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Shedding light on a common sleep problem: The problem with light sleepers

“Lights out” is a very common phrase meant simply to imply that it’s time to go to sleep. In days past, our ancestors lived their lives according to what was a naturally determined version of “lights out” – typically rising with the sun and turning in when it set. Over the last century, however, we have been given far more control – now able to not only artificially and technologically manipulate our light exposure, but prolong it to such an extent that some of us live our lives in a state of nearly 24/7 light exposure. Given this fact, along with all we now know about what it takes to get a good night’s sleep, it occurs to me that it’s high time for “lights out” to be seen in a new light.

The fact of the matter is a whole lot is known about light’s impact on our likelihood of getting a good night’s sleep. The potential problems and pitfalls of living in a world of electronic devices and ubiquitous screens give new meaning to the description, “light sleeper.”

According to the National Sleep Foundation, 90 percent of people in the US admit to using an array of technological devices – from TVs and tablets to smartphones and laptops – during the hour before they go to sleep. The problem with this tech-heavy approach, simply put, is that darkness matters. Insufficient darkness not only delays the onset of sleep, but also leads to more frequent and prolonged wakenings. Light exposure is one of the most powerful signals in our environment when it comes to setting the body’s internal clock – a biological “clock” responsible for determining our sleep-wake cycles (also referred to as circadian rhythms). Keeping in mind this simple concept, the reasons for the following common sleep-enhancing tips should become both more obvious and enlightening.

  • Rise and shine. Like “lights out,” rise and shine is an expression – as well as a piece of advice – that comes with plenty of supporting evidence. Exposure to sunlight (or bright, blue light) in the morning and during daytime hours is known to reinforce your body’s natural sleep-wake cycle and signal that it’s time to be awake. 
  • Face (smart)phone facts. The screens on smartphone typically give off bright blue light – a design feature meant to help make them easier to see even in bright sunshine, but one that unfortunately comes with potential sleep consequences. Designed to mimic sunlight, this blue light is considered worst with respect to throwing off your body’s sense of day and night. The solution? Reduce your exposure to bright and blue-rich light in the evenings (generally recommended 1 to 2 hours before bedtime). If you find yourself unable to set aside your phone altogether, the iPhone added a new feature (in iOS 9.3) called Night Shift that allows you to shift to “warmer” and less eye-opening hues by cutting down your exposure to the harsher blue light at bedtime.
  • Electronic-free bedrooms. Smartphones aren’t the only offenders when it comes to devices that interfere with getting a good night’s sleep. Common sleep-enhancing recommendations also routinely include turning off and/or keeping all close-range electronic devices (ie those which emit blue light) out of the bedroom. While phones, tablets and other screens definitely fall into this category, don’t forget to consider (and remove) chargers, sound machines, and other blue-light electronics and accessories as well.
  • Choosing the right nightlight. Nightlights have increasingly become the subject of scrutiny in light of what we now know about sleep/wake cycle disruptors. This seems to be especially true for parents wondering whether or not to install nightlights in their bedrooms. Clearly, blue-emitting nightlights are not a good idea. But apparently, white light isn’t so great either. For those committed to using a nightlight, it seems that red light might be your best choice. From a practical parenting standpoint, however, I will point out that newborns enter into the world already well-accustomed to sleeping in the dark. As much as possible, it would seem best to keep it this way, rather than introducing them to artificial light at night.

The bottom line is that sleep is something we all do, and that we all need. It is also one of those key aspects of our everyday lives that all too often gets too little attention…that is, until we find ourselves fatigued. Representing much more than a casual expression, “lights out” now represents a succinct yet valuable piece of advice that, firmly supported by the latest in sleep science. It is my hope that by shedding some light on this important issue, you will see the value of turning out the lights, shutting off the screens, pulling the shutters and, at least in this particular instance, choosing to remain in the dark.

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Back-to-School Parenting: Addressing Common Ailments

It’s that time of year again, when prepared parents get a head start on supply shopping while our children eagerly pick out new backpacks in anticipation of the rapidly approaching return to school. As both a parent and a pediatrician, I’ve found that this is the time when it’s also useful to arm oneself with information about some of the more common ailments and health-related challenges of the season.

What first comes to mind, in addition to the annual scramble to get school physicals and sports forms signed (a necessary and important pre-requisite for getting the school year off to a good start), are the not-so-eagerly anticipated maladies that predictably show up each fall. While children predictably share everything from strep throat, pinkeye, and common cold viruses to dreaded head lice – I’ve found that it’s the back-to-school headaches and stomach aches that have a way of leaving parents scratching their heads wondering which ones warrant being taken seriously.

When it comes to stomachaches, parents often find it difficult to determine which ones are “real,” and which are simply the result of not wanting to go to school. By “real,” most parents are thinking of the stomach-flu type illnesses that often cause symptoms like fever, vomiting and/or diarrhea. It’s important for parents to understand, however, that stomach aches not attributable to a virus or other medical cause can still be quite real. Stress-related stomachaches in school-age children are actually quite common and often said to be the equivalent of headaches in adults. Even if the underlying cause is due to a child’s stress or desire not to attend school, very “real” symptoms (such as vomiting and diarrhea, but not fever) can result, and it’s worthwhile trying to identify and address the underlying cause(s).

Similarly, the appearance of headaches can often cause parents to question whether they are serious or simply related to new school year nerves. When it comes to getting a head start on school-year headaches, as well as stomachaches, it’s always important to consider when they first start (after the first day of school? or during the family’s eagerly anticipated summer vacation?), when they occur (first thing in the morning? Or after a long day of reading and/or computer use?), how bad are they (do they make your child stop doing even those things they really enjoy? Or only get in the way of chores and going to school?) And what makes them better or worse.

There are common medical explanations – the eye strain and/or the yet-identified need for glasses, or the onset of seasonal allergies, for example – but it’s equally important to enlist your child’s doctor if you need help sorting out stress-related causes of headaches and/or stomach aches, as the resulting symptoms can be just as “real,” and addressing them just as important.

Getting a handle on these school-time ailments, as well remembering to help ensure your children get a good night’s sleep and eat a good breakfast, will go a very long ways towards making this a more enjoyable and productive school year.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Tending to Tummy Time Troubles & Going Back to Sleep

Back-sleeping and tummy time are common phrases in today’s parenting lexicon. Yet that hasn’t always been the case.

The Back to Sleep Campaign – primarily responsible for the switch to back-sleeping babies and related recommendations for tummy time while awake — was launched in the mid-1990s to educate parents, caregivers and health care providers about ways to reduce the risk for Sudden Infant Death Syndrome (SIDS).

At the time, this represented a big parenting shift. Before this public education campaign, parents had little reason to think twice about putting babies to sleep on their bellies. Generations of parents routinely did so. But with compelling evidence to support the Back to Sleep campaign’s primary message — that placing babies to sleep on their backs reduces the risk for SIDS (sometimes referred to as “crib death”) – great progress was made in helping babies sleep safer.

Just how much progress? It is estimated that since the campaign started, the percentage of infants place on their backs increased dramatically while at the same time, overall SIDS rates decreased by more than half.  As far as public health campaigns go, the Back to Sleep campaign is a hands-down success, and the benefits of raising back-sleeping babies and creating safe sleep environments are as clear as ever.

What isn’t always so clear, however, is how parents and caregivers should go about compensating for all this additional time that babies spend sleeping on their backs. By compensating, I mean tummy time. Encouraging back-sleeping babies to spend awake time on their bellies can help stave off the dreaded “positional plagiocephaly,” more understandably referred to as a flat head.

This all might sound fairly straightforward, but I am routinely asked about, interviewed on, and pressed on the subject of tummy time (and the challenges it seems to pose). How much time should babies spend on their tummies? What can one do to encourage tummy time? Is there a certain position babies should be put in? What if they don’t like it?

My first child was born right around the time that the Back to Sleep Campaign was really taking hold. As a pediatrician-in-training, I was well aware of the recommendations, and my daughter didn’t seem to have any problem following them as she established herself as a very good back sleeper. The problem was that I was far more comfortable with the recommendation for her to spend plenty of time on her tummy while awake than she was. Every time I put her on her belly, she’d squawk, cry, push off with her feet, and convince most everyone around her that she was in great distress. I managed to convince myself that her tummy time displays weren’t truly those of a distressed child, so she did get in a sufficient amount of tummy time. I find, though, many parents find tummy time troubling.

Try the following tummy time tips and tricks to help take the pressure off of you as well as your baby!

  • Tummy timing: The key here is quite simple. Just remember back while sleeping and tummy while awake. Despite what you may have been led to believe, there are actually very few rules about how much time a baby needs to spend on his tummy. There’s no need to set a timer, mark your calendar or otherwise formalize what essentially boils down to a simple concept. Just make sure your baby sleeps on his back, and then I commit to trying to make tummy time your baby’s default for hours when he’s awake.
  • Make tummy time a habit. I’m well aware that this may sound like stating the obvious, but it has been my experience – both in dealing with parents and with child care providers – that laying a baby down on her back seems to be somewhat of a force of habit. That’s great if you’re talking about a baby who’s going to sleep. But if it’s on the floor or a playmat, for example, it can take a conscious  effort to switch to the routine of placing an awake baby on her tummy.
  • Understand the benefits. There’s no magic to tummy time. Simply put, until they  learn to roll, sit and crawl, babies generally spend an impressive amount of their time laying down. If all of this down time is spent with pressure being put on the same spot(s) on the back of their skull while it’s still somewhat soft and not fully formed, it’s bound to make an impression. Tummy time not only takes the pressure off, but also allows babies the ability to strengthen their head and neck muscles.
  • Tummy time entertainment. Not all babies need to be entertained in order to be coaxed into spending time on their tummies. Some are perfectly content to lay there and look around. Feel free, however, to help your baby enjoy this new view of the world by placing toys in front of him, help him prop himself up a bit on his elbows, and even lay down facing him so you can look at, talk to, and even sing face-to-face.
  • Tummy time dissenters. If your baby is a tummy time squawker, as mine was, then don’t be discouraged. Make sure you ask yourself whether your baby’s squawks truly count as cries of distress or rather of effort. While my daughter’s cries certainly had my mother-in-law distressed, in reality my squawking little newborn really wasn’t truly upset, she managed to keep her perfect little round head and build up her tolerance for tummy time while all the while mastering the skill of scooting long before she could even roll, and I have some impressive baby videos to prove it.

Originally posted on Omaha World Herald’s Live Well Nebraska

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I admit it – I do well with resolutions. I truly believe that people tend to accomplish more when they have a set goal in mind. I personally love to rise to a challenge, and find that setting a formal (and preferably public) goal definitely has a way of bringing out one’s competitive nature.

So when it comes to New Year’s resolutions, I have to say I’m a believer. As someone dedicated to promoting health and safety year-round, I obviously think it’s important to set goals throughout the year. But if ushering in a new year happens to give you an increased sense of motivation, then by all means, run with it because now is the perfect time to shift gears from helping your children create holiday wishlists to helping them (and you) focus on setting some realistic family goals that are sure to deliver on the promise of an even happier, healthier 2012.

Okay, so what’s the best way to figure out what one’s family goals should be? While each of your family members’ individual resolutions can be customized according to age, ability, and circumstance, I figured it might be helpful to get you started by offering you some simple family-friendly resolutions – you know, those completely do-able resolutions that don’t seem nearly as challenging as, say, signing up for a gym membership in January only to lack the willpower come March to make use of it. Or running a marathon. While there’s nothing wrong with either of those resolutions (I’ve made them both myself in years past), there’s nothing wrong with first reaching for the “low-hanging fruit” resolutions that are sure to give your family both a sense of accomplishment and a big bang for your buck when it comes to improved healthy, safety and well-being.

–       Walk more. That’s right, walk more. Around the block, to the grocery store, with friends, on the treadmill – wherever and whenever you can. Running is fine, too. But if that seems a bit daunting or impractical, the important thing for kids and adults alike is to be more active in 2012. As someone who just placed my own order for a FitBit, let me add that if you and/or your children are more likely to put their best foot forward with a concrete goal (or a cool new gadget), then using a pedometer may prove to be just what it takes to get up and get going.

–       Sleep more. You see – I told you these resolutions would be attainable, if not downright desirable. I mean, who doesn’t want to sleep more? But as a pediatrician married to a surgeon and therefore accustomed to dealing with the demands of both professional schedules and with the many sleep-related challenges of parenthood, I fully understand why most of us simply don’t get enough sleep. I have also become increasingly impressed with how important sleep is to one’s overall health. So whether it’s an improved bedtime routine for babies or toddlers, taking/keeping the TV set out of your child’s bedroom, keeping tabs on your teenager’s sleep habits or simply placing more value on your own sleep needs – I strongly recommend it.

–       Read more. Daily, whenever possible. Not just for work, not just when your kids are required to, but for fun. Read aloud to your kids. Read quietly alongside them.  Make a point of reading the newspaper. Encourage your tweens or teens to start reading it too. Read on paper or in any electronic form you choose. Regardless of what angle you take, resolving to read more will enrich your family’s new year.

–       Drink more. Water, that is. Just back from a recent trip to NY where I discussed water as a key aspect of health, hydration, and tackling the obesity epidemic with a wide range of magazine editors, I decided to toss it in my resolution list. It’s not just because I think drinking more water is the one and only solution to better health, but because it strikes me as such an easy one once you and your family set your minds to it. The goal in encouraging more water consumption in large part actually relates to getting everyone (kids and parents alike) to drink less soda, less juice, and less sugary liquids in general. If your family is not in the water-drinking habit, consider committing to milk with meals and water with snacks, and making water more appealing by filtering it (typically tastes better), bottling it (re-usable water bottles are both convenient and better for the environment), or simply adding some natural flavor (a wedge of lemon/lime or even a slice of cucumber!).

–       Engage more. Social networking now seems to be the key to everything from successful weight loss to professional success. Yet one of the things we risk in what is sure to be an increasingly wired (or wireless) 2012 is the lack of meaningful, personal engagement with others in our community. That’s why I firmly believe that all families should set a goal of teaching their children to more actively engage and become contributing members of society. Taking some lessons from the Helping Hands curriculum at my child care center, this can be as simple yet meaningful as having even very young children visit the Humane Society or a local retirement home; send letters of thanks to those serving in the military; and/or collect mittens, books, pennies, diapers, coats or cans of food for those less fortunate. Whatever you choose, remember that one of the most powerful lessons we stand to teach our children (and live by ourselves) is that it is our meaningful connection with others that brings the most happiness.

–       Laugh more. At yourself, with your kids….the point is that while resolutions can be a good way to improve one’s health, it’s just as important to make sure that stress doesn’t get the best of you. I’ve found the best way to do this is to remember to laugh, and always remind yourself of how fortunate you are to have your family, your friends, your health, and the gift of another year.

On that note, I want to take this opportunity to wish you all a very happy, healthy and accomplished new year. I’ll look forward to sharing 2012 with you and everyone in the Live Well Nebraska community.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Parenting News Flash: TV Under 2 isn’t exactly educational

Recent advice from the country’s largest advocacy group for children leaves me concerned that what I’m about to write is going to be met with poor reception. Following extensive review of more than 50 research studies, the American Academy of Pediatrics released its October 2011 Policy Statement: Media Use by Children Younger Than 2 Years. I would like to think that all parents of young children tuned in, but for those of you who missed it – here are some of the highlights.

First, let’s start with a few facts about the current state of our children’s media diet. A full 90 percent of parents report (admit?) that their children under the age of 2 watch some form of electronic media – on average consuming 1 to 2 hours of television a day. For 1 in 7 of these young children, we’re talking 2 or more hours a day of media. By age 3, nearly one-third of our nation’s youngest have televisions in their own bedrooms. While these numbers may not be entirely surprising, given the ubiquitous nature of ipads, iphones, ipods, computers, laptops and TVs, they should nevertheless be disturbing given what we know about the potential effects of screen time for babies and toddlers.

There are several important questions we all should now be asking before taking even one more baby step towards the TV set.

  • Are infant- and toddler-directed programs educational?
  • Is there any harm in letting babies and toddlers watch TV (and other screens)?
  • What is “secondhand TV” and why should I care?

Let’s start with the question of educational value. In the words of my pediatric colleague (and the lead author of the policy statement) Dr. Ari Brown, the phrase “educational TV/videos for children under two” is an oxymoron. That’s because in order for anything to be educational, children need to “get it.” This inherently involves understanding both the content and the context. Given that young children have been shown to fundamentally lack the ability to distinguish between programs shown backwards from those shown forwards, one would be hard pressed to suggest educational benefit from watching. Sure these TV-viewing infants and toddlers laughed at viewings in both directions – suggesting some entertainment value – but entertainment does not equal education.

That’s not to say that there’s no such thing as educational television, or that educational television can’t be entertaining. Studies have actually shown proven educational benefit for children over the age of two from quality shows such as Sesame Street. It’s just that if you happen to be one of the majority of parents who have been led to believe (most likely by extensive explicit and/or implicit marketing) that TV programs and/or videos are going to enhance your baby or toddler’s intellect, you need to tune into the fact that it’s simply not.

Okay, so screen time isn’t the answer to making your baby smarter. What about those parents who readily admit they use the TV (and various other screens) as a sure-fire reprieve from entertaining their babies/toddlers just long enough to make dinner, take a shower, make a phone call….you know – all those things that just about all parents of young children struggle to find time to do in the day. I get that, and readily admit that TV did, on occasion, get used as a babysitter in my own household.

But the fact of the matter is that there are several key concerns regarding the time toddler and infants spend in front of screens, not the least of which involve language development. We already see expressive language delays in the short term. And the fact that we don’t yet know for sure about screen time’s long-term effects on language should not rule it out. In the meantime, there is a valid concern that screen time interferes with “talk time” – especially given findings such as the fact that 84 percent of parents talk less when the TV is on, and 74 percent use fewer new words. This is huge, considering that we’re talking about the most crucial time for language development.

There’s also reason to worry about the quality of sleep our children are getting. While most studies thus far have looked at media effects on older children, we know that healthy sleep habits impact just about every other aspect of all children’s health. Remember that a reported 30 percent of kids under 3 have TVs in their bedrooms. We clearly need to tune in to the possibility that their sleep may be suffering as a result.

Even during our children’s waking hours, the time that babies and toddlers spend in front of screens may simply not be time well spent. Not if it ends up displacing reading, playing, and entertaining oneself. We know that free play is hugely important for young children’s development, as are 3-dimensional, real world interactions with parents and other caregivers.

I would imagine with all of that, many of you may now be tempted to adjust your child’s media diet just a bit – and that’s great. But before you simply commit to eliminating an episode or two of toddler TV from your child’s daily viewing schedule or limit how often your baby watches his admittedly captivating video, don’t forget to take into account your own viewing schedule. That’s right – the evidence presented by the AAP is equally worthy of your attention when it comes to having your own shows on in the background. In other words, as parents we also need to take into account what is now being referred to as “secondhand TV” – an unintended exposure that is occurring in an estimated 40 to 60 percent of households across America. While parents may report “the TV is on but no-one is watching,” the fact of the matter is that someone is watching. Someone, as in our children. One study found that young children playing in a room shifted their gaze to the television that was left on in the background three times every minute!

So with that news flash, what’s a parent to do? Pediatricians fully understand that screens are everywhere, and it is entirely unrealistic to avoid exposing young children 100% of the time. But it is well worth your time to acknowledge that in many instances, there are better things for them to do to help them learn and develop. The AAP recommends the following strategies for making this happen.

  • Set media limits for children under two, bearing in mind that the AAP discourages media use for this age child.
  • Opt for supervised independent play rather than screen time to occupy your child when you aren’t able to sit down and actively engage in play. A simple set of nesting plastic cups on the floor can work wonders for engaging toddlers while their parents prepare dinner.
  • Keep TVs out of all children’s bedrooms
  • Recognize that your own media use can have a negative effect on your children. Help your child avoid secondhand TV exposure.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Raising Healthy Kids: Reaching for the Low-Hanging Fruit of Parenthood

For good or for bad, parents today are faced with the fast paced nature of both the real world and a virtual one. Much of the virtually continuous stream of information, videos, tweets and texts we receive on a 24/7 basis relate in one way or another to what we can, should, and/or are expected to do to be good parents. And let’s face it – keeping up with all of the modern-day parenting advice would be hard enough even if all of it was fact-checked for us. Unfortunately, this is not often the case, as much of what we hear, see and read is unfiltered, potentially unfounded, and confusingly contradictory.

Having spent much of my professional career as a pediatrician increasingly committed to making sense of pediatric and parenting advice in both of these worlds, I have found that what parents often want to know from me is simply how to filter the good from the bad and separate fact from fiction.

Knowing that you all are probably as busy as I am, I decided that this week I would distill down to as few words as possible the handful of things I consider to be some of the most well-founded, important things you can do as parents can do to make your kids smarter, safer and healthier. In other words, the following is my list of the “low-hanging fruit” of parenting.

Move more. I feel the need to say this because it’s painfully obvious that it has become incredibly easy for our children (and for us) to barely move in the course of any given day. Whether it’s walking instead of driving to school (or work) or taking an evening walk around the block, getting out of the car instead of rolling your way through drive-thrus, or signing up for organized sports, joining a gym, or participating in more vigorous daily exercise regimens – every step counts towards an healthier life style.

Use restraint. Literally speaking, I’m simply referring to the use of car seats and seat belts in motor vehicles. With motor vehicle crashes clearly identified as the number one cause of death in children, and the correct use of car seats and seatbelts clearly shown to have a huge impact on reducing motor vehicle-related injuries and deaths, taking the time to buckle up comes with a huge return on your parenting investment.

Read. For every parent who has ever asked my opinion on what they can do to help their children become smarter, excel in school, or head down a path of success, reading always factors in to my answer. Reading aloud to babies, toddlers, young children and teens alike not only fosters improved language skills, but also a love of reading that will serve children well for their lifetime. One of my favorite sayings to emphasize this point is that children spend the first few years of school learning to read, and the rest of their lives reading to learn.

Sleep. For parents of infants and young children, this conversation usually focuses on getting children to fall asleep, stay asleep, sleep in their own room, and do so without requiring repeated interventions. For parents of teens, the conversation often shifts to too little and too late. But regardless of your child’s age, it is becoming convincingly clear that instilling your child with good sleep habits is not only a good thing for your own chances of getting a good night’s sleep, but your child’s overall health and well-being.

Wash your hands…and while you’re at it, remember to cover your cough (preferably with your arm rather than your hand) and vaccinate. The fact of the matter is that while modern day science and research is continually coming up with new medicines, treatments and technologies to improve our families’ health and more effectively treat disease, the simple act of teaching our children to wash their hands (which includes committing to consistently doing so ourselves) remains one of the single most effective things we can do to limit the spread of disease. So is protecting against all of the vaccine preventable diseases.

Originally posted on Omaha World Herald’s Live Well Nebraska