Kids and sleep: How primary care providers can help 

More than one third of kids ages 4 months to 17 years in the U.S. slept less than recommended for their age, according to an analysis by the Centers for Disease Control and Prevention (CDC). The CDC, which reviewed findings from the 2016-2018 National Survey of Children’s Health, also found rates of insufficient sleep was highest for kids in racial and ethnic minority groups, of low socioeconomic status, and with special health care needs. Kids who do not get enough sleep are at increased risk for injuries, poor mental health, obesity, type 2 diabetes, attention and behavior problems, and poor cognitive development.  

Poor sleep can frustrate an entire family, so when a child is suspected of having a common or complex sleep disorder, it’s important to get to the root cause of the problem quickly. In the Talking Pediatrics podcast episode, “What’s Sleep Got to Do With It?,” host Dr. Angela Kade Goepferd talked with Dr. Ben Ryba-White, pediatric sleep medicine clinician at Children’s Minnesota Sleep Clinic, about the importance of sleep for kids and what primary care physicians can do to help. Dr. Ryba-White is board-certified in pediatrics and sleep medicine. 

The “right” amount of sleep for kids 

There is no strict rule for the perfect amount of sleep for anyone. However, the National Sleep Foundation (NSF) recommends these daily sleep durations for the following age groups:  

• Newborns (0 to 3 months): 14 to 17 hours 
• Infants (4 to 11 months): 12 to 15 hours 
• Toddlers (age 1 to 2): 11 to 14 hours 
• Preschoolers (age 3 to 5): 10 to 13 hours 
• School-aged kids (age 6 to 13): 9 to 11 hours 
• Teens (age 14 to 17): 8 to 10 hours 
• Adults (18+): 7 to 9 hours 

The NSF recommendations are helpful guidance, but pediatricians need to also consider the specific needs and circumstances of each patient. “It’s a range and everyone is going to have their own individual sleep need,” said Dr. Ryba-White. “It’s incumbent upon [health care providers] and parents to be thinking about that and see how [is the child] doing during the day. That can help inform us of how their nights are going.” 

Researchers (and most parents) will also confirm: consistent nightly bedtime routines can lead to many positive outcomes beyond improved sleep, including a child’s behavior, physical and emotional development, and overall wellbeing.  

Ideally, a child will have a consistent bedtime – and sleep for the recommended duration of time for their age group – but there are still variables unique to each patient. “We have to understand that some cultures and some families are going to have their own way of doing things, so as long as things are going well in their setup, it doesn’t mean we have to change everything,” said Dr. Ryba-White. 

Identifying a sleep-deficient child 

Unlike an adult who has not slept enough so they’re yawning and leaning over a cup of coffee, a sleep-deficient child is often hyperactive and acts like they’re being driven by a motor. They might also have difficulty with focus and concentration, can be irritable, moody, aggressive and have tantrums. 

Diagnosing sleep deficiencies and disorders in kids can be time-consuming and difficult in a busy primary care clinic. However, even simple interventions like working on bedtime routines can have a positive impact on behavioral problems. Some helpful starter questions for parents and caregivers in the primary care clinic include:  

• What time is the child’s bedtime and how consistent is that bedtime? 
• What’s the difference between how much sleep they get during the week versus weekend? 
• How long does it take the child to fall asleep? 
• Do you have to wake them up every day for school? 
• Do you ever hear the child snoring or restless in other ways during sleep times? 

Answers to these questions should give clinicians good insights about the child’s sleep behaviors and help determine what’s next for assessment and/or treatment, including referring the child to a pediatric sleep expert. 

A few thoughts about melatonin for kids 

Melatonin is a hormone made naturally by the body to help regulate sleep. Over-the-counter melatonin supplements for adults and kids are widely popular and sold in various forms, including pills and gummies. Melatonin is classified as a dietary supplement and not regulated by the Food and Drug Administration, but health care providers still consider melatonin a medication. Some kids greatly benefit from melatonin supplements, including kids with neurologic or neurodevelopmental conditions.  

The American Academy of Sleep Medicine (AASM) issued an advisory to caution about the use of melatonin by children and adolescents, with reminders for parents to consult a physician before giving it to their child. The AASM also encourages trying behavior and schedule changes to improve a child’s sleep before giving them melatonin. 

“Even if we’re not worried necessarily about the safety of [melatonin], there’s also the idea that when we’re giving something for sleep, we are potentially creating a habit there,” said Dr. Ryba-White. “We are sending the message to that child, ‘I need this to go to sleep. I need to take this to go to sleep,’ and that may not be true. So, I think the best thing we can do in busy primary care practices is, if they are using melatonin, that can be a good opportunity to ask some more questions about what’s going on, or why are we using it.” 

For more information about sleep and kids, listen to the full podcast or read the transcripts here.