Category Archives: Parenting

‘I’m a cancer survivor’

Ted Sibley's work as a doctor has taken him to Central and South America. (Photos courtesy of Ted Sibley)

Ted Sibley’s work as a doctor has taken him to Central and South America. (Photos courtesy of Ted Sibley)

This is part four of a four-part series written by Ted Sibley, MD, a former Children’s cancer patient from Plymouth, Minn., who used to work as a nursing assistant and pharmacy technician at Children’s while attending medical school, about how cancer drastically impacted all aspects of his life from youth to adulthood.

Part 1: Cancer patient reflects on diagnosis — 20 years later

Part 2: Cancer delivers another blow

Part 3: Cancer-patient-turned-doctor adds new title: Dad

Ted Sibley, MD, is a doctor at Truman Medical Centers Emergency Services in Kansas City, Mo. (Photos courtesy of Ted Sibley)

Ted Sibley, MD, is a doctor at Truman Medical Centers Emergency Services in Kansas City, Mo.

Ted Sibley, MD

Childhood cancer survival rates are on the rise. Current estimates are that there are more than 325,000 children, teens and adults living in the United States who are survivors of childhood cancer, and each of us has a story to tell.

If we were too young to understand what was happening, our parents could tell you about the struggles they went through — their worries and tears they cried for us when we were too young and weak. Some of us have made it into adulthood, and we can tell you how cancer is something we carry with us. We are part of a collective group who faced death at a young age and now are living life in a newfound light. And we are the lucky ones. For every story like mine, there are countless children who lost their fights with cancer:

  • Children who had bright futures, energizing smiles and did nothing wrong to have lost their lives so soon
  • Children who should have grown up, graduated high school, attended college and changed the world
  • Families who are left with memories of these children
  • Parents and siblings who can tell you the brave fight their child or sibling fought and how they feel about their vacancy in the world

Much like me, they can tell you exactly when and where they were when they discovered that their young loved one had cancer. And they can tell you about their life before and after cancer crept its way into their world and changed them forever.

A younger Ted with Children's Bruce Bostrom, MD

A younger Ted with Children’s Bruce Bostrom, MD

During my time as a nursing assistant, I had the pleasure of sharing my story with patients and their families, but I also got to see firsthand the loss of a child taken from the world too soon.  Late one December, a young boy undergoing chemotherapy spent Christmas in the hospital because his blood counts were too low to go home. I spent time in his room, talking with his mother about how my roommates and I had had a very small Charlie Brown-esque tree on our table years before, but we did not have a star to place on the top. The young boy made arts and crafts to pass the time that evening, and the next day I came to work, his mother handed me a gift. He had made a star for the top of our tree. I thanked him and promised that this would be on my tree for years to come. This little boy lost his fight with cancer within a couple of months, but his small balsa wood star with yellow paint and gold trim sits atop our tree every year. It is one of the most precious things I own and reminds me of those who have lost their fight with a terrible disease.

The impact of being a cancer survivor has changed my life since I was diagnosed. The life I lead now is correlated to the experiences and person that I had become after undergoing treatment. Since my wife and I adopted our first son, I have finished medical school and residency, and I am now a practicing emergency medicine physician. I have had the opportunity to become a father two more times since our first adoption. My wife and I are parents to an Ethiopian boy along with another Colombian child, making an incredibly busy (but wonderful) family. I have become heavily involved in international medical work and am the medical director for a team that provides medical care to the indigenous people of the Amazon River. I have been able to travel extensively throughout Central and South America to work in various hospitals and clinics. I also have been allowed the opportunity to extend my medical services to countries throughout Africa and use the medical knowledge I’ve received through my training to help others on an international scale. My cancer history led me to the life I have now.

The Sibley family

The Sibley family

My wife also has been affected deeply by cancer. Though she was not directly involved in the initial effects of my therapy, she has experienced the ripple effects of my treatment. She changed the way she saw our marriage after my diagnosis of infertility. She has now become a mother who has embraced our adopted children and focused her heart and mind to be a champion for international and domestic orphan rights. She has led numerous teams to work throughout Haiti in orphanages and works endlessly for homeless children in our current city. She has volunteered our home a designated “Safe Families” house for homeless children. We provide temporary placement for various children from our area while their parents secure housing and job opportunities. We now have three sets of bunk beds in our home, countless extra sets of shoes and clothing for boys and girls, and we are just a phone call away from getting additional children who need a temporary place to stay.

Sometimes I worry that my past will strike again when I least expect it. Do you ever have a stomach ache or feel short of breath and wonder if you have a tumor in your abdomen that has now spread to your chest? Probably not. I try not to dwell on such things. But, on more than one occasion, I have taken myself in for a CT scan — just to make sure. Because germ cell cancer secretes the same hormone as a pregnant female, I will occasionally purchase a pregnancy test at the store and test my own urine. (No, not pregnant; I actually just had gastric reflux.) But with every mundane cough, body ache or pain that I experience, the thought that cancer could recur remains in the back of my mind.

This year, I turned 33 and reflected on what 20 years of cancer survivorship has meant to me. I wonder what type of person I would have been without cancer. For better or worse, my experience had substantial effects on my loved ones and me. I’m a different person today because of May 18, 1995. To my wife, I am a husband. To my parents, I am their son. To my kids, I’m their dad. I’m also a friend, brother and physician. But to those who know my history, I’m also proud to be called a cancer survivor.

Ted Sibley, MD, is a doctor in emergency services at Truman Medical Centers in Kansas City, Mo., and a clinical assistant professor for the emergency medicine department and adjunct clinical assistant professor for the master of medical science physician assistant program at the University of Missouri-Kansas City.

“Children’s Pedcast”: Dr. Gigi Chawla on well-child visits


On Episode 5 of “Children’s Pedcast,” Dr. Gigi Chawla, senior medical director of primary care at Children’s, joins the show to discuss all things well-child visits and the importance of finding the right pediatrician for your child from birth to adulthood. She answers a lot of questions and provides helpful information for parents with kids of all ages.

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

Raising kids with the Internet as a co-parent

Every generation faces unique challenges in life, this generation is no exception. The main difference for new parents in 2015 is the Internet — offering a mixed bag of benefits and burdens to the ancient art of parenting. (Pimonova / iStock illustration)

Every generation faces unique challenges in life, this generation is no exception. The main difference for new parents in 2015 is the Internet — offering a mixed bag of benefits and burdens to the ancient art of parenting. (Pimonova / iStock illustration)

Jeri Kayser

While visiting my marvelous niece and her exceptionally marvelous newborn baby, she mentioned that women who have already raised their children don’t know what it’s like to be a parent in today’s world. This struck me as interesting on many different levels.

I remember having that same exact thought after having my first child; it’s only after that baby has grown a bit or you’ve had your second or third child that you can look back on this phase of your parental evolution and see that the change is less about the world and more about you. You have changed. Your priorities, your worries, your decreased expectation that sleep is something you get to choose. The world is now more demanding but infinitely more fascinating and filled with an indescribable love. Plus, you get to learn some awesome multitasking skills!

subscribe_blogSo, is it different to raise a child now?

Every generation faces unique challenges in life, this generation is no exception. I would argue that the main difference for new parents in 2015 is the Internet — offering a mixed bag of benefits and burdens to the ancient art of parenting. It’s a great place to find bargains for the stroller you want or show you how to install the car seat. But it’s equally a never-ending source of unsolicited advice and distorted parent bragging that can make any rock-solid parent feel insecure, questioning if it’s true: “Should I really only feed my child blue foods?”

When I was raising kids and standing in the checkout lane at the grocery store, the magazines would shout from their rack all of the things I could be doing to be a better parent: “How to create the perfect birthday party!” “Fun and easy Halloween costumes you can make at home!” “Teach your child 12 languages before they enter kindergarten.” Every title offering a suggestion came with the subliminal message that failure to follow the advice was evidence that you weren’t up to this whole parenting thing. It’s hard not to feel insecure when you’re so motivated to be perfect for your obviously perfect child while residing in the imperfect package of a human being.

I could step away from the parenting magazines in the checkout line, maybe read up on what alien has married what celebrity, but you can’t really avoid the Internet. Those photos of your friends and relatives in gorgeously orchestrated family bliss are still going to pop up in your feed.

Sigh.

Mining the Internet for truly helpful information that empowers your parenting mojo instead of inviting in trolls who create chaos with your self- esteem requires some thoughtful navigation.  The Internet is great for advice about things that have easily verifiable facts, like “where can I find an indoor playground?” Questions that have long-term consequences like “how do I get my kids to get along with each other?” are best answered by the posse of people closest to you — your friends and family as well as professionals educated in the field of question.

Important parenting advice should be gathered from people important to you, people who are invested in you for the foreseeable future who will be around to be held accountable for their advice. Sift through that advice and take from it what seems right to you. Trust yourself. Yes, others have sailed the parenting seas, but this is your journey and you are the captain. Respecting yourself and recognizing there is no perfect parent smoothes the waters and makes the trip so much more fun!

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

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.

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.

Prepare your child’s sleep for daylight saving time

Four days before daylight saving time starts, get your child to bed 15 minutes earlier the first night. (iStock photo)

Four days before daylight saving time starts, get your child to bed 15 minutes earlier the first night. (iStock photo)

Karen Johnson, APRN

Preparation is the key to minimize the impact of daylight saving time on your child’s sleep patterns. It’s a good idea to get your child into bed a little earlier in the week leading up to the time change.

subscribe_blogChange the child’s body clock

Four days before daylight saving time starts — it takes place at 2 a.m. Sunday, March 8 — get your child to bed 15 minutes earlier the first night. Your child may not actually go to sleep earlier, but by getting him or her to bed sooner, you are encouraging the body to relax earlier than usual. This will lead to falling asleep earlier, too. Make the child’s bedtime progressively earlier by 15 minutes each of the four nights before daylight saving time until it adds up to an hour the night of the time change.

Daylight saving time sleep tips

Make sure that the bedroom is dark. The big challenge for parents during daylight saving time is having the child go to bed when the sun is out. Sleep is influenced by having a dark environment, as this allows for the natural secretion of melatonin that is needed to invite sleepiness.

Calm bedtime routine

Take extra care to ensure that the bedtime routine is calm and as relaxing as it can be. A calm and regular bedtime routine is best, without debates and arguing to promote sleep.

Waking too early

Ensure that your child understands that it’s not time to get up for the day. Encourage him or her to go back to sleep. Some parents put a clock beside their child’s bed and explain what time it has to be before the child can get up for the day. If you have a toddler or young child, use a sleep clock such as the Good Nite Lite. The light is a cue that informs your child to stay in bed until the sun shines on the clock in the morning. This isn’t just effective for time changes; it also can help you train an early riser not to wake Mommy and Daddy too early in the morning and may help with bedtime battles.

Get some sun

Besides making sure to get the proper amount of sleep, early morning bright light exposure also can help set a regular sleep-and-wake pattern called a “circadian rhythm.” Eating breakfast in a bright part of your house or going for an early morning walk outside in the sun will help you and your child wake easier as well.

Daily physical activity is recommended for all children, but don’t try to wear your child out in an effort to get him or her to sleep earlier. Overtired children often take longer to fall asleep and may even resist sleep completely.

Be consistent

While your child is getting used to the new sleep schedule, stick to your usual bedtime rules and routine.

Be patient during this time adjustment as you may have a tired and grumpy child on your hands in the days after the time change. It generally takes about a week after the clocks have changed to be in a new sleeping pattern. Prepare to feel unfocused in the days after you set clocks forward. You might want to keep your family’s schedule more open in the days after daylight saving time in case you aren’t well rested.

Other tips

  • Newborn babies usually are not affected by the start and finish of daylight saving time.
  • Change clocks Saturday evening before going to bed.
  • Check the smoke alarms. Changing the batteries as a good safety rule.
  • If your child has difficulty sleeping, please contact the Children’s Sleep Center.

Karen Johnson, APRN, is a certified nurse practitioner at the Children’s Sleep Center.

“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.