When the American Academy of Pediatrics issued their last book on sleep advice nearly 15 years ago, cribs with drop-down sides were perfectly safe and teens weren’t texting into the wee hours of the night. Now the pediatricians’ group has a new book called Sleep: What every parent needs to know and the book’s editor Dr. Rachel Moon said the old version had to be completely scrapped and rewritten because so many of the sleep issues she hears about regularly from parents weren’t around in the late 1990s. What’s more, some of the advice she learned during her training as a pediatrician has become outdated.
I was curious about how much had actually changed since I first became a parent 18 years ago. Before I’d gotten to the end of the book’s introduction, I found something that I was never told to do: Keep a newborn in the parents’ room for up to the first year of life.
Moon wrote, “I prefer that a baby sleep in the parents’ room for the first 6 to 12 months of the baby’s life because room sharing without bed sharing is safest for the baby.’’ If the baby is still in the room after the first year, she asks during the appointment, “is everyone okay with that?’’ and goes on to urge parents to determine when it’s best for their child to move to a separate room — and not to wait for the child to decide.
I asked Moon, a professor of pediatrics at George Washington University School of Medicine in Washington, DC, to name the five biggest things that have changed when it comes to advising parents on smart sleep strategies in children of all ages.
1. Teens need limits on nighttime screen time. “The impact of technology has been the biggest change,’’ Moon said. “Smart phones, social media, and texting weren’t around a generation ago and are much more pervasive in our lives than TV ever was.’’
Light exposure and action from video games and social networking can rev up the brain disrupting the body’s natural circadian rhythms that make kids feel drowsy close to bedtime. “We recommend that all technology be turned off an hour before bed,’’ Moon said. That includes cellphones, so teens aren’t awakened by buzzing texts and tagged status updates that get sent at all hours of the night.
2. Room sharing, but not bed sharing, is encouraged for infants. In 2005, the AAP started recommending that parents place bassinets and cribs in the master bedroom for the first six months to a year. This was based on research showing a lower risk of sudden infant death syndrome among babies who roomed with their parents. Risks of suffocation, however, may be higher when babies sleep in bed with their parents, Moon said, so this practice isn’t recommended.
3. Cribs with drop down bars should no longer be used. They pose a risk of injuries and have been pulled from the market by the Consumer Product Safety Commission. Along with the drop-down ban, the federal agency also issued new safety standards for cribs in 2011 that strengthen crib slats and mattress supports, improve the quality of hardware, and require more rigorous testing. So, no, parents shouldn’t borrow an old crib from a friend or family member.
4. Parents need to curtail their kids’ caffeine intake. With the boom in caffeinated energy drinks and Starbucks’ beverages that taste like milkshakes, kids are becoming caffeine addicts at younger and younger ages — and this is likely keeping many awake at night. “I’ve started asking about tea consumption in my practice,’’ Moon said, since so many kids now drink Snapple and other iced tea products instead of water or milk.
“A lot of parents give their kids green tea thinking that it’s healthier but it often contains a lot of caffeine,’’ she added. The AAP takes the position that the less caffeine kids have, the better, but Moon said kids should avoid all caffeinated products after 6 p.m. to avoid sleep disruptions.
5. As more kids get diagnosed with autism and ADHD, parents need to deal with their unique sleep problems. Prescription stimulants used to treat attention deficit hyperactivity disorder have contributed to sleep problems in children since that’s a common side effect that often occurs either from the drugs themselves or as these drugs wear off at night which triggers more hyperactivity.
Some children’s sleep problems can be alleviated with a set bedtime and a calming routine at night involving dim lights, a bath, or quiet activities. Others may benefit from the hormone supplement melatonin to induce drowsiness or a low-dose of their prescription stimulant at night. Supplements and prescription changes should only be initiated with a doctor’s guidance, Moon said.
Sleep problems often plague children with autism and can cause nighttime awakenings. Melatonin supplements or an over-the-counter antihistamine that causes drowsiness could be used as remedies; in severe cases, doctors may prescribe certain antidepressants like mirtazapine or trazodone.