How to address sleep trouble in children

While sleep is being recognised as an important factor in maintaining the health and well-being of a person, the community of sleep says that sleep patterns change according to age. Experts agree that sleep problems in kids needs to be addressed in different ways and it has to begin with understanding the reasons affecting their sleep daily.

Dr Shantanu Tandon, senior consultant, ENT, Sakra World Hospital categorically said, “In youngsters and adolescents, the problem of sleep arises from the devices they use. They stay as long as possible with devices and that is where the trouble kicks in. They don’t give importance to sleep and rather prioritise what they watch on the OTT platforms.”

A report, ‘health behaviour in school-aged children (HBSC)’ published in 2014 by the University of Hertfordshire, Hatfield, is a cross-national research study conducted in collaboration with the World Health Organisation (WHO) Regional Office for Europe. HBSC is the longest-running international study focusing on the health behaviours and social context of young people. 5,335 young people aged 11, 13, and 15 years participated in the 2014 HBSC cycle for England. The report demonstrated that, for 15-year-olds in England, 30 percent of boys and 49 percent of girls reported experiencing sleeping difficulties. Thirty-six percent of 15-year-olds reported not having enough sleep to be able to concentrate on schoolwork. Poor sleep in adolescents and young adults can result in longer-term sleep problems, which may impact them in adulthood.

The Sleep Health Foundation is a not-for-profit health promotion charity that aims to raise community awareness about the value of sleep and its common disorders and to improve public health and safety. They say on weekends, about 90 percent of teenagers go to bed later, and then sleep in longer. This can be okay if they do not change their weekend bedtimes by too much (no more than two hours). However, about 40 percent of teenagers go to bed two or more hours later on weekends. This raises their chances of getting less than eight hours of sleep on school nights.

Dr Tandon said, “Adolescents who are not giving importance to sleep have made it a habitual practice. But, in youngsters, the trouble sleeping might also be because of frequent allergies, nose blockages, etc. We get to know these signs in 14- to 22-year-olds when they show irritable behaviour throughout the day after parents receive feedback from schools or colleges. This age group lacks focus, and they need to get a minimum of seven hours of sleep.”

Age-wise sleep trouble explained

Dr Sujatha Thyagarajan, senior consultant and lead, paediatric intensive care unit (PICU), Aster RV Hospital said, “In the first one to two years, having a proper sleep routine is a challenge. A two- to three-year-old might get night terrors which we call ‘bad dreams.’ Children above three have poor sleep routines due to huge tonsils, adenoids and wheezing.”

Thyagarajan pointed out the warning signs parents can look out for. “Difficulty falling asleep, poor sleep-wake cycle, no sleep routines, snoring and breathing difficulties, bed-wetting especially in children over the age of five, nodding off during the daytime, poor concentration, excessive irritability during daytime are all the signs parents can be cautious about,” she said.

Medically treating Sleep-Disorders in Children

Dr Tandon said there are many ways to address sleep problems in children.

“Firstly, we need to identify if there are any obstructive problems. Then doctors could advise sleeping devices. Medicines can be given, but they can only reduce the quality of sleep. There are also allergies that could lead to poor sleep. Experts can conduct allergy tests to find out the cause. After that, the child will be advised modifications to the local environment. If there is a problem like a deviated septum (of the nose), then a minor surgical procedure will help deal with this issue,” he said.

Lifestyle issues affecting sleep in youngsters

“Setting a good sleep routine is vital for a child from a very young age. For infants, essential night-time feeding, changing diapers and maintaining darkness will help. Remember to keep it dull and boring at night – no unnecessary entertainment at night. For older kids, timely family meals, bath and toilet, bedtime stories, limited noise and lighting are important. Avoid extra fluids after 7-8 pm to enable good sleep. Also, avoid late-night meals and gadgets in bed,” pointed out Dr Thyagarajan.

What do paediatric sleep specialists say?

Dr Srikanta J T, paediatric interventional pulmonologist and sleep medicine, Aster CMI Hospital, Bengaluru, said, “A common reason (for poor sleep) in children is obstructive sleep apnea. This can include adenotonsillar hypertrophy (the unusual growth of the nasopharyngeal tonsil) and allergic rhinitis (a form of allergy which can be either seasonal or perennial affecting the nose). In adolescents and adults, it can be due to drinking caffeinated beverages late in the evening or night, alcohol consumption, smoking, excessive screen viewing, obesity, allergic rhinitis and more.”

Family support for children makes a big difference.

Dr Nandana Bala, consultant, paediatric pulmonology and allergy, Rainbow Children’s Hospital, Bengaluru, said, “Gadget-free hours before sleep time is a good starting point. Family activities that are calming in nature are a great way to bond together and end the day positively. A simple example of a night routine could be as follows: a homely early family dinner with the whole family sitting together, with no devices. Everyone discusses how their day has been and ends by sharing what was good about the day. The children can then have a dental-hygiene routine followed by story reading for young children. These should be calm bedtime stories. Older children can read a little before bedtime. Some families like to do meditation or yoga together.”

Reach out to doctors

“A detailed history of sleep routines, sleep-wake cycle, general condition of the child and physical examination to determine if there is any cause for possible sleeping difficulties is essential,” noted Dr Thyagarajan. “If causes are due to illnesses that are identified, then the youngsters need to be referred to relevant specialists such as pediatric pulmonologists who will assess their sleep, heart rate, oxygen saturation, breathing rate, etc. If necessary, children are referred to paediatric ENT doctors to consider adenotonsillectomy (surgery to remove the adenoid glands).