommended range, according to the 2004 Sleep in America poll conducted by the National Sleep Foundation (NSF).

If you can't figure out why your child is so sluggish -- you do get him tucked in at an appropriate bedtime -- it could be that he's one of the nearly 70 percent of kids who experience sleep problems, including insomnia and nighttime awakenings. Many parents don't recognize the symptoms, and more than half of all doctors don't ask about children's sleep habits. Yet the consequences of not catching the problem are more serious than many people realize. "Sleep is as vital to a child's well-being as exercise and a proper diet," says Parents advisor Jodi A. Mindell, Ph.D., associate director of The Sleep Center at The Children's Hospital of Philadelphia and coauthor of the book Take Charge of Your Sleep: The All-in-One Resource for Solving Sleep Problems in Kids and Teens. "Sleep deprivation can affect a child's health, safety, development, learning, and behavior." Here's what you need to know.

1. Tired children get hurt more often. Kids ages 14 and younger who get less than ten hours of sleep a night are 86 percent more likely to injure themselves, according to a 2001 study by researchers in Udine, Italy. (Preschool-age boys are at particular risk.)
   
   "Exhausted kids don't slow down like adults do. Instead, they get wound up and hyperactive, and may hurt themselves," explains Sarah Stolz, M.D., associate medical director of Sleep Medicine Associates, in Seattle.
2. Sleepy kids get sick more easily. If your child seems to be getting sick more often than usual, you may want to cast a suspicious eye on his sleep habits. Even modest sleep deprivation reduces the efficiency of the body's natural immunity by as much as 30 percent, leaving a child more vulnerable to viruses and other infectious diseases, say researchers at the University of San Diego.
3. Fatigue is stressful. Kids who aren't getting a good night's sleep have higher levels of cortisol, the "fight-or-flight" hormone that is released in the body and spikes in times of stress. A pilot study at Brown University found a connection between sleep quality and the levels of salivary cortisol secreted in response to social and academic stress in children ages 7 to 17. The significance? Continually elevated levels of cortisol are associated with higher blood pressure and weakened immune response.
4. A child needs a good night's sleep to grow. Some researchers believe that the body builds new bone and muscle cells during the deepest phase of sleep; chronic sleep shortfalls can impair growth.
   
   Fortunately, kids can catch up: Hospitalized premature infants sleep longer and gain weight faster when nighttime lights and noises are minimized. Also, children with obstructive sleep apnea (OSA) -- which causes frequent involuntary breathing pauses and repeated awakenings -- often experience growth spurts after the disorder is treated.
5. Sufficient sleep may cut a kid's risk of diabetes and obesity. A single week of reduced sleep interferes with the body's ability to process carbohydrates, say researchers at the University of Chicago. This triggers increased insulin production and elevated blood-sugar levels that can lead to type 2 diabetes. Sleep debt also interferes with the secretion of leptin, a hormone that tells you you're full. When leptin is low, a person craves carbs no matter how much he's eaten. Does the same go for kids? "So far, studies have looked only at adults, but it's probably true for children too," Dr. Stolz says.
6. Sound sleepers get better grades. As you probably remember from your own all-nighters, inadequate sleep can fog the brain. Concentration, problem-solving, verbal fluency, and creativity all go out the window. What's more, a lack of sleep impairs learning -- potentially making a big impact when report-card time rolls around. Experts believe that during sleep, the brain replays and rehearses knowledge acquired during the day, improving memory. It's no surprise then that University of Louisville researchers found that children with late or irregular bedtimes don't do as well in school and that those who snore (a symptom of OSA) are more likely than others to be academic underachievers.
7. Tired kids are crabby kids. Fatigue can transform even the sweetest children into aggressive, hyperactive, demanding, dependent, or moody mini tyrants. "Exhausted youngsters can't control their emotions, so they're likely to have a tantrum or burst into tears," says Dr. Mindell.
8. When kids don't sleep well, parents don't either. "Most nights my 16-month-old daughter wakes me up at least once -- and occasionally as many as six times," says Jeanna Munch, of South Salem, New York. Many moms and dads can empathize: According to the NSF, half of all parents have their sleep disturbed by children, on average twice a week; and most get only 6.8 hours of the eight to nine hours of snooze time they're dreaming of. "After a long night of pleading and power struggles, it can be hard to feel like a good parent in the morning," says Dr. Mindell. "The whole family suffers."