Have you read all of the most popular 2018 posts from Quest for Health KC?
At the end of the year I like to take a look at which posts were popular to help identify what I should write about in the next year. It also gives me the opportunity to share with readers all the best posts they might have missed along the way.
10. Help! I’m sick and I have a baby at home!
Parenting is a tough job, even when you’re not sick. When you have an infant and you’re sick, not only do you have extra sleep needs, but you have to try to keep your baby healthy despite being around your germs. What can you do when you’re sick with a baby at home?
During the summer months one of the most uncomfortable reasons I see boys is that their penis and/or scrotum is swollen significantly. Learn what Summer Penile Syndrome is and what to do about it.
7. Dark Under Eye Circles
When kids have circles under their eyes, parents worry that something’s wrong. Sometimes there’s a treatable reason, sometimes not. Learn all the most common causes of under eye circles and what to do about them.
6. The flu shot doesn’t work
I’m pro-vaccine, so this title might surprise you. I hear the argument that the flu shot doesn’t work so often that it deserves to be addressed.
5. Flu Season Fears: What should you do?
Every flu season as we start to hear reports of kids dying from influenza the fear surfaces. This was written during one of the worst outbreaks in recent history. Be protected against each flu’s season fear with a flu vaccine and healthy habits!
When saliva gets on our skin, it breaks it down. Licking the lips leads to increased cracking and bleeding. Some kids have a wide ring of dry skin around their mouth from lip licker’s dermatitis. Learn what you can do to help them heal their smile.
I’m surprised at the popularity of a few of these and sad that some of my personal favorites didn’t make the list.
I wish more people would read what fever is so they worry less about a number. Learning the evolution of illness might also help parents understand why exam findings are different on different days. I hear far too often that an ear infection was missed, but it’s more likely that they developed since the first exam.
I’ve also written a little on insurance and the business of medicine, but it doesn’t surprise me that those are not as popular. Sadly, we all need to understand the intricacies of billing and insurance as well as how the business of medicine works. As more and more private practice physicians sell out to large corporations, we’ll all feel the negative impacts.
I see many kids each month who complain of being too tired. Parents often fear the worse, such as low iron or even cancer. There are many things to consider, but there are a few very common reasons that could explain why a child or teen is tired. I’m also including some less common things that make kids feel tired, but are common worries of parents. Always remember that common is common. Serious causes of being tired will not happen with fatigue as the only complaint.
Here are 10 reasons a child or teen is tired:
1. Not enough exercise
Strenuous aerobic exercise helps our bodies get healthy, quality sleep. Better quality sleep improves our performance, both physical and mental.
If you lay around, you tend to feel more relaxed, lazy and tired. Getting up and moving can help.
Many kids sit all day at school, then come home to sit more doing homework, watching tv, or playing video games.
Limit time on screens, especially before bedtime. We need to encourage kids to get up and move, ideally outside.
Make it fun!
Take a walk to a park, then play
Go on a bike ride
Join a sports team
Try yoga — there are many online videos to get you started
Several of these ideas you can do with your kids. Make it a family goal to be active together! It models the healthy habits you want your kids to live.
2. Celiac disease
Celiac disease is an autoimmune disease in which people can’t eat gluten (a protein found in wheat, barley and rye) because it will damage their small intestine. This can lead to malnutrition and anemia (low red blood cell counts). Symptoms vary, but often include abdominal pain, diarrhea, constipation, fatigue and bloating. In kids it can affect puberty and growth. Celiac disease can run in families.
There are a lot of people who say they feel healthier when they avoid gluten for non-celiac gluten sensitivity. These people have symptoms that are found in celiac disease, such as abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, but do not test positive for celiac disease. It is not clear what the etiology of this is, but removing gluten seems to improve symptoms.
It’s uncommon for kids to have fatigue as the only symptom of celiac disease, but if you are worried about their symptoms, schedule a visit with their physician to discuss it as a possibility.
A quick warning…
Do not remove gluten from their diet without talking to your doctor. Gluten in the diet is needed for testing, which is needed to confirm celiac disease.
Celiac disease is important to diagnose and treat due to chronic issues that can occur from long-term damage to the intestines. If a child doesn’t have a true diagnosis, it is more likely they will not remain compliant with the diet changes that are required.
We often think we would recognize a depressed child or teen. We picture them crying often or appearing sad, but this is not necessarily how they appear. Yes, they can cry and appear sad, but sometimes they don’t.
Depression doesn’t always look like you’d think.
Sometimes parents think their child is angry. Or parents are mad because a teen stops trying at school. The child might get into fights.
Common symptoms of depression:
Sadness, crying and tears
Losing interest in things they usually enjoy
Appearing angry or irritable
Boredom and apathy
Isolation from friends and family
Headaches, stomach aches, and other ill type symptoms
Thyroid problems are relatively common and can be present at birth or develop later in life.
Hypothyroidism occurs when the thyroid gland does not make enough thyroid hormone. About 5% of people over 12 years of age has hypothyroidism.
People with hypothyroidism might feel depressed, be tired, have poor focus, and become forgetful. They might gain weight or have slowed growth. They might feel colder than others or have constipation. Sometimes they’ll develop a swelling in their neck called a goiter.
Most of these are very common symptoms that are not specific to thyroid problems. Having some of them does not necessarily mean that there is a problem with the thyroid. If there are several of these symptoms, it’s relatively easy to screen for thyroid problems with a blood test.
Schedule an appointment to talk to your pediatrician if you’re concerned about a thyroid problem.
5. Too much sugar
Although the body needs sugar for energy, eating too much refined sugar can cause weight gain, chronic disease and sugar crashes. Excess weight can make it harder to exercise and sleep, both of which help us not feel tired.
Limit the juices, candies, and other high-sugar / low nutrition foods. I know this is easier said than done when kids beg and cry for candy. It’s even harder to limit when kids grab their own snacks.
Keep easy to eat healthy snacks available as much as possible. Don’t buy the junk. Kids will get plenty of it outside the home. If it’s not at home, they won’t grab it.
Most adults have grabbed a caffeinated beverage to help ward off fatigue, but caffeine can lead to poor sleep and more tiredness. It can become part of an unhealthy cycle.
Kids don’t need caffeine. If they do have it, it should be before noon. Caffeine can stay in your body for about 8 hours and keep you from sleeping.
Children under 10 years of age should not have caffeine due to jitteriness, irritability, and other side effects. It’s recommend that kids who are 10 – 12 should get no more than 85 mg per day. Teens should have 100 mg or less. Up to 400 mg of caffeine a day appears to be safe for most healthy adults.
Mixing caffeine with certain medicines or alcohol can increase its problems.
Our red blood cells bring oxygen to the cells of our body, and when the levels are low we can feel tired. Other symptoms are irritability and pale skin coloring. Often there are no symptoms with mild anemia.
There are many causes of anemia. Blood work can help to identify anemia and its causes. Treatment depends on the cause.
If you’re worried about anemia, schedule an appointment with your pediatrician. A history and exam will be needed to determine if labs are indicated.
It makes sense that if you don’t sleep enough, you’ll be tired. When people have insomnia, they do not sleep enough hours.
There are many causes of insomnia, but all can lead to insufficient sleep. Addressing the underlying cause is important.
Nicotine (growing in popularity among kids due to vaping)
If your child is struggling to sleep, schedule an appointment to discuss potential reasons and treatments.
9. Sleep apnea
Sleep apnea happens when a person stops breathing during sleep. It’s usually caused by something blocking the upper airway. You might hear snoring followed by pauses in the breathing pattern, gasps, or choking sounds.
Because the airway is obstructed, oxygenation levels can fall briefly. This triggers the brain to wake up to open the airway. When this happens repeatedly throughout the night, sleep quality is affected. A person wakes feeling tired.
Not enough sleep is the common thread to many of these.
Not enough sleep is the #1 reason I find for kids being tired. They need more sleep.
Studies show that many of us just don’t sleep enough. It’s important for kids to get adequate amounts of sleep. If your child is tired and is not able to sleep sufficiently, talk to your pediatrician about ways to improve sleep and decrease fatigue.
Bonus post! I’ve been scheduling posts on Tuesdays and Saturdays, but forgot about the clock change that’s happening next weekend. I wanted to post off schedule to give people a week to think about how they’ll adjust and Spring forward!
Spring forward and lose an hour of sleep
Spring is a wonderful time with warmer weather, flowers blooming, and more daylight hours to play outside.
Most of the US will move our clocks forward on March 11th.
There are some things we can do to help ease the transition though.
If you have early risers
If your little ones wake too early consistently, this is a great time of year! Instead of them waking at 6 am, they’ll wake at 7.
This is great if you want them to sleep an extra hour in the morning.
If your kids are used to waking up at the “correct” time, you’ll have to re-train them to go to bed and wake up an hour later.
The good news is the change happens over the weekend, so plan on waking kids up Sunday at the same time you always wake them, even if you have a lazy Sunday planned. Get them up and moving!
If your clocks don’t automatically reset, set them before everyone goes to bed for the new time. They will be going to bed at the old time, but they should be aware that when they wake it will be the new time. It will look like they’re going to bed an hour late.
If they go to bed at their usual time, they will be short an hour of sleep. Some kids might benefit from a little longer nap due to this, but don’t let them sleep so long that they won’t fall asleep on time Sunday night.
Do your normal activities at their normal times on Sunday so that Sunday night they’ll be ready for bed at their regular bedtime in the new time.
Teens and other kids who have a hard time getting up
Make a plan
Talk about a plan for waking earlier by Monday morning to see what your teen (or older child) thinks will work best for him or her.
Try to not dictate what they want to do. That just won’t work.
A defiant kid will just not listen.
Some kids might get anxious about the change if you push it too much – and anxiety is one of the biggest triggers for insomnia.
No one wants to be tired, and even teens will admit they want more sleep.
It’s not their fault that they stay up late and want to sleep in. It’s built into their circadian rhythm.
Spring Forward Plan suggestions
Slowly back it up over days
Go to bed 10-20 minutes earlier for several nights before the switch and get up a little earlier than normal each day.
It’s important that they get up a little earlier because that helps them reset their internal clock, even if they couldn’t fall asleep earlier.
So if they normally wake at 6:30 for school, get them up at 6:10, then 5:50, then 5:30 over a few days, so they will be ready for 6:30 on Monday morning.
Wake early for the weekend
Wake up an hour early on Saturday the weekend the clock changes. Or 30 minutes earlier on Saturday and the other 30 minutes Sunday.
This might help them readjust to the new time over the weekend and be able to go to bed a little earlier Saturday and Sunday nights, which helps with Monday morning.
Each day this week they can use a mindfulness app to practice mindfulness. Then when it comes time to sleep, they can get into their mindfulness place and relax.
Parents often try to keep the crib as long as possible to avoid the problem of their toddler/preschooler leaving the bed again and again at bedtime, but eventually they all need to take the plunge and get a big kid bed. How do you get a kid to stay in a bed?
Daycares do it
It always blows me away that daycares get 1 year olds to sleep on cots.
They stay there… how???
I suspect they are following what the older kids in the class are doing and they are never left alone. That makes it easier on many levels. Parents don’t have that luxury at home when transitioning to the big kid bed.
When’s the right time?
Many parents are tempted to move their toddler to a bed before the child is really ready. Many experts advise continuing the crib until around 3 years of age.
Remember that the crib also is a place of security, so sleep problems can develop if kids are transitioned too soon.
Many kids that leave the crib before they can understand rules (around age 3) have a hard time staying in the bed.
Some kids are able to climb out of the crib, so parents think it’s safer to move to a bed. This is one solution, but you can also work on ways to keep your toddler in the crib.
Make sure the space is safe
Before you let kids sleep in a bed that they can easily get in and out of, make sure the room is safe.
This is a great time to check the smoke and carbon monoxide detectors. Change batteries when you change your clocks.
Furniture should be secured to walls so climbing kids won’t pull them down.
Don’t allow window cords to be reachable by kids. Too many kids get hurt from cords and window coverings.
Don’t put beds near windows.
Keep all medications and poisons out of your child’s room. This includes diaper rash cream and other “non-medicine” hazards.
If you have a bunk bed, be sure kids under 6 years of age don’t sleep on the top bunk. If your little ones won’t follow the rules, you should unbunk the beds.
Make sure kids can’t get out of their room without you hearing them. They could be at risk falling down the stairs or simply get into trouble helping themselves to junk food or extra tv time.
Parents can get the child excited about leaving the security of the crib by talking about the bed before it is used.
Have kids help pick out sheets or a pillow for the bed.
Remind them during the day how big they are when they ___ (fill in the blank with “use a spoon,” “pick up a toy,” etc). Warning: This can backfire if they really are afraid of the bed and they do want to not be big, so they stop all the “big kid” behaviors.
If kids are afraid of their new bed, lay together to read books at nap and bed time.
If you still have the crib available, ask if they want to sleep in the bed or the crib. Simply having the choice might empower them to want to stay in the bed.
Feel free to leave a light or night light on in the hall (or even in the room if they prefer). Eventually they won’t need it, but it can really help if they want it!
Go through a routine of checking the closet (then closing the closet door), checking under the bed, and picking a favorite toy to be there while your child sleeps.
Use a comfort item. It’s amazing how much the power of suggestion that a stuffed toy will stay with them works!
Let them know you will check on them soon… and do, but wait a little longer each night until they are asleep when you check.
For kids who are prone to falling out of bed, decide what works best for that child.
Some parents put the mattress on the floor instead of on a bed frame, so if they roll off it’s no big deal.
Many parents use bed rails that keep kids in the bed. Unfortunately if they roll hard enough, they can get trapped between the mattress and bed rail. I know this from experience! My son would do that and it would FREAK him out. He usually went to sleep without much fuss, but after he would get stuck in the rails he was too scared to sleep. We finally just put the bed against one wall and moved everything away from the other side of the bed except a nice layer of pillows and blankets. When he fell out of bed (yes, most nights…) he landed on the pillow pile and kept sleeping. Problem solved!
Pick a reasonable bedtime
Account for all the time it will take to do all the stall tactics when picking the bedtime.
If sleep time needs to be by 7:30, and you know they will resist brushing teeth, need to potty a 2nd time, get a drink, check the closet and under the bed, and read 3 books… get started in plenty of time to do all of that and still have them tucked in for the last time before 7:30.
Ironically as kids get more tired, they get more wired, so DO NOT allow this process to run too late! They will hit a 2nd wind and be up far too long. We all know what kind of day tomorrow will be if they are up too late tonight… and it isn’t pretty! Then they are overly tired for the routine the next night, which can lead to an earlier 2nd wind and more troubles!
One trick I’ve learned that works well for older toddlers and preschoolers is the card trick.
They start each night with 3 cards.
Every time they leave their bed for another hug, a drink, to potty, etc, they surrender a card to you.
Once all 3 cards are gone, they can’t leave the bed any more.
If they have cards left over in the morning, they get a sticker for each card.
They can earn up to 3 stickers (or make it special to get an extra sticker if they have all 3 cards!)
When they reach a set number of stickers they earn a prize.
You can use cards from a regular deck, or you can make it even more fun by having your child make his own cards.
I also suggest making a simple sticker reward chart, keeping in mind how difficult you think it will be to earn stickers and set a realistic goal for all the needed stickers to be earned within a week.
If they don’t earn the prize fast enough at the beginning they might lose interest (but it needs to be enough time that they earn it). You can make it more difficult over time, as their bedtime routine gets better.
For ideas of reward charts, check out this fantastic free site!
Prizes shouldn’t break the bank.
You can find trinket toys inexpensively or even pick an “event” as a prize. Maybe your child has been wanting to go to a new park. Maybe they want to have an extra book read at bedtime.
The most important thing is that the child will want to earn the prize.
Playing the game
Go over the rules of the cards and stickers during the day several times so they know the rules before you start the system.
At bedtime minimize the talking and just let them figure it out when you ask for cards or refuse to let them have a 4th resistance tactic.
Remember that each day is new, so they start with 3 cards and you can talk up how much you know they can keep them all!
Praise all the good choices.
If they struggle with it, find positives to praise… “You kept your cards a little longer last night. I can tell you’re working on keeping them all night!”
When kids leave their bed
If kids end up in your bed in the middle of the night and you don’t want them there, you must firmly but without much discussion bring them back to their room.
Too much snuggling, talking, or other interactions will only reinforce them coming to you again.
Night after night they get to spend more time with you– that’s what they see every time you give them attention when you need to limit the interaction.
Attempt to get them to walk themselves, but if they refuse, carry them with outstretched arms facing away from you to decrease body contact.
If you don’t mind them in your bed, be sure you’re ready for a long term commitment to a family bed. Once the habit’s started it will be harder to break until the child wants to sleep independently.
Sleep deprivation makes parents do things they never thought they would… you just want to get sleep.
Yes, I’m one of those parents who succumbed to being tired and let a little one stay in my bed. I realized I was kicked and punched often throughout the night by my lovely little angel who was not a great bedfellow. She affected my quality of sleep for quite awhile. She wasn’t sleeping well either. We all needed to have our own space. Her nightly visits didn’t stop until we made a firm decision to stop the behavior.
We made a bed on the floor of our bedroom and let her sleep there. We slowly moved that bed further from our bed, then into the hall, and finally into her room. Eventually she even made it to her own bed.
If problems continue
If all else fails, talk to your child’s doctor about sleep problems.
Some sleep problems are due to real medical conditions and these should be evaluated.
If sleep problems continue, loss of sleep can affect growth, learning, behavior, and more… don’t let it get to that point!
There’s a lot of debate about pacifiers and since it’s Children’s Dental Health Month I thought I’d tackle the issue. Many parents are apprehensive to start one with a baby, yet many babies need to suck. Sucking is a natural reflex. Sucking on thumbs, fingers, pacifiers or other objects may make babies feel secure and happy and help them learn about their world. They can even be sucking on a hand or arm when still in the womb. Many babies find their thumb or a finger to suck on and self-soothe if not offered a pacifier.
I personally was unhappy to hear of the “baby friendly” initiative at our local hospitals that discourages any pacifier use during hospitalization. I think it makes parents fear the pacifier even more than they had before and they have benefits as well as cautions.
I’ve seen more mothers get frustrated with breastfeeding when they can’t use a pacifier. I have rarely seen a problem with breastfeeding when babies are allowed to use a pacifier.
Even in the womb we can see babies sucking. A pacifier allows them to fill this need, which allows parents to have a much needed break.
Pacifiers can help with pain relief.
There’s a natural pain relieving property to sucking. Think about how addicted older kids are to sucking on a thumb or pacifier. It is soothing. Adding sugar to the pacifier for painful procedures helps pain even more.
Don’t give your baby sugar at home. It’s not good for them and can lead to cavities once they have teeth.
Pacifiers help prevent Sudden Infant Death Syndrome (SIDS).
We don’t know why they help, but studies show that pacifier use decreases the risk, along with sleeping alone on a firm, flat surface, on the back, without soft bedding.
Parents can control use.
Pacifiers can be weaned gradually and kids tend to outgrow them earlier than thumb-sucking.
Infants over about 4 months of age can develop other self-soothing abilities, so you can use them just for sleep in older infants and toddlers.
Keep them in the crib to decrease the risk of germ spreading from displaced/replaced pacifiers.
I like pacifiers better than thumbs
If a baby wants to suck, he will find his hand if something else isn’t offered. Babies eventually find thumbs or fingers if they want to suck on something.
Thumbs are always with a baby and child, so they can suck on them whenever they want, not just in the crib when a parent gives it.
Thumbs can get red, dry, and cracked with sucking behaviors – especially in dry weather. This can be painful to the child. The drive to suck is so strong they continue to do it despite pain. It can also lead to infections of the thumb.
Most kids will stop a pacifier habit by 3 years of age. If a pacifier is limited to sleep time only, kids are already not in the habit of sucking on something all day long. They only have to learn to fall asleep without sucking.
Thumbsuckers continue their habit more often and much longer. Often it’s not until they’re teased at school that they decide they want to quit. Until they make the decision to quit it’s hard to make it happen.
Thumbs are never clean. At least you can wash the pacifier and keep it in the crib. Kids play with their hands and you can’t keep the thumb out easily after they’ve touched everything.
a few cautions to pacifier use:
Don’t use them instead of feedings
Don’t use a pacifier to try to limit the number of breast feedings in a day, especially early on. Newborns need to eat quite a bit. Trying to “hold them off” with a pacifier will only limit your milk supply and could cause them to not gain sufficient weight.
Work with your pediatrician or a lactation consultant to be sure your baby is feeding enough if you’re feeling a need to breastfeed less.
I find that most babies can go back and forth from breast to pacifiers easily.
Most isn’t all.
If your baby seems to have trouble latching on the breast after using an artificial nipple (either a pacifier or a bottle) then stop the artificial nipples and focus on breastfeeding. (If you need to supplement, you can use a syringe, a supplementing system, a spoon, or other methods.) Continue avoiding artificial nipples until breastfeeding is going well.
Work with a lactation consultant if you have continued problems.
Pacifiers can spread infections.
Ear infections and other illnesses can spread easily from pacifier use.
Wash them regularly.
Keep them in the crib for babies over 6 months of age to avoid exposing it to germs from other kids.
Pacifiers can crack and come apart as they age. Be sure to check it regularly to make sure it’s not damaged. You don’t want it to become a choking risk.
What about teeth?
After permanent teeth come in, sucking can cause problems with the proper alignment of the teeth. It can also cause changes in the shape of the mouth.
Both finger or thumb-sucking and pacifiers can affect the teeth in the same ways, but pacifier use is often an easier habit to break.
General recommendations about stopping the sucking habit
Be careful how you approach stopping a thumb-sucking habit or pacifier use. If you are too harsh or negative it will probably make the habit worse.
Use positive rewards.
Have your child come up with goal ideas and things to earn. Rewards don’t have to be expensive. It can be a trip to a special park or the ability to pick dinner or what book to read. You can also get stickers, trinket toys, an
Sticker charts are a great way to keep track of times that there was no sucking!
Think about making it more difficult for your child to suck his thumb. Keep the hands busy with crafts, toys, etc.
For the older child, talk about germs and how important it is to keep the thumb out of the mouth unless she just washed her hands.
Consider sewing socks or mittens onto long sleeve pajama tops. This will keep the thumb out of reach. (Unless your Houdini takes the PJs off.)
Using a “bad” tasting polish or tabasco doesn’t really keep kids from not sucking their thumbs unless it’s only a reminder to stop. If they really want to suck, they don’t care about the taste. But if they do want to stop and need reminders throughout the day to keep it out of their mouth, the bad tasting nail polishes can help.
Plan a countdown to not using the pacifier any longer.
Make getting rid of the pacifier a big deal, like any other special event. Find a fun name for the day, like “Big Kid Day” or “Give to baby day”.
Put the chosen date on the calendar and do a count down every day by crossing off dates. Or make a paper chain and tear off one chain daily until the big day.
Find a replacement for the pacifier, such as a new stuffed animal or blanket. The stuffed animal can even be from Build-A-Bear. Put the pacifier inside so the child knows it’s there when he hugs his bear. Whatever you choose, be sure it can be snuggled or used to replace the pacifier for comfort.
Fill a box with all the pacifiers on the big day and leave it out for the “binky fairy” to take to new babies. The fairy can leave the new comfort item. Or you can just have your child put all the binkies in the box and seal it shut with tape when he’s ready to earn the new comfort item.
The big thing is you need to get rid of all the pacifiers. If your child finds one hiding somewhere, he will sneak it and return to the habit quickly.
Books that might be helpful
Note: These are Amazon Affiliate links and I do get paid a small amount for the referral.
In this book for toddlers,Little Brown Bear finds some tricks to help him stop sucking his thumb. It can help put the idea into your child’s head.
This is not specific to thumb-sucking, but the Berenstain Bears always teach kids in a fun way. Sister bear has trouble biting her nails in this story.
Thumb Love is appropriate for the older child who wants to stop sucking his or her thumb. If your school aged child has been the object of teasing due to thumb-sucking, he or she will relate.
I preach about sleep to kids all the time, both at the office and at home. It’s one of my three most important things for overall health along with eating nutritious foods and daily exercise. Most of us don’t get enough sleep. Here are some tricks to get in a few extra minutes each day… they all add up!
Most of these tips are appropriate not only for kids and teens, but also for their parents! In November I wrote about the problems I often see with teen sleep deprivation specifically.
Know how much sleep is typical for every age group.
Warning: It shows generalizations. For example, when tweens and teens go through a growth spurt many need 10-11 hours of sleep per night, which is more than the graph shows.
Just remember that individuals are just that: individual.
Think of sleep as a currency.
We can go into sleep debt when we don’t get enough. If it’s just a little loss of sleep, it’s easy to catch up and pay back the debt. The further into debt you go, the harder it is to get out of debt.
Don’t let the bank come after you in terms of health problems!
Listen to your body and teach kids to listen to their needs.
If you’re tired, you need more sleep. It’s sometimes easy to recognize but not always. Some kids are notoriously not able to do this well.
The longer you stay up, the harder it will be to fall asleep. It’s ironic, but sleep deprivation leads to insomnia. If you suffer, try to allow extra zzz’s on a weekend to fill the deficit. But don’t let the sleep deprived person sleep in so late that he can’t go to bed on time that night.
Many parents have realized that the later the kids stay up, the earlier they wake. Despite waking early, they didn’t get enough sleep. Behavior shows that they’re tired when they don’t sleep enough – you might see whining, tears, frustration, and irritability when this happens.
Many kids get hyper when they’re tired, so don’t be fooled if they have lots of energy in the evening. If they don’t wake easily in the morning or are whiny during the day, they are tired!
Go to bed and get up at the same times every night and morning. If you let your kids stay up later on a weekend, be sure it isn’t more than 2 hours past their ideal bedtime.
Remember that going to bed just 15 minutes late each weeknight gives over an hour less sleep during the week – it all adds up!
Resetting the internal clock.
If someone has a hard time getting up, have them get natural sunlight as soon as possible in the morning. It helps set the circadian rhythm. If you can’t get natural sunlight, turn on lights in your home.
Use a night mode on a screen if you must work online prior to bed – a common problem for teens who have homework these days. I have used a free app called f.lux with great success. I can tell the difference in tiredness and ability to fall asleep when I have this active on my computer.
There are many ways to wind down before climbing into bed.
Journal before bed if thoughts keep you awake. People who spend bedtime thinking about everything can’t sleep. Jot a few things down to give yourself permission to not think anymore. Sounds weird, but this “worry list” works for many people!
Coloring is another way to relax. It’s not just for kids anymore!
Belly Breathing is very effective and can be taught to kids. Some kids will put a stuffed animal on their tummy and try to raise the animal with a slow, deep breath.
Set the mood in the room: darken the room, get the temperature “just right”, and find the number of blankets that helps you sleep. Setting up a fan or other white noise maker helps many people sleep. For more tips on setting up the perfect room for sleeping, see Bedroom.
Weighted blankets have been shown to help many people, especially those with anxiety fall asleep faster but there is a concern about safety when used by kids.
Listen to Weightless – music that’s been shown to help initiate sleep.
Reading at bedtime can be a great relaxing thing, but if you have a page turner, be careful to not get caught up in the book for hours. I find that stopping at a lull mid-chapter is better than waiting until the end of a chapter. A good author leaves you hanging at the end of a chapter and begging for more! Set a time limit and stop reading when time’s up! That’s what bookmarks are for.
Take a warm bath. This can help relax you for a good night’s rest.
Ask a family member to give you a massage or back rub. Again, a great way to relax!
Warm milk or herbal teas might help some sleep.
Be active during the day.
Lounging around makes you feel more tired during the day, but it’s then harder to fall to sleep at night.
Experts recommend avoiding exercise for a few hours before bedtime, but I know that is really hard for kids in sports. I don’t have a great fix for that, unfortunately.
Skip the snooze.
Kids and their parents who hit snooze several times miss out on all that sleep that they are in a half awake zone. If you really don’t need to get up until the 3rd snooze time, set the alarm for that time. You will be more well rested so it will be easier to get up immediately. Train your body (or your kids) to get up at that time. After several days of an extra few minutes of sleep, you’ll notice the difference!
Kids sleep alone.
Keep kids out of the parent bed so everyone gets the best sleep. Snoring, different bedtime, and other body movements makes it hard to sleep together. No one sleeps well, which makes everyone grumpy the next day.
Pets can either help an anxious child calm down and sleep or can keep kids awake. Know the situation and act accordingly.
If pets make noise or try to wake their person, they should not be in the bedroom at night.
If the pet is quiet and lets kids sleep, they can provide reassurance to a child who doesn’t like being alone. But be sure they don’t wake the child!
Melatonin is a hormone that’s made in our body and helps us feel tired. It’s also available as a supplement. I think that if other sleep techniques fail it can be a great sleep aid, but I also think that if you’re going to give it to your child you should talk to his physician first.
Dr. Craig Canapari is a pediatric sleep expert who has written a great deal on how melatonin works, when it would be appropriate to try it, what concerns there are regarding melatonin, and more. Check out his Melatonin Guide for Parents.
Don’t be fooled with hidden sources of caffeine. I have occasionally gotten ice cream with coffee for a family bedtime treat, only to find out upon tasting it that it had coffee. Caffeine is often added to drinks, so read labels. But be careful! It might not say caffeine directly. Some are labeled as “guarana” — a plant with caffeine. Pretty much anything that is labeled as an energy drink (or food) is a likely culprit. Even decaf coffee has a small amount. Chocolate naturally has caffeine… the darker the chocolate the higher the caffeine content. Some pain relievers and other medicines have caffeine.
Especially for those not accustomed to caffeine, it will disrupt sleep even if taken several hours before bedtime.
Teens do not get enough sleep. Most teens need 8.5-10 hours of sleep each night. Not 6 hours. Not even 8 hours. Most don’t get even close to meeting their needs and that’s a bigger deal than many realize. Sleep is very undervalued, but we need to prioritize it. Sleep deprived teens suffer from many physical and emotional problems.
Why don’t teens get enough sleep?
One of the most common reasons is that their biological clock (AKA circadian rhythm) makes it hard to fall asleep before 11 pm and school starts too early to allow them to sleep until 8 am, which would allow for 9 hours.
In addition to their circadian rhythm, some of their habits and activities can interfere with a healthy bedtime.
Screens are a big problem.
The light interferes with our natural melatonin rising. I regularly ask teens (and parents) to limit screen use for at least an hour before bedtime, but most teens say that’s impossible because they have to finish their homework at that time and they need their computer or tablet to do homework. If you can’t turn off the screen, at least use a program that limits the blue light that prevents the rise of melatonin. I personally use f.lux. (It’s free and works on PC, Mac, ipad, android, and Linux). I find that it really helps. (This is not a paid endorsement, just a personal statement.)
On a similar note, phones distract kids from what they’re doing, delaying falling asleep. It takes longer to finish homework when there are distractions from the phone. Kids often are tempted to check in one more time on all their social channels, which delays sleep time. And then friends who are still up will text to see who’s up (or who they can wake up).
Activities are too late.
I’m not talking about kids just out and about on a school night. I’m talking about regularly scheduled activities that otherwise help build a well rounded person. It’s not uncommon for activities to be scheduled to run until 9:30 or 10 on school nights for middle and high school aged kids. They get home and are hungry, need a shower, and are ramped up so not ready for sleep.
Activities start too early.
I know many kids who must be at school before school actually starts. Whether it’s band practice, church study groups, sports, or taking a missed test before school, they all interfere with sleeping in, which is what teens need.
School starts too early.
Most school districts around the country start school well before the recommended 8:30 earliest start time. School districts that have initiated later start times have shown improved test scores, fewer absences and tardies, less depression, improved athletic performance, and better graduation rates. Unfortunately, those schools are still in the minority.
Medical causes of sleep deprivation and fatigue can also occur.
If you suspect any of these, you should schedule a visit with your doctor.
Restless leg syndrome
Sleep apnea – pausing of breath, often associated with snoring
Medications that affect sleep cycles
Heartburn or acid reflux
Hormone imbalances, such as thyroid problems
Anemia, or low red blood cell counts
Nutrition: not eating enough, or eating foods that are not nutritious. If you eat foods that cause spikes in your blood sugar, as those sugars drop you feel fatigued.
Chronic pain conditions
Chronic sleep deprivation – I know this is counter-intuitive, but being tired can make it harder to sleep.
What happens with too little sleep?
Sleep deprivation can lead to many problems that are often not attributed to poor sleep, such as irritability, poor academic performance, accidents, obesity and more.
We all associate the teen years with angst, so we can easily attribute a teen’s moodiness to just being a teen. But being chronically tired can lead to emotional dysregulation. This will look like irritability, frustration and anger.
It has been well established that getting proper amounts of sleep can help with focus and learning. When our teens fail to get enough sleep, they often report problems with attention, memory, decision making, reaction time, and creativity. It’s no surprise that teens report problems paying attention to a lecture or trouble completing homework in a reasonable time with full accuracy. Grades can easily fall, which leads to anxiety and depression, which in turn leads to more moodiness and trouble sleeping.
Sleep deprivation mimics ADHD. Whenever I see a teen who wants to be evaluated for ADHD because of new loss of focus, falling grades, problems with behavior, or similar issues, I always look at sleep. Most often they don’t have ADHD if this is a new problem. They need more sleep, not a stimulant medication. You can’t put a band aide on a broken bone. Fix the problem, not the symptoms! (The same goes for a teen with ADHD who thinks the medicine that’s worked for years suddenly isn’t sufficient. Unless the medicine recently changed, they need sleep.)
Teens with chronic sleep deprivation are more likely to be accidentally injured.
Drowsy driving is comparable to drunk driving. Teens are at the highest risk for falling asleep at the wheel. Drowsy driving is the most likely to occur in the middle of the night (2-4 am), but also in mid-afternoon (3- 4pm) as teens drive home from school.
Athletes are more likely to be injured while playing their sport, so it is in the best interest of the team to let players sleep.
Teens with chronic sleep deprivation have been shown to participate in more risk taking behaviors, such as driving without a seatbelt, drinking alcohol, skipping the bike helmet and tobacco use.
Pros and Cons of later school start times for our economy
There are many temporary issues with changing school start times. Parents might have to find solutions to child care of younger kids if they rely on teens babysitting after school. New bus schedules need to be started. Sports programs will need to change practice times. After school job availabilities will change.
Despite these common arguments, economic analysis from the Brookings Institution shows that a one hour delay of school start times could lead to a $17,500 earnings gain for students, compared to a cost of $1,950 during the student’s school days.
Another study that presumed all students start school at 8:30, with a year-by-year economic effect. The study did not take into account other potential benefits of later school start times, such as decreased depression and obesity rates. They found an average annual gain of about $9.3 billion due to fewer automotive accidents, improved graduation rates, and other factors.
What can teens do to get more zzzz’s?
Go to bed when tired at night.
Fighting sleep initially will make it harder to go to sleep when you finally go to bed.
Attempt to follow a regular sleep schedule.
Going to bed and getting up at about the same time every day helps. While sleeping in on weekends can help repair a sleep deficit, it can make it harder to get to sleep Sunday night and getting sufficient sleep every night is better than just getting more sleep a few days/week. Try to sleep in no more than 2 hours past your school day wake up time.
Follow the same routine each night at bedtime.
Brush teeth, read a book or color, take a bath or shower — do whatever helps you wind down and relax. Repeating this every night can help your brain get ready for bed.
Nap to help make up missed sleep.
A short 15-20 minute nap after school can help revitalize the brain to get homework done. Just don’t sleep too long or it can interfere with bedtime.
Turn off the screens an hour before bedtime.
This includes tv, computer games, computer/tablet use for homework, and smartphones for socializing. Use night mode screen lighting and apps that dim the screen (like the f.lux app I mentioned above).
Avoid caffeine in the later afternoon.
The time it takes half of the caffeine to be removed from your body is 5-6 hours. Ideally teens would sleep and never drink caffeine, but I know that isn’t reality. Any caffeine in the later afternoon can make it harder to fall to sleep. Don’t forget “hidden” sources of caffeine, such as chocolate, energy bars, and workout supplements.
One interesting concept that has scientific backing (but goes against the “no caffeine after 3 pm” rule) is the coffee nap. Basically, you drink coffee then quickly nap for 15-20 minutes. Sodas and teas don’t work as well as coffee due to too much sugar and too little caffeine. The coffee nap has been shown to be more effective than either a nap or caffeine alone. Don’t do this often — use it at times you really need it. Don’t do this too late in the day or the caffeine will inhibit your regular night’s sleep.
Skip the snooze button.
Set your alarm for the last possible moment you can, which allows your body to get those extra minutes of sleep. If you need to get out of bed by 6:45, but set your alarm for 6:15 and hit snooze several times, you aren’t sleeping those 30 minutes. Set your alarm for 6:45!
Skip the late night studying.
Studying too late is ineffective. When the brain’s tired it won’t learn as well and you will make mistakes more readily. It takes a lot longer to get anything done when you’re tired. Go to bed and get up a little earlier to get the work finished if needed. Of course you should also look at your time management if this happens too often. Are you involved in too many activities? Do you work or volunteer too many hours? Did you waste too much time on tv, games, or socializing? Do you put off big projects until the last minute? Homework needs to take priority when you’re more alert in the afternoon and evening. If you have problems with this, talk to parents and teachers about what you can do.
If you lay awake for hours or wake frequently, try these techniques to help fall asleep:
listen to Weightless – music that’s been shown to help initiate sleep
If these fail, talk to your parents and doctor to help find a solution.
Charge your phone in another room.
Friends who decide to text in the middle of the night keep you from sleeping. Even phones on silent have blinking lights that can spark your curiosity. It’s too tempting to look at your social media apps one more time.
Don’t use the excuse that you need your phone as an alarm. Alarm clocks are cheap. Get one and put your phone elsewhere!
Use your bed for sleep only.
Stop doing homework in bed. Stop watching YouTube and Netflix in bed. Train your brain that your bed is where you sleep.
Exercise helps our bodies sleep better, but it should ideally be earlier in the day. Too close to bedtime (which is common with athletes and dancers) wires us up.
Get natural sunlight in the morning.
This helps to set your circadian rhythm.
Keep the bedroom cool and dark.
It is harder to sleep if the room is too warm or too bright. A fan can be used to circulate air.
Use blackout shades if needed.
Keep pets out of the bedroom.
Your animals might love you and you love them, but if they keep you up, it’s just not worth having them around at night.
Nicotine and alcohol affect sleep.
These should not be used by teens in an ideal world, but I know teens will not always follow the rules. Teens should know that if they are using nicotine or alcohol, their quality of sleep will be affected.
Nicotine is a stimulant (like caffeine), which leads to more time sleeping lightly and less time in deep sleep. And yes, vaping and chewing lead to this problem too, since it’s the nicotine that causes the problem.
Alcohol reduces the time it takes to fall asleep but it increases sleep disturbances in the second half of the night, often leading to early wakening. Alcohol relaxes muscles, which can lead to sleep apnea (often noted as snoring). Sleep apnea does not allow the body to have restful sleep. Alcohol is also a diuretic, which might increase the need to wake to go to the bathroom during the night.
We all need to prioritize sleep: for our kids and for ourselves. Our bodies and minds will thank us.