Every once in a while a parent will tell the nurse that they want the child out of the room to discuss an issue with the doctor privately. This is usually something they perceive as a negative thing for the child to hear. Some of the most common concerns are about the child’s weight or behaviors. Sometimes it relates to a change in the family dynamics, such as divorce or a parent having a significant illness.
Secrets should never be kept…
While I understand the parent’s intentions, I find this to be disruptive and counter productive. As much as I try to find an excuse to have a child leave, it is usually obvious that the nurse keeps them out longer than needed.
If we have the child leave the room, he knows something is up. We are talking about him.
But not sharing with him.
What could possibly be so bad that we won’t talk to him about it?
How do you feel when you suspect people are talking about you?
Why then should parents and doctors keep things from the child?
That doesn’t mean kids need to know everything.
We all know that as adults that we do shield our kids from things.
Kids do not need to know our financial worries. We can teach them financial responsibility without increasing their anxieties.
They do not need the burden of knowing about extramarital affairs. If there are problems in a relationship, they will know there are problems, but they do not need to know details.
I don’t think that kids need to know everything, but that doesn’t mean that we should make it obvious that we’re hiding something. Especially when it pertains to them.
What does the child know?
Any patient needs to know what the issues are so they can be addressed. This includes most kids.
My guess is most of these kids already know what the concerns are.
They may need help working on the concern or help adjusting to the home life situation.
If they are overweight, we need to talk about what they eat, how they exercise, and how they sleep.
When there are behavior problems, they need to give insight into how they feel and what leads to the behaviors.
Regardless of the issue, they need to be a part of the plan to fix the problems. If they aren’t on board, they won’t change their habits. I can talk about weight (or behavior, or drugs, or whatever the concern is) sensitively and in an age appropriate manner with the child. The kids at school are likely talking about it in a not-so-sensitive manner, so it’s best to not make it worse by secretly discussing it.
What if it really needs to be said?
If a parent really wants to let a physician know specific points without the child present, there are ways to do that without making the child feel left out.
Send in a letter or secure electronic message with your concerns before the appointment. Be sure it’s at least a few days before the appointment so the doctor has a chance to review it!
Schedule a consult appointment for just parents to come in without the child.
Call in advance to note your concerns so the physician can address it as needed during the visit.
Slip a note in with all the paperwork you’re turning in during check in so the physician can read it before coming into the room. Be sure whoever you give it to realizes it’s included with the standard paperwork so they can pass it on.
Don’t bring siblings to an appointment where you want to discuss a private matter with your child.
All of these help the physician know your concerns without blatantly kicking a child out to talk about something privately.
The Netflix series “13 Reasons Why” came in like a whirlwind last year. With it came increased thoughts and attempts of suicide. I’m worried that Season 2 will have a similar contagion effect this year. I’ve already heard from many teens that they plan on watching it. Last year I saw many teens significantly affected by Season 1, so it was on my radar to watch “some time soon.”
When my 15 year old said she wanted to watch it but needed me to unlock her Netflix restrictions to be able to view all maturity levels, I knew I had to watch it sooner rather than later.
It hit me hard.
I’m hoping we can all be more prepared this year to talk to our kids and teens about watching “13 Reasons Why” responsibly.
The show did a great job of getting me hooked. I binge watched most of the episodes over one weekend. I put off grocery shopping and other necessities. It was hard to stop watching despite the fact that it was hard to watch.
There was a lot of debate about whether or not Netflix was responsible in showing this series. The producers claimed they wanted to bring the issues to the forefront. Mental health experts argued that it sensationalized suicide. I can see both sides. It does bring the conversation to the forefront, but can also lead to increased feelings of depression and post traumatic stress.
I couldn’t stop thinking about it for several weeks. There was so much to process! And I’m a 40-something year old pediatrician mother of teens who has a lot of life experiences to help with the processing. I can’t imagine processing this as a teen. And for those who have a history of abuse, rape, or other traumatic life events, this series could really be traumatic to watch.
This blog was first attempted a year ago, but it was too fresh and I could not finish it. I went to it many times, but never could finish it. It’s been a year and now Season 2 is coming, so I thought I’d finally finish it it in anticipation of all the kids who will see the upcoming season.
What’s it about?
Season One was about a girl who committed suicide and left tapes to explain the 13 reasons why she did it. It left a number of issues unresolved, such as a victim dealing with rape, a shooting, a counselor who failed to help on an at-risk child, and more. Season Two is expected to tackle these issues based on the previews.
Depression is a significant problem. We do need to discuss it.
Between 10-15% of teenagers have some symptoms of depression at any given time. We need to recognize and address it better than we do. Less than a third of teens with depression get help, yet 80% of teens with depression can be successfully treated.
Schedule a visit that is dedicated to discuss depression if you’re worried about depression. If your teen has significant risks for suicide, take action immediately.
Again and again in Season 1 there are opportunities for the teens to talk to an adult, but they don’t, which is too often the case in real life. It’s not that parents don’t ask. They do.
In real life and in the show, parents offer to listen, but kids don’t talk. You can argue that parents should push harder, but that usually tunes teens out even more. Having teens fill out a standardized questionnaire can help identify problems that might be missed at home and school.
Open the conversation.
Conversation is desperately needed. Our kids are exposed to much more than we were.
The internet allows them to research just about anything – and they can find inappropriate things intentionally or accidentally.
Rumors spread much faster than they did when we were kids due to social media.
Our kids are at risk of being photographed in compromising situations more than we were in the days of bulky film cameras and when video recorders were not in everyone’s phone.
This show could be a great eye-opener for parents of teens. The first season depicted teens getting drunk, struggling with relationships, drug abuse, abusive relationships among family and friends, sexuality, bullying, and rape. Maybe parents already know these things happen, but don’t realize how it affects their kids. Watching shows like this with your teens can help to start the conversation.
Teens hear about and see this stuff so we as parents cannot shy away from it. Whether they go to public schools, private schools or religious affiliated schools, they are not in bubbles. These situations and topics affect them in real life.
Watching shows that tackle controversial topics together (or watching separately but discussing) helps open a needed conversation. They need help processing all the “stuff” they encounter at school and online.
For more on bullying and suicide, see this comprehensive summary from Drug Rehab.
Warning!
It might be risky for people who have been sexually assaulted or have experienced trauma of any sort to watch this series and shows like it. I have seen some teens who suffered from post traumatic stress reactions after watching Season 1.
If you struggle with a history of assault or abuse, cautiously watch it with someone you trust. Stop if viewing becomes uncomfortable.
Things to discuss.
Of course I haven’t watched Season 2 yet so I can’t comment specifically on it. Common Sense Media has a short video on things to know and once the shows are available online, they will have more.
Some things that can be discussed from Season 1:
Social Media
Social media is a theme throughout the series. Kids send messages that spread to everyone at school several times. Cyberbullying is real. It doesn’t go away when kids go home, which is historically a safe zone, but there are no longer safe zones for kids due to the internet.
In the first season, a picture that can easily be mistaken for something it isn’t is shown to friends to brag (inappropriately) about a sexual experience (that didn’t happen) is shared by a friend (with minimal resistance). This of course causes the girl in the picture to be thought of as a slut and the guy as cool. This slut label lasts for months despite the fact that it isn’t true. There are several discussion points here:
Talk to your kids about never sharing pictures or words online that could be hurtful or embarrassing to anyone. Ever.
Talking to adults
There is a consistent theme in season 1 of teens not wanting to talk to adults. I have teens of my own so I know this is an issue regardless of how often parents try to connect.
It is a normal phase of life, but kids need to know that it’s important to talk to a parent or another trusted adult if any significant issues arise. I always remind teens that their brains aren’t mature until the mid 20s, so if they need advice, they need to ask an adult. Even very smart and kind teens can give bad advice because they just don’t know yet what the best advice is.
Alcohol and drugs
Each party these characters attend has what appears to be every teen drinking alcohol. This normalizes the use of alcohol. There is talk of not drinking and driving, but it is still not responsible (or legal) use.
Talk about how Jessica goes from occasional use of alcohol to regular use, even at school, as a means to deal with her emotions. As she becomes more depressed, she attempts to self medicate with alcohol and marijuana. This is not a healthy way to treat depression.
Teens need to know there are many healthier options to have fun at a party and more effective ways to address any depressed feelings. I have written more on teens and alcohol previously.
There is much more written about how alcohol and drugs can increase the risk of suicide on Drug Rehab.
Accepting responsibility
Use some of the show’s examples to highlight how individual choices and actions make a difference.
Jessica’s actions restrict her from cheerleading. She blames the coach, but it is her behaviors that are causing the coach to make consequences.
When a minor accident caused a stop sign to be knocked down, it led to a more serious accident. By not calling the police when the stop sign was knocked down, they indirectly lead to the death of a friend. It didn’t seem like such a big deal but actions have consequences.
Guilt
After suicide, many friends and family members feel guilty, but people who are suffering from depression and suicidal thoughts need professional help. Friends and family members should show love and support, but they are not capable or trained to help sufficiently.
There is a general theme of girls being objectified and sexually harassed at school. There are few students who seem to realize the seriousness of this.
We need to open the discussion of how to treat others with respect, not objects.
Sexual consent
Sexual assault and consent is an often misunderstood topic. While rape can result in physical trauma, it does not always cause physical injury or involve brutality. Victims do not always have bruises or obvious physical symptoms.
In Season 1 we learn that Jessica was raped and didn’t even know it due to alcohol. There are many instances of rape where victims blame themselves for not saying no firmly enough or because they lead someone on.
Victims are often blamed for dressing suggestively or flirting too much.
People who have experienced sexual assault but have no physical trauma are less likely to report the incident to the authorities or to get proper healthcare related to the encounter. People who have had sexual assault are more likely to have symptoms that seem unrelated, such as headaches, chronic pain, difficulty sleeping, poor physical health, depression, and anxiety.
National Suicide Prevention Lifeline. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.
National Suicide Prevention Lifeline – 1-800-273-8255
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
Play catch
Go on a bike ride
Swim
Join a sports team
Play frisbee
Golf
Go bowling
Dance
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.
3. Depression
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
Extreme sensitivity
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.
6. Caffeine
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.
8. Insomnia
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.
The light emitted from televisions, computers, tablets, and smart phones trick our brains into staying awake.
When kids are on a screen up until bedtime, their brain is not yet ready to go to sleep. This leads them to stay up too late, which makes them too tired the following day.
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.
I tried to convey why it’s so important to get a proper diagnosis of learning and behavioral problems in my last blog, Labels – Why should my child be diagnosed? Today I’d like to explain what is done during the evaluation and who’s involved in testing and treatment. Primary care physicians are a great place to start with questions about how to evaluate and treat various concerns. After that where should you go?
Start with the pediatrician
Parents are sometimes surprised to learn that I treat ADHD, anxiety, and many other behavioral disorders. I see many kids every day with these issues. I enjoy watching as they learn to manage their behaviors and improve their executive functioning over the years. Even kids who really struggle in the early years can grow into confident and accomplished adults.
I often say that kids with ADHD are talented, smart and can do wonderful things. They have unique gifts.
There are some pediatricians who don’t treat these issues, but I find there’s a huge need. In many cases since I’ve followed a child for years, I know them well and can help better than a specialist who doesn’t have that history.
Despite plenty of experience, I do use specialists often.
Many learning and behavior problems have similar symptoms, so it might take several professionals to help evaluate the situation.
Of course the professionals at school are imperative to being part of the team. And there are times when the diagnosis isn’t clear or a child doesn’t respond to the treatment well, other specialists are very helpful to assess the issues.
There are tests available, such as EEG for ADHD, that are not shown to be beneficial and can increase cost without adding to the diagnostic evaluation.
There are many treatments that haven’t been shown to be effective but still advertise good results for a fee.
If it sounds too good to be true, it probably is. Discuss tests you are considering with your child’s doctor, especially if there is a large price tag attached.
Who’s who?
The alphabet soup of credentials confuses many parents. I’ve tried to compile a list of experts in various fields who might need to be involved in your child’s assessment and care as well as explain what types of things they can do to help in the process of evaluating and treating learning and behavior issues.
Parents
Parents (or primary caregivers) are critical to giving insight into how children learn and behave. They should be interviewed and fill out standardized questionnaires to help with the diagnosis. Their feedback on how each treatment is working is helpful in fine tuning treatment plans.
Teachers & Other School Professionals
Teachers are imperative in helping assess the issues and concerns since they can compare any one child to a room of their peers and they know how your child handles various situations and what their typical behaviors are.
Many schools will have a school counselor or psychologist evaluate and help treat students.
Teachers with advanced background in learning disabilities are used to help address specific concerns.
It’s recommended that each teacher fill out standardized questionnaires to help with the initial evaluation of focus and behavior disorders and again to assess responses to treatments.
Schools may put students on IEP or 504 Plans to help with their education. For more on these see IEP & 504 Plan.
Therapists (not mental health)
Physical Therapists, Occupational Therapists, Audiologists, and Speech Therapists can be school based or private, but they are helpful in addressing specific motor skills, sensory issues, hearing issues, or speech/language concerns.
They do not prescribe medication, but work within their area to improve certain skills that affect learning and behavior.
Check with your insurance to see what is covered in your plan. Ask the school if they offer any of these services.
Mental health specialists
Psychologists (clinical psychologists, cognitive psychologists, educational psychologists and neuropsychologists) and clinical social workers offer testing as well as therapy for many disorders.
Some therapists specialize in testing, others in treating. Some do both. You will have to ask what their qualifications are and what role they play in diagnosis and management.
Clinical therapists can do parent training to help parents manage behaviors at home, especially for younger children.
Therapists cannot prescribe medications, but some people find that the therapy provides enough benefit that medication is not needed or that the therapy in addition to medicine helps better than either treatment alone.
Cognitive behavioral therapy is the preferred first line treatment for certain disorders, such as ADHD in young children and anxiety.
Therapists often provide social skills training, which is needed for many children with behavioral and learning issues who don’t learn social skills as easily as their peers.
You should check your insurance list of providers to see who is covered. It also might be worth pricing some who do not take your insurance but will give you a bill to submit yourself. If a person is out of network your cost might be about the same as a person who is harder to get in to see but on your plan.
I find the searchable database from Psychology Today to be helpful. You start with your zip code, then you can choose insurance, issues needed, male or female providers, and more to limit your list of suggested therapists.
Physicians
Physicians (pediatrician, family physician, developmental pediatrician, neurologist, and psychiatrist) can make a diagnosis and prescribe medications for treatment of certain diagnoses, such as ADHD or anxiety.
Not all have experience with each of these issues so you must ask what their experience is.
It can take quite a while to get into specialists and they can be expensive, so starting with your primary care physician often is easier and very helpful to rule out medical issues and to do the evaluation and treatment if they are comfortable.
Many psychiatrists do not accept insurance and they are typically difficult to get in to see.
Physicians (including psychiatrists) generally do not do therapy. They focus on the medication benefits and side effects. Therapy along with medication often improves outcome, so multiple specialists working together can be beneficial.
Physician-extenders
Nurse practitioners and physician assistants can work with physicians to diagnose disorders and prescribe medications to treat them. In some states they can work independently.
They do not offer psychotherapy, so it is often beneficial to work with more than one person to get the best outcome.
Benefits include that they are generally easier to get in to see and they are relatively inexpensive compared to physicians. Not all are comfortable with treating these issues. Ask about training and experience.
Working as a team
The types of professionals who work with any given child to assist in diagnosis and treatment vary depending on the issues at hand. The most important thing is that they work as a team and communicate with one another.
This communication is often done through parents and written reports. It’s important that all members of the team have access to what the others are doing.
Looking for more?
Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!
ADHD
CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!
New in Fall 2018: ADHDKCTeen – a group just for teens with ADHD (and anxiety, learning difference, and anyone else who thinks it will help them).
Anxiety
Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.
Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.
Learning Disabilities
Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.
Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.
Midwest ADHD Conference – April 2018
Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.
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.)
Phones.
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.
Anxiety
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
Depression
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.
Infections
Celiac disease
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.
Moodiness.
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.
School problems.
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.)
Injuries.
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.
Risky behaviors.
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.
Coffee nap?
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
coloring
journaling
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.
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.
