Category Archives: Health tips

5 tips for home and neighborhood safety

Summer is around the corner, we promise. A steady helping of the warm weather isn’t far away.

The season brings neighbors together for all kinds of outdoor activities. While your local barbecue or block party is a great time to reconnect with neighbors and enjoy a potluck, it’s also a great chance to review home and neighborhood safety tips with your children.

Here are five tips to bring up with your kids ahead of summer:

1. Post important personal and contact information in a central place in your home.

  • Include parents’ names, street address, mobile, home and work phone numbers, 911, poison control, fire department, police department, and helpful neighbors.
  • Use a neighborhood party to help children to familiarize themselves with their neighbors and identify whom they can go to for help.

2. Teach your child how and when to call 911.

  • Discuss specifics of what an emergency is and when 911 should be used.
  • Role play different scenarios and make sure kids know what information to give to the 911 operator.
  • For younger kids, discuss the different roles of emergency workers and what they do.

3. Discuss “stranger danger.”

  • Talk with your kids about who is allowed to pick them up from school or activities.
  • Talk to your kids about the importance of walking in pairs.
  • Ensure they always take the same route home from school and do not take shortcuts.

4. Practice proper street safety.

  • Have kids practice looking both ways before stepping into the street, using the crosswalk and obeying the walk-don’t walk signals.
  • Teach kids what different road signs mean, such as a stop sign.
  • Remind children about the importance of biking with a helmet and reflective light.

5. Talk to your children about fire safety.

  • If fire trucks are present at the neighborhood party, use their presence as an opportunity to discuss what to do if there were a fire.
  • Plan and practice escape routes in your home and designate a meeting spot in case you get separated.

It’s never too early to talk to your children and family about ways to stay safe.

Advice for first-time marathoners from Coach Antonio Vega

Coach Antonio Vega of Zoom Performance will guide Team Superstars with an online training plan, weekly training tips and two group runs and presentations. (Photo courtesy of Antonio Vega)

Coach Antonio Vega of Zoom Performance will guide Team Superstars with an online training plan, weekly training tips and two group runs and presentations. (Photo courtesy of Antonio Vega)

Earlier this year, we launched our first-ever charity endurance program. With Coach Antonio Vega’s help, Children’s Team Superstars will participate in the Medtronic Twin Cities Marathon in 2015. Because many of our runners will be lining up for 26.2 miles for the first time, we asked Antonio a few questions.

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RELATED: Add a Children’s race to your calendar

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How do you start training for your first marathon?

Starting to train is always the hardest part of training. Keeping yourself accountable and motivated can be challenging when starting to train for a marathon. The best way to get started is to make a schedule of days and times when you will dedicate time to getting your run in. Find a friend who is willing to keep you company during your training. Keep your running fun by finding new places to run, join a running club or meeting a group of friends for a run and then going out for brunch, post-run.

Do you recommend doing any races while training and gearing up for a marathon?

Racing during marathon training is a great way to break up the monotony of training, and it’s a good time to gauge your fitness. I recommend adding in a couple of 5Ks and 10Ks before the marathon.

What is the best cross training?

Cross training is a great way to give your body additional time for recovery while still working your aerobic system. Any form of cross training that you enjoy is a value toward your marathon training.

What do you recommend for fueling before, during and after training runs?

Fueling can be one of the most important aspects of your marathon training. Having a good meal about two hours before a run is important. Keep with foods that you are used to and sit well in your stomach. During training runs, practice taking fluids and some form of nutrition. With the athletes with whom I work, we use a diluted sports drink and a gel during long runs. Post-run, it is just as important to replenish the calories that you lost during your long run. A 16-ounce glass of chocolate milk has the right balance of fats to protein and is a great way to replenish the calories you lost.

subscribe_blogTo stretch or not to stretch before and after runs?

I like to stretch after doing a run. This allows me to focus on areas that were tight during my run. I find that before doing a run I like to do more of a dynamic warm-up. A dynamic warm-up is a way to get your heart rate up and stretch out the muscles that you will be using during your run.

What is normal pain versus bad pain while running?

It is always tough to determine what is considered pain and what is just regular training soreness. My rule of thumb is if you start running and the pain starts to go away the more you warm up, this is usually a sign of training soreness. Training soreness is to be expected and not something to worry too much about. However, if you start to run and the pain stays the same or gets worse the more you run this can be the start of an injury, and it might be wise to take some time off.

There’s still time! Join Team Superstars by contacting Brady Gervais at [email protected] today!

The importance of play — for kids and adults

Hands-on play, where a child uses his or her imagination and ideas to self-discover, creates the best learning environment. (iStock photo / Getty Images)

Jeri Kayser

When people try and remember the name of my profession, child life specialist, they often shorten it to “play lady.” That used to bug me when I was a young professional and ready to solve all of the world’s problems, but now I recognize the compliment. We breathe, drink and eat to stay alive – we play to bring forth a reason for all of that effort. Play is how we learn about our world, practice that knowledge and foster our sense of well-being and personal joy; it’s an honor to promote play in the world of health care, but it’s not without its challenges.

One current challenge is tied to the hot topic in popular culture about the value of gaming devices. Is playing a game on a smartphone when you’re 2 years old considered quality play? Short answer: No. The Academy of Pediatrics recommends no screen time for kids 2 and younger and only one to two hours a day for older children. The core aspect of the definition of “play” is that it’s self-directive. You’re deciding what you’re going to do with whatever you’re interacting with. One of the problems with electronic games is that game designers have done most of that for you.

Your toddler recognizes the status that phone holds, and it works for a bit to keep a child distracted from the fact that he or she is in the hospital or in a long checkout line at the grocery store.

subscribe_blogSo what can we use to help guide our decisions to promote healthy play? A great way to look at this is similar to how we all work to promote healthy choices for our diet. Potato chips are fine for an occasional treat, but we wouldn’t want to eat them all the time. If we did, we’d feel awful. Video games kind of are the junk food of play. The more the play requires from the child, the better the value and healthier the choice.

I notice this in the hospital when I come into a room to meet with a family about what to expect with surgery. People often are busy with an electronic device, but as soon as we start to talk, the interest is there to engage and the devices get turned off. When I bring a toy or some arts and crafts activities, kids always gravitate towards that; they want what they need.

I used to work in a summer daycare program for school-aged kids. We would spend the morning on a field trip and the afternoon at a beach. The director wanted us to provide structured activities for the kids in the afternoon, but we quickly learned that the combination of water, sand and friends led to a more-creative, imaginative and enriched play than anything with which we could have come up. Hands-on play, where a child uses his or her imagination and ideas to self-discover, creates the best learning environment.

I heard an interesting story on public radio on my long commute home. At the electronic show in Austin, Texas, at the South by Southwest conference, the big news at the conference was the “Maker Movement,” stressing the importance of hands-on play to promote understanding of how our world works. They interviewed an inventor, Ayah Bdeir, who created a toy of electronic bits that fit together with magnets, creating circuits. With this process, you can make all kinds of fun things. He explained the value of this explorative play by stating, “We need to remember that we are all makers and touching things with our hands is powerful and inspiring.”

In another century, another scientist noted the same thing. Albert Einstein declared, “Play is the highest form of research.”

Self-directed play offers the healthiest value for our play “diet,” and this extends throughout our lives. We all need to play. As I wrote this, I overheard a conversation between two anesthesiologists talking about how they used play to help them cope with life stressors. One likes his guitar, while the other enjoys making remote-control helicopters.

This important fact, one of the highest forms of self-care, needs to be part of the planning of how we provide health care. Play is important for all age groups, not just those adorable preschoolers. We need to incorporate this in everything we do, for teens, parents and staff.

Late Irish playwright George Bernard Shaw said it best: “We don’t stop playing because we grow old; we grow old because we stop playing.”

Jeri Kayser is a child life specialist at Children’s Hospitals and Clinics of Minnesota.

“Children’s Pedcast,” Episode 4: Child life specialists on taking medicine


On Episode 4 of “Children’s Pedcast,” child life specialists Jeri Kayser, Sarah Magnuson and Sam Schackman join the show to talk about the different challenges parents face with kids of all ages when it comes to taking medicine, both short and long term. The trio provide tips and strategies for help and success during the most difficult times when med taking seems impossible.

subscribe_blogIdeas for medicine taking

Developmental considerations

Infants: Birth to 18 months

  • Babies typically will react with any new flavor in their mouths; it’s important to avoid labeling the medicine as “yucky tasting” in response.
  • Be mindful of how you present the medicine, a positive attitude goes a long way.
  • Start practicing saying out loud what the medicine will be doing for your baby as you give it — it’s a good habit to start: “This medicine is going to help your ear feel better.”

Toddlers: 18 months to 2½ years

The hallmark of toddlers is to say “no” to anything and everything. If it’s not their idea, it’s probably not a good idea to them! Medicine fits neatly into something that is not their idea, so it helps to show them exactly why it should be their idea. “You told me your ear hurts and you want it to feel better, right (wait for the ‘yes’)? This medicine will make it feel better, but only if it gets down to your tummy.”

Pre-schoolers: 2½-5 years

They have had some life experience, tasted medicine and may not be excited to repeat that experience. Also, they are age-appropriately seeking control and recognize the opportunity for control when they zip their lips. Find ways to add fun as well as choices. Choices help a child regain control and still meet the goal of taking the medicine. Routine works well to help understand the time-limited nature of the experience. Sticker charts add a sense of accomplishment and measurement of progress.

School-age children: 5-12 years

Kids this age are old enough to understand how the medicine will help them but can become easily frustrated if they are struggling with the taste of medicine or difficulty swallowing a pill. Practicing with similar-sized candy is helpful if you work up in size to the size of the prescribed pill. Start with something small, like a Tic Tac, then incrementally larger candies until you get to the desired size. Finding opportunities to point out to your child how the medicine is helping them adds to their motivation.

Teens

Many teens don’t like to interrupt their lives or appear different in any way from their peers. It can be a challenge to coordinate their schedules with the requirements of taking a prescription. It’s helpful to walk through what it would be like to take the medicine and coordinate any necessary adjustments with your physician and pharmacist. The school nurse can be a great resource to make sure the medicine is taken. If your teen has a long-term medicine to take, this is a great time to teach them how to be responsible with their meds.

Behavioral support

  • Implement a routine for taking the medications: sitting in a certain chair, drinking something of their choice right after, etc.
  • Incorporate medical play with small candies and a doll or stuffed animal to practice the routine.
  • Give appropriate choices: Syringe or cup? Sitting at the table or sitting on the couch? Explain why the medicine is important. Older kids can understand if they take the medicine, their ear won’t hurt, etc.
  • Parents: Try to keep a positive attitude. Your child will be able sense your frustration, which will only make the situation more difficult. Work together toward your end goal.
  • Take the child to the store to buy a special cup and drink choice to chase after medicine.
  • Be honest. Never tell your child medicine is candy or try to hide medicine in food (it’s OK to use food/liquid to help administer the medicine — just make sure your child knows the medicine is there).
  • Use visual supports to help a child understand medicine routines. For instance, visual supports can help a child learn each important step to swallowing a pill and can even be used to help make the connection between taking the medicine and getting to enjoy that favorite activity (by showing a picture of a child taking medicine paired with a picture of the activity). You can download the ATN’s free Visual Supports toolkit.

Dealing with taste

Check with your physician and pharmacist on how medicine should be taken and what you can take it with before you try any of these suggestions.

  • Have a frozen treat (popsicle, etc.) or chew on ice prior to taking medicine. This “numbs” your taste buds to minimize taste.
  • When possible, crush it up and put it into pudding, applesauce, etc.
  • Mix crushed pills with frozen juice concentrate (numbs the taste buds and masks the taste). Grape, raspberry and lemonade are stronger flavors.
  • Mix crushed pills with maple syrup or coat the tongue with maple syrup to mask the taste.
  • Put the whole pill in a small spoonful of Jell-O.
  • Wash the tongue, scrub the taste buds if the taste is lingering, or pretend a wet wash cloth is an ice cream cone and lick it.
  • Blackberries can be used as edible medicine cups. The pill fits quite well in that little hole, and if your child is a fruit eater it makes it easier.

Other resources on the Web

“Children’s Pedcast” can be heard on iTunes, Podbean, Stitcher, YouTube and Vimeo.

“Children’s Pedcast,” Episode 3: Nicole Skaro and Dr. Anne Bendel on parents’ roles on care team

Episode 3 coverDr. Anne Bendel, the director of neuro oncology at Children’s Hospitals and Clinics of Minnesota, and Nicole Skaro, the mother of Victor “Valiant Vito” Skaro, discuss the importance of establishing a strong relationship between the doctor and patient family as well as parents’ roles as members of a child’s care team. Vito was diagnosed with medulloblastoma in August 2014, when he was 11 months old. Nicole and Dr. Bendel share what questions parents should ask when facing a life-changing medical diagnosis.

Listen to “Children’s Pedcast” on iTunesPodbean, Stitcher, YouTube and Vimeo.

Sleep tips from Children’s Sleep Center

Children's Sleep Center in St. Paul specializes in identifying and treating the full gamut of sleep challenges. (iStock Photo)

Children’s Sleep Center in St. Paul specializes in identifying and treating the full gamut of sleep challenges. (iStock Photo)

subscribe_blogKaren Johnson, APRN

Parents know good sleep is essential for healthy growth and functioning. Parents also know that good sleep can be hard to come by.

Families seek out the Children’s Sleep Center for our experience in treating rare and common sleep disorders in infants, children and adolescents. At Children’s Hospitals and Clinics of Minnesota, we specialize in identifying and treating the full gamut of sleep challenges, ranging from difficulties falling asleep, staying asleep, or with breathing during sleep, to difficulties waking up and staying awake.



SLEEP TIPS FOR ALL CHILDREN

Random bedtimes breed bad behaviors in kids

Many parents have learned the hard way that late bedtimes make for cranky kids the next day. In one study, children who went to bed after 9 p.m. were rated as having more behavior problems. During the day, later bedtimes affected the child’s school performance. Irregular bedtimes cause worse behaviors than short amounts of sleep. Behavioral problems improve when children have regular bedtimes.1

Sleep tips for a better bedtime routine

1. The bedtime routine should take place in the child’s bedroom where it’s quiet — a great time to read two to three books to your child, developing a love for reading, too.

2. Your child will be calmed when the routine is done in the same order each night.

3. Younger children may benefit from a visual schedule (pictures, words, or both) to remind them of the steps.

4. Determine which events are calming and which are stimulating. Calming events are required for bedtime. For example, if bathing is stimulating instead of relaxing, move the bath time earlier in the evening or to the morning.

Kids and electronics

Screen time can impact the quantity and quality of sleep. The American Association of Pediatrics recommends no more than one to two hours of screen time a day for children two years and older. The light from these screens suppresses melatonin, a hormone in the brain that signals sleep. Due to the usage of multiple electronic distractions (cellphones, computers, tablets) for tweeting, texting, social networking and entertainment, kids’ evenings are “lit up.” The light from these devices is keeping many kids awake long into the night, creating sleep deprivation. Losing one hour of sleep at night can negatively affect a child’s academic performance at school.

Tips for improving sleep

1. Implement an electronic curfew at least one hour before bedtime.

2. Remove all electronic devices from the bedroom.

3. Adjust your child’s schedule to accommodate for homework to be completed earlier in the evening when homework requires using electronic devices.

4. Consider doing homework in the morning, as the light from these devices helps your child wake easier.3,4

SLEEP TIPS FOR PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Can I get sick from my CPAP mask?

Unwashed CPAP/BiPAP masks may have an odor and harbor germs. Because you breathe through the mask for several hours each night — particularly if you use a heated humidifier in conjunction with the CPAP machine — you create a warm, moist environment inside your mask. Fungi, bacteria and viruses can thrive in this environment. These infectious agents then have direct access to your airway and can make you sick.

  • Wipe the CPAP mask clean each day with a mild detergent and allow it to air dry.
  • If you have any questions, call your equipment vendor or the Children’s Sleep Center for help.

Important things to know about CPAP/BiPAP and sleep

1. You should start to feel better during the day soon after you consistently start using your CPAP/BiPAP at night.

2. CPAP/BiPAP improves your health and well-being in many ways.

3. Not everyone finds CPAP/BiPAP easy, but there are things that you can do to make it easier. Ask your sleep specialist for ideas.

4. To succeed with CPAP, you need to be patient and stick with it. Since it generally will make you feel better the next day, taking a night off from using it is not a good idea.

5. It is not unusual to find your mask is off when you wake at night. What matters is being aware and putting the mask back on again when you notice it is off.

Treating sleep apnea in kids improves behavior, quality of life

Kids with untreated obstructive sleep apnea often are tired during the day, have trouble paying attention and other behavioral problems; these children are not getting enough quality sleep at night.

Obstructive sleep apnea (OSA) is marked by pauses in breathing while asleep. These pauses can occur through the night and disrupt sleep. Positive airway pressure machines help keep the airway open. The main message is that this treatment — although it may be difficult to tolerate — can result in a significant improvement in the child’s behavior and quality of life. One of the issues is that children may not want to wear the bulky mask while they sleep, but the study shows that even three hours a night is enough to make a big difference by improving attention, behavior, sleepiness and quality of life.5

PEDIATRIC PARASOMNIAS

Pediatric parasomnia refers to movement or experiences that take place during sleep as a child transitions from sleep to wake phases. A few common parasomnias include sleepwalking, sleep terrors and confusional arousals.

Parsomnias can be common in families and may be triggered by other sleep disorders, such as OSA and restless leg syndrome (RLS). Other triggers include certain medications, sleep deprivation, irregular sleep schedules, fever, sleeping in unfamiliar places, stress and separation anxiety.6

Sleep terrors occur during the first hours after falling asleep. The child wakes abruptly from sleep with loud screams, is agitated and frightened. The child is unresponsive to a parent’s efforts to calm and does not recall the event in the morning. It’s best to stand by during the event, observe and maintain the child’s safety. The terror is not traumatic for the child, only for the observer.

Nightmares occur at the last half of the night during REM sleep. They are disturbing dreams that wake the child, usually creating fears and anxiety. The child can recall the nightmare in the morning.

Sleepwalking occurs in about 15 percent of children, peaking between 8-12 years of age. Some may exhibit inappropriate behaviors at night, even urinating in strange places. Children have injured themselves by unconsciously carrying out dangerous behaviors such as leaving the house at night. Safety is the biggest concern in managing sleepwalking events. Second-floor bedroom windows should be locked and alarms placed on outside doors to alert parent if the child attempts to leave the home during the night.

Confused arousals may occur at any time during sleep. The child may sit up in bed, cry, whimper, moan and seem agitated and confused. Usually they do not respond to your interventions to comfort.

Home management

  • Maintain a regular sleep and wake schedule seven days a week. Getting the proper amount of sleep to feel well-rested will reduce the triggers for an event.
  • Precautions for safety during sleepwalking events need to be addressed. Alarms on doors and windows are advised.
  • Night terrors and confused arousals do not require the child to be comforted, as this will intensify the event. Parent should stand by to observe and maintain child’s safety.
  • Children will outgrow parasomnias as they get older.
  • If your child is having regular parasomnia events, an evaluation by your sleep provider may be required.

Karen Johnson, APRN, is a certified nurse practitioner at the Children’s Sleep Center in St. Paul. Get more information about the Children’s Sleep Center.

Resources
1. www.npr.org, 2003
2. Sleep for teenagers; www.nytimes.com, (2014).
3. Treating sleep apnea in kids improves behavior, quality of life; www.webmd.com, (2012).
4. Limiting screen time improves sleep, academics, behaviors, study finds; www.sciencedaily.com, (2014).
5. American Journal of Respiratory and Critical Care Medicine, 2012
6. Suresh Kotogal MD (2014). Sleepwalking and other parasomnias in children.

8 tips to prevent poisoning

With one of the busiest pediatric emergency medicine programs in the nation and more than 90,000 emergency department visits annually for a variety of reasons, you can trust we’ve treated just about everything. We love kids here at Children’s, but we’d rather see them safe at home.

In recognition of Poison Prevention Awareness Week (March 15-21), we’ve gathered tips from our experts. Share these tips with your kids and print them to share at their schools or with your friends. Together, we can make safe simple.

Keep all potential poisons up high and out of the reach of children — in a locked storage container. Set up safe storage areas for medications, household cleaners, and chemicals like antifreeze. (iStock photo / Getty Images)

What is Poison Prevention Week?

National Poison Prevention Week was established by Congress in 1961 for annual, national recognition. The goal of the week is to educate the public about poisoning risks and what to do to prevent poisonings.

What you should know

Did you know that injuries are a leading cause of death in children? Each year, 5,000 kids die and another 6 million are hurt as a result of unintentional injuries. One in 4 children is hurt seriously enough to need medical attention. Most childhood injuries occur at home, and many of these injuries, including poisoning, could be prevented.

Facts about poisoning

  • More than 1 million accidental poisonings per year occur in children younger than 6 years old.
  • Approximately 1 in 10 poisonings involves cleaning products.
  • Approximately 1 in 10 poisonings involves indoor and outdoor plants.
  • Approximately 1 in 20 poisonings are caused by cosmetic and personal-care products.

Tips to prevent poisoning

  • Review the poison prevention home checklist from the Minnesota Regional Poison Center.
  • Keep all potential poisons up high and out of the reach of children — preferably in a locked storage container. Set up safe storage areas for medications, household cleaners, and chemicals like antifreeze.
  • Keep medications and vitamins out of the reach of children. Never call medicine “candy.”
  • Keep foods and household products separated.
  • Keep products in original containers. Do not use food storage containers to store poisonous substances (i.e. plant food in a drink bottle).
  • Destroy old medications.
  • Identify all household plants to determine if poisonous.
  • Post the Poison Center phone number, 1 (800) 222-1222, near each phone in the home.

subscribe_blogWhat do you do if you suspect someone has been poisoned?

  • Swallowed poison: Remove anything remaining in the mouth. If a person is able to swallow, give about 2 ounces of water to drink.
  • Poison in the eye: Gently flush the eye for 10 minutes using medium-warm water.
  • Poison on the skin: Remove any contaminated clothing and rinse skin with large amounts of water for 10 minutes.
  • Inhaled poison: Get fresh air as soon as possible.
  • Call the Poison Center, 1 (800) 222-1222, immediately.
CROSSWORD PUZZLE: Poison Search

Cognitive-behavioral therapy for insomnia an option for kids with sleep trouble

Cognitive-behavioral therapy for insomnia (CBT-I) requires regular visits with a sleep provider who will work with you and your child to help change the way he or she sleeps. (iStock photo)

Cognitive-behavioral therapy for insomnia (CBT-I) requires regular visits with a sleep provider who will work with you and your child to help change the way he or she sleeps. (iStock photo)

Terese Amble, PsyD, LP

Insomnia is broadly defined as difficulty falling asleep, staying asleep and/or subjective, poor-quality (“non-restorative”) sleep.

Everyone has problems sleeping at times; however, a diagnosis of insomnia is made if sleep problems persist for more than one month and result in some degree of daytime impairment. Untreated insomnia can result in chronic sleep loss that can cause excessive daytime sleepiness and impact daytime functioning, which may range from fatigue, moodiness/irritability or mild cognitive or behavioral problems (difficulties with concentration/attention, hyperactivity) to significant effects on mood, behavior or school performance. Chronic insomnia also increases the risk of physical and mental illness.

Given the negative impact of chronic poor sleep, it is important to have sleep problems evaluated and treated. Behavioral treatments are the first line treatment for insomnia and involve improving sleep without the use of medications, as there are no medications that are FDA-approved for the treatment of insomnia in youth. Cognitive-behavioral therapy for insomnia, commonly referred to as CBT-I, is a safe and effective treatment that aims to help children and adolescents identify and replace thoughts and behaviors that cause or worsen sleep problems with thoughts and behaviors that promote sound sleep.

CBT-I requires regular (usually weekly or biweekly) visits with a sleep provider who will work with you and your child to help change the way he or she sleeps. The frequency of treatment may vary from as few as two sessions to as many as eight of more sessions, depending on the specific sleep concerns and progress. At the beginning of treatment, a comprehensive sleep evaluation will be conducted to determine factors that are underlying or contributing to sleep difficulties and to help develop an effective treatment plan. As part of this initial evaluation, you will be asked to keep a sleep log of your child’s sleep patterns for one to two weeks and your child may be asked to wear an actigraph, a portable wristwatch-like device which records and stores more objective information about body movements and sleep-wake patterns.

subscribe_blogAfter this initial evaluation, treatment is individualized and each session is focused on learning specific cognitive and behavioral strategies to improve sleep. The cognitive part of CBT-I involves teaching your child techniques to quiet his or her busy mind at night to relax and fall asleep. Your child will learn strategies to recognize, modify or eliminate unhelpful/negative thoughts or worries that interfere with his or her ability to sleep, including unrealistic beliefs and attitudes about sleep and the possible daytime consequences of poor sleep (e.g. “I’ll never be able to fall asleep tonight,” “If I can’t fall asleep, I won’t be able to get up in the morning and I’ll miss my test”).

The behavioral part of CBT-I involves identifying and changing behaviors that may keep your child from sleeping well and developing good sleep habits to promote quality sleep. Treatment is tailored to each child or adolescent and may include some combination of the following techniques:

  • Sleep restriction: This strategy involves temporarily restricting the total time in bed to current amount of sleep each night to decrease the amount of time spent in bed awake. Being extra-sleepy can help your child fall asleep quickly and stay asleep. Once sleep has improved, the amount of time in bed is gradually increased until desired bedtime is reached.
  • Stimulus control: This technique involves eliminating any activities in bed that are not conducive to sleeping to disrupt the association between being in bed and wakefulness (and strengthen the association between being in bed and sleepiness). Stimulus control instructions often include only going to bed when sleepy, leaving the bed (and possibly bedroom) to engage in a quiet activity if not asleep within 15-20 minutes and only using the bed for sleeping both during the day and at night (not watching TV, doing homework, worrying, etc.).
  • Sleep hygiene: This involves learning positive sleep practices and habits that are important for getting sound sleep, such as establishing an optimal sleep environment, implementing a developmentally appropriate and consistent bedtime and wakeup time (no matter how much sleep you got the night before!), avoiding naps, establishing a calming, consistent bedtime routine, decreasing stimulation near bedtime (caffeine, physical activity, conflict/stress) and removing electronics from the bedroom.
  • Relaxation training: Increased mental activity at night (such as worrying or not being able to “switch off” an active, busy mind) or stress about not being able to fall asleep leads to increased activity and tension in the body, which further interferes with the ability to unwind and fall asleep. Relaxation strategies, such as deep breathing, visual imagery, progressive muscle relaxation, autogenics, meditation and mindfulness can be used to help quiet the mind and calm the body at night and improve sleep.

Given the potential negative consequences of chronic sleep loss, it’s important to actively treat sleep problems. CBT-I is a safe and effective way to treat insomnia in children and adolescents without the use of medications. CBT-I is generally short term, but the skills learned during this treatment can lead to lasting, improved sleep if positive habits are maintained.

Terese Amble, PsyD, LP, is a pediatric psychologist in the sleep center at Children’s Hospitals and Clinics of Minnesota.

“Children’s Pedcast,” Episode 2: Dr. Keith Cavanaugh on sleep health

subscribe_blogDr. Keith Cavanaugh and Karen Johnson, APRN, of the Children’s Sleep Center in St. Paul talk about healthy sleep habits for kids from newborns to teens.

They cover children and schedules, sleep apnea, daylight saving time, teens and technology, and other sleep habits, both good and bad, providing information for parents and kids.

Listen to “Children’s Pedcast” on Podbean, iTunesStitcherYouTube and Vimeo.

Mindfulness a technique to relieve stress

Many teachers of mindfulness suggest visualizing thoughts as leaves floating down a stream or as clouds drifting by in the sky. (iStock photo / Getty Images)

subscribe_blogLeslie Partin

Whether you’re a busy, working parent or a teen trying to balance a full social calendar and school, life can be stressful at times. Mindfulness, otherwise known as mindful meditation or mindfulness-based stress reduction (MSBR), is a tool any one of us can use as we navigate through the demands of our days.

The basic tenet of mindfulness is paying attention to the present moment. So much of the time we’re thinking ahead to the next task or mulling over something that happened in the past. For example, have you ever driven past the exit you intended to take, only to realize you missed it because you were thinking of something else? When we are caught up in our thoughts, we miss what is happening around us like that missed freeway exit.

Our minds are powerful, and we can harness that power to help us manage difficult experiences and distressing (or afflictive) emotions. When we are in the midst of a strong emotion or physical sensation like anger, sadness, disappointment or physical pain, it can feel like things will never get better. But if we’re able to step back and observe our distress, we may notice that it changes, ebbs and flows. Noticing and recognizing that the intensity varies, whether it’s an emotion or physical sensation, offers hope and reassurance that it won’t always be so hard. And when we focus on what we’re experiencing right now, instead of what’s going to happen — “I don’t want to have a headache at the dance,” “I don’t want to be stressed out at my child’s game,” etc. — then we don’t add the additional suffering of anticipation or worry. We suffer when we focus too much attention on what may happen in the future.

Mindfulness doesn’t mean trying not to think or making one’s mind blank. Instead, mindfulness teaches us to watch our thoughts, observe them while not attaching to them. Many teachers suggest visualizing thoughts as leaves floating down a stream or as clouds drifting by in the sky. Practitioners of meditation say that having a regular “practice” — a time set aside to practice meditation — allows us to develop our capability to be mindful in times of distress. It’s like building our mental muscles in the same way we build physical muscles by lifting weights or working out. Committing to a meditation or mindfulness practice helps us develop those muscles so we have the ability to use them when we need them most.

Neuroscience studies show us that the brain develops neuro-pathways as a result of our thinking habits and patterns. Similar to the way a trail through the woods is developed by animals and people following the same path over and over, our neuro-pathways, or thought habits, are made as we repeatedly take the same path of worry, fear, joy, happiness, etc. Mindfulness is one technique we can use to help form new neuro-pathways or mental habits. When we practice mindfulness we increase awareness of all of our thoughts and emotions, the positive as well as the afflictive ones. We then can choose which thoughts, emotions and sensations we want to focus on and nurture, and of which ones we want to let go. Remembering that we have this choice can help us cope when we hit stressful times.

If you’re interested in learning more about mindfulness, here are few links that can help you and your family get started (the first six links are centers that are located in the Twin Cities):

The Kiran Stordalen and Horst Rechelbacher Pediatric Pain, Palliative and Integrative Medicine Clinic at Children’s – Minneapolis has medical providers that work with children to teach relaxation techniques that can include the use of mindfulness. These strategies are helpful for chronic conditions such headaches and abdominal pain or problems with sleep and anxiety.


[1] Jon Kabat-Zinn developed Mindfulness Based Stress Reduction programs in Massachusetts and has several books and CDs, which provide a good starting point. “Everyday Blessings” is his book on mindful parenting, with Myla Kabat-Zinn.

Leslie Partin is a social worker at Children’s Hospitals and Clinics of Minnesota.