Marc Weissbluth's Blog, page 11

Sleep quality, cortisol levels, and behavioral regulation in toddlers.

From Developmental Psychobiology. 52(1); 44-53, 2010.

            Children aged 12-36 months with more fragmented sleep compared to children with fewer awakenings during  sleep displayed higher cortisol level upon awakinings.  High cortisol levels indicate more stress or arousal. 

            These children with elevated cortisol levels upon awakening showed more internalizing behaviors and negative emotionality.

            Therefore, creating or maintaining a night waking habit (for example, by comforting your child at night when your child needs to be asleep or allowing the bedtime to be too late) has predictable biologic and psychological consequences.

Marc

Filed under: Healthy Sleep

Friday Parenting Myth #7

A few weeks ago, I wrote a "myth" about how some people think the flu vaccine casues the flu and one of our readers, Andrea, thought we should do more debunking on vaccines. I asked one of our colleagues, Dr. Scott Goldstein to guest write in this myth. Enjoy!- Daniel Weissbluth

His area of expertise is vaccinations and so here is his "myth":

Myth – Vaccines Are Not "Safe"

Nothing in life is without risk. Every year, people are harmed in unusual and unlikely ways (like slipping on a wet floor, or being struck by lightning). If we define something as "safe" if it is 100% free from danger, then nothing would be safe. While it is difficult to prove that a very rare event that happens after a vaccine (like having seizure or developing a muscle weakness) is due to the vaccine, it is possible that in a very small minority of cases vaccines can cause unusual side effects. There have been cases where vaccines have been directly linked to rare but serious side effects, and in those cases the vaccine responsible has been immediately removed from public use.

If a child does not get a vaccine, their risk of getting the disease the vaccine prevents is much, much higher than any possible risk from getting the vaccine. No vaccine causes death, but every disease that vaccines prevent can.

Every year, 28 people get attacked by sharks, but 4.5 million get bit by dogs. 300 people die in plane crashes, but 34,000 die in auto accidents. Despite this, most of us fear sharks and planes much more than dogs and cars. Fear of extremely rare side effects from vaccines may lead to the much more real possibility of children getting vaccine-preventable diseases.

Both the government and vaccine manufacturers are constantly monitoring reports sent in by health professionals and parents regarding possible issues with vaccine safety. Even vaccines that have been around for decades are constantly being monitored. Vaccines are the safest way to prevent your child from some of the most serious types of illnesses.

Sources : www.cdc.gov/vaccinesafety

www.aap.org/immunization/families/saf...

www.vaers.hhs.gov

Filed under: Common Myths

Success Stories: 7-12 Months

Many parents successfully get their child sleeping through the night and on a good nap schedule and then hit some major "speedbumps" during the second half of the first year. Oftentimes, getting their child back on a healthy schedule seems daunting- we were hoping some of our readers could share their stories of successful attempts at extinction or resetting their child's nap schedule in this age range. Did any of our readers struggle with a nap transition from three naps to two naps a day?

- Marc and Dan

Healthy Sleep Habits, Happy Child

Weissbluth Method Infant Nap App 0-12mos.for iPhones/iPod/iPad

Weissbluth Method Toddler Bedtime App 12-36 mos.

Filed under: success stories

Friday Parenting Myth #6

Myth: Co-sleeping is safe.

"Co-sleeping" is when a parent and baby sleep side by side in the bed together. This term is not to be confused with bassinets that latch onto the sides of the bed and are commonly sold as "co-sleepers." "Co-sleepers" have an actual barrier between the sleeping infant and the sleeping parent.

Co-sleeping or "bed sharing" causes a lot of controversy. Some parents share a bed with their infant because of their cultural or familial beliefs. Other parents co-sleep because they believe it to be more convenient for breast feeding and creating a stronger parent-infant bond. The American Academy of Pediatrics states, "Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep." One study stated a 20 fold increase in risk of suffocation in infants that sleep in adult beds instead of in cribs.

So why does the American Academy of Pediatrics recommend against co-sleeping? The risks of co-sleeping are two-fold: there is the sleep environment and then there is the parent. The sleep environment in adult beds, chairs, and sofas usually includes duvets, pillows, covers, softer cushions/mattresses, and stuffed animals: all of which present a suffocation risk to the infant. For this same reason, when parents put children in a crib or bassinet, pediatricians advise them against using bumpers or "positioners."

The additional suffocation risk comes from the parent who may accidentally roll on top of their infant. Some have argued that if a parent is not "impaired" (drugs or alcohol), that this is a negligible factor. However, no expectant parent fully appreciates the level of sleep deprivation that comes with a new baby. This exhaustion (combined with the maternal relaxation that accompanies breastfeeding) does "impair the parent" and becomes a risk to the infant.

In conclusion, know you're ABCs of safe sleep!

Alone –no cosleeping

Back – baby needs to sleep on their back

Crib- no blankets, pillows, stuffed animals, bumpers, or positioners

References:

Scheer, N.J. G.W Rutherford, and J.S Kemp 2003. Where should infants sleep? A comparison or risk fro suffocation of infants sleeping in cribs, adult beds, and other sleeping locations. Pediatrics 112 (4): 883-889.

American Academy of Pediatrics Policy Statement: The changing concepts of Sudden Infant Death Syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 116 (5): 1249-1255.

Filed under: Common Myths

How Much Sleep Do We Need and the Regulation of Sleep

(Adapted from Science: 325:825, 2009)

Sleep and Wakefulness are controlled by two interacting processes which are each independently regulated and under genetic control. It's messy and complex but I will try to give you an overview so that you better understand why you should never compare children. The bottom line is that sleep, like height and weight, is highly inherited.

1. Circadian Process

This sets the timing of sleep onset and offset. The biologic times of drowsiness and awakening are controlled by this internal clock.

There are individual differences among adults and children.

2. Homeostatic Process

This tracks sleep need and forms the genetic basis for how long we sleep (sleep need). If we get shorter and shorter on sleep, we feel more pressure (drowsiness, sleepiness) to get sleep. It's like feeling more and more thirsty as we become more dehydrated. But there is a catch. Sleep loss is primarily recovered by increasing sleep intensity (deep or slow wave sleep) and not necessarily by sleep duration. Maybe shorter periods of intense sleep can be more restorative than longer periods of light sleep or fragmented sleep. That's why sleep quality (intensity, consolidation, and in phase with circadian rhythms) is more important than just sleep duration.

There are individual differences among adults and children.

The developmental pace of these two processes is not the same in all children as any parent of fraternal twins knows! So don't compare children and be PATIENT. Some children will sleep longer and easier than others at any given age.

Our goal is to have well rested families. But, always remember, the amount of sleep we need and the amount of sleep our children need is measured by mood, behavior, and performance…not hours by a clock.

Marc

Filed under: Healthy Sleep

Friday Parenting Myth #5

Myth: "Educational Media" will make my child smarter.

This myth preys on the natural desire for parents to see their children succeed. Constantly, parents are being told that certain mobiles, baby carriers, books, and toys will give their child an intellectual edge. Additionally, there are educational DVDs, mobile Apps, computer games etc… The combination of parental anxiety and the competition for good schools can make families susceptible to marketing.

One might think, "Well, even though this might just be marketing, it is not doing any harm to my child." There has been some studies that show that educational media, especially before the age of two, is associated with language delay. Even though some researchers dispute these findings, the American Academy of Pediatricians recommends no "screen time" prior to the age of two ("Screen time" includes television, DVDs, video games, smart phones, and tablets).

One important idea to consider when it comes to media and development is called the "displacement effect." There are only twenty-four hours in a day and time spent in front of a screen "displaces" the time interacting with parents, the environment, or sleeping-all three which have been proven to be beneficial to cognitive development. So the question to the parent is: "Digital media may or may not be beneficial and it does have the potential to be harmful via displacement of sleep and parental and peer interaction so why take the chance?"

-Daniel Weissbluth

References:

Thakkar, R. R., M. M. Garrison, and D.A Christakis 2006. A systematic review for the effects of television viewing by infants and preschoolers. Pediatrics 118 (5): 2025-31.

Zimmerman, FJ., D.A Christakis, and A.N. Meltzoff. 2007. Television and DVD/video viewing in children younger than 2 years. Archives of Pediatrics and Adolescent Medicine 161 (5): 473-79.

Filed under: Common Myths

Success Stories 0-6 Months.

We understand that new parents can encounter all types of challenges in the first 6 months of life while attempting to create healthy sleep habits for their infant. Additionally, some of the advice not only in "Healthy Sleep Habits, Happy Child" but in this blog may seem hard to implement.

To encourage families new to some of these concepts, we were wondering if any of our readers wanted to briefly share their "success stories" while using this "method" and seeing positive results.

- Marc and Dan

Healthy Sleep Habits, Happy Child

Weissbluth Method Infant Nap App 0-12mos.for iPhones/iPod/iPad

Weissbluth Method Toddler Bedtime App 12-36 mos.

Filed under: success stories

REPOST: HAS PARENTING CHANGED?

Has Parenting Changed?

By weissbluthmethod

When I talk to groups of parents about sleep, some parents state that it is more difficult today to be a parent than in the past. I do not know if this is true but I would like your input on how new challenges today might interact with sleep issues. Here are some observations to kick-start the discussion:

1. There is parenting information overload. With so much information and so many choices, who are you going to believe? Does this lead to a paralysis so that decisions regarding when or how to do sleep training get postponed?

2. More women are working outside the home, more men are working from home or are stay at home dads, and there is more day care and nanny care. How does this effect children's sleep?

3. Are parents more anxious or fearful regarding the health or safety of their children, either because of a real increase in potential harm or world-wide instantaneous media magnification of risk. More anxiety might cause parents to not want to let them cry to sleep better because they fear that crying might harm their baby.

4. Are parents more intrusive/directive/controlling (hovering helicopter parents) because they are competitive for their children so they want to schedule many social or skill building activities which might interfere with healthy sleep habits? Is competitiveness simply another form of anxiety; that is, "I am anxious about the successes of my child."

5. Are parents more anxious or fearful regarding the social, athletic, and academic successes of their children?

Is there any good data to support any of these observations? Please share with us your own observations?

6. As reported in the Wall St. Journal, July 9, "The Divorce Generation," half of all marriages ended in divorce during the 1970′s. The children of these families are now "orphans as parents." …"Call us helicopter parents, call us neurotically attached, but those of us who survived the wreckage of split families were determined never to inflict such wounds on our children…We hadn't slept in the same room for at least two years, a side effect of the nighttime musical bed routine…"

Your thoughts.

Marc

Filed under: Barriers to Sleep Solutions

Friday Parenting Myth #4

Last week, we had a great response to our colic post so I thought this week's parenting myth should address this issue- Enjoy!- Daniel Weissbluth

Myth: You can buy a cure for "colic"

Historically, colic has been attributed to: allergies, lactose intolerance, intestinal cramping, and maternal anxiety. The actual cause is unknown but Wessel's commonly accepted definition of colic is "crying for more than 3 hours/day, for more than 3 days/week, and for more than 3 weeks." It is a very common complaint in the pediatric office because colic affects about 20% of infants. Because, the parents often times are frustrated with conventional approaches, they start to look for alternative therapies for colic. There are infant "gas" drops (aka simethicone or mylicon), gripe water, probiotic supplements, sucrose solutions for the baby, different formulas marketed specifically for colic, herbal teas for breastfeeding mothers, and chiropractic manipulation for babies. Unfortunately, none of these interventions has been proven to work. There simply is not enough evidence to support these marketing claims.

To prove these treatments are effective, investigators look at studies to see if the children being treated with one of these interventions do significantly better than the "control" group who have often received no treatment or a placebo. This type of study is called a RCT: Randomized (and double blind and placebo controlled) Clinical Trial and this study is considered the gold standard by many doctors when looking at treatments.

In practice, many pediatricians would not forbid parents from trying these alternative treatments because, for the most part, they are not harmful to the baby. However, for every parent that swears that one of these treatments "cured" their baby's colic, there is another parent who thought the treatment was a waste of time and money.

References:

Garrison M, Christakis D. A systematic review of treatment for infant colic. Pediatrics. 2000;106 (1pt 2): 184-190

Perry R, Hunt K, Ernst E. Nutritional supplements and other complementary medicines for infantile colic: A systematic review. Pediatrics. 2011; 127: 720-733

Filed under: Common Myths

Questions and Comments: 9-12 Months Old

Due to the difficulties of our readers in asking and answering each other's comments, we are going to create posts which separate sleep forums by age. Because there are so many questions, we ask that the reader states these items prior to each question:

1. Age of child (corrected age if born before due date)

2. Self-soothing skills: Yes or No?

3. Colic: yes or no?

4. Bedtime and nap time

5. Time required to soothe for bedtime and naps.

After answering these items, please try to create a brief narrative (~300 words max) that describes your problem- the long questions make the forums difficult to load and access by not only us but also the other readers. We believe that these changes will benefit all of the readers on the blog. We also added a category called "Questions and comments" on the sidebar.

Thanks, Marc and Dan Weissbluth

Healthy Sleep Habits, Happy Child

Weissbluth Method Infant Nap App 0-12mos.for iPhones/iPod/iPad

Weissbluth Method Toddler Bedtime App 12-36 mos.

Filed under: Questions and Comments