What Can Improve Sleep Hygiene in Children, Adolescents?

In addressing sleep-related challenges prior to and influenced by the coronavirus disease 2019 (COVID-19) pandemic, a study published today in JAMA Pediatrics outlines factors that contribute to optimal sleep hygiene among children and adolescents.

The authors, from the University of Florida College of Medicine in Gainesville, sought to provide the latest research and guidelines to help parents in adjusting sleep schedules for their children, especially amid COVID-19 pandemic. As they note, the pandemic has significantly altered normal sleep patterns for children and teenagers.

Speaking on the importance of sleep, the researchers highlighted that if children and teenagers do not receive their recommended duration, they can be irritable and undergo behavioral changes, attention difficulties, and memory problems. According to a prior study, these behavioral issues may impact their school performance, as well as their physical and mental health.

Based on recommendations from the American Academy of Sleep Medicine, sleep duration need varies among children and adolescents, by age:

• For those aged 3 to 5 years, guidelines recommend 10 to 13 hours
• For those aged 6 to 12 years, guidelines recommend 9 to 12 hours
• For those aged 13 to 18 years, guidelines recommend 8 to 10 hours

To assess whether sleep may be impaired, the researchers say to look for signs, such as difficulty getting up in the morning, falling asleep during the day (outside the appropriate napping age), longer weekend sleep, yawning, or poor behavior.

If impaired, how can parents improve sleep hygiene for their children?

As a first step, the researchers say to establish a daily routine for all family members, with set times for waking up, meals, school or work, recreation, and bed. “School-aged children and adolescents can help create their schedules, but parents must provide healthy boundaries,” said the study authors.

Next, a consistent evening routine characterized by a regular bedtime was touted, as was avoiding caffeinated drinks and technology usage. In fact, the researchers say that electronic devices should be removed from the child’s room at night because of the blue light that stimulates wakefulness.

After-bedtime snacks and drinks were also noted to stimulate wakefulness. “Finally, keep sleep spaces dark and cool, but a night-light is OK," the authors said.

Depending on the severity of a child’s sleep hygiene, the researchers said that it may take a few weeks to gradually transition to earlier bed and rise times as it's easier to stay up later than to go to sleep earlier.

“Set [an] awake-time goal, and gradually move bedtime earlier by 10 minutes every 3 to 4 days. Once a child can fall asleep within 30 minutes of bedtime, move bedtime 10 minutes earlier the next night.”

As a child continues to adhere to new bedtime routines, the researchers say to move up wake time and to avoid napping if possible, with a limit of 20 minutes if needed.

Additional recommendations include using light-blocking shades to make the bedroom dark, using a fan or air conditioner to keep the bedroom cool, reading a calming story before bedtime, and if thirsty, drinking a small glass of water.

If these recommendations do not help to improve a child’s sleep-wake schedule or if behaviors such as snoring, gasping, kicking, or sleeping too much are observed, the researchers say that these could be signs of a different health issue.

“Adjusting sleep schedules can be challenging at first and will take time to implement,” they note. “Sleep is a critical part of health for children and adolescents, so make sleep a consistent priority and your child will benefit from this for years to come.”

Reference

Stern M, Wagner MH, Thompson LA. Current and COVID-19 challenges with childhood and adolescent sleep. JAMA Pediatr. Published online September 28, 2020. doi:10.1001/jamapediatrics.2020.2784