Issue Date: November 17, 2002

In this article: What childhood sleep disorders look like Also this week: Meet the Tutts: Dr. Tedd makes a house call Follow-up visits from Dr. Tedd Health Briefs: Crying babies, light therapy for prostate cancer, duct tape for warts, etc. Ask Dr. Tedd Mitchell a health question

Past House Calls #1: Heart Health: Meet the O'Briens #2: Meet Debbie Handkins. Arthritis. Asthma. Migraines. #3: Meet the Urbans. Prostate cancer. Diabetes. Back pain.

Sleep trouble in school-age kids

Up to 30% of children don't get enough sleep. The fallout: problems with behavior, learning, health and safety.

By Patty Rhule

In an on-the-go nation that prides itself on "getting by" on very little sleep, children are the latest victims of this cultural disinclination toward rest.

But sleep experts say a bit more sleep can make your children better behaved, better able to learn and -- get this, teens -- better looking.

Parents are frequently unaware of the subtle signs of chronic, low-level sleep deprivation in children, says Judith Owens, director of the pediatric sleep disorders clinic at Hasbro Children's Hospital in Providence, R.I. Behavior and mood changes may be due to sleepiness.

Scientists don't know exactly what goes on in the body during sleep, but if a child doesn't get enough, it can stunt growth and weaken the immune system.

In fact, some children are mistakenly diagnosed with attention deficit/hyperactivity disorder when all they need is more or better sleep. "Children react to sleep deprivation with hyperactivity," says Richard Gelula, executive director of the National Sleep Foundation (www.sleepfoundation.org). "It's a coping strategy for maintaining wakefulness."

Experts think sleep has a role in processing outside stimulation. Sleep seems to be important for learning and memory, "not just learning facts, but also learning skills," says Ronald Dahl, professor of psychiatry and pediatrics at the University of Pittsburgh Medical Center. "Something about sleep helps consolidate or support learning."

Babies, who are sponges for learning, sleep more often and more deeply, and dream more than other age groups. But in school-age children, unyielding classroom schedules, after-school activities and homework are at war with sleep.

Dahl estimates 10% to 30% of children suffer symptoms of insufficient sleep. It's especially true for adolescents, who struggle to get enough sack-time as body clocks shift, activities keep them up later and school buses come earlier.

"Young people are leading an incredibly hectic life," Dahl says. "Sleep is the one thing that goes."

Beyond under-eye bags and a tired appearance, there are dire consequences. "The youngest drivers are horribly over-represented by late-night accidents," Dahl says. "Somebody's probably falling asleep. They're just learning the skills. They're sleep deprived. Add alcohol ... [and] you couldn't make a more volatile mix for disaster."

For adolescents already hit by strong emotions, lack of sleep makes it more difficult to control them. "It's the equivalent of a toddler falling apart," Dahl says. "They just can't control what they're feeling."

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What childhood sleep disorders look like

Sleep deprivation is simply a shortage of adequate rest. To encourage your child to sleep, establish a 20- to 30-minute calming routine before putting him or her to bed. For elementary-school ages, bedtime should be 8 or 9 p.m.

Sleep disorders are diagnosable medical conditions. Although children have the same disorders as adults, they often manifest themselves differently. Here are four conditions.

Most common among children is obstructive sleep apnea, in which the body is roused from sleep because a blockage in the airway makes breathing difficult. Common among 3- to 6-year-olds, apnea can cause snoring, noisy or labored breathing, and overall tiredness in a child. Apnea has heredity links and is tied to obesity. Generally, it is cured by surgical removal of the adenoids or tonsils, or through a weight maintenance program. Children with apnea can be irritable and have symptoms similar to attention deficit, night sweats, or wake with a dry mouth or headache, says Clete Kushida, director of the Stanford Center for Human Sleep Research. In chronic cases, apnea can retard a child's growth.

Bed-wetting is more common in boys than girls and generally is outgrown, Owens says. Alarms that wake the child to go to the bathroom are the best treatment, she says, and there are medications as well.

Night terrors and sleep walking are related disorders that children generally outgrow by adolescence. These are benign disorders and don't mean a child has been traumatized, clinic director Judith Owens says. Nonetheless, they are frightening to witness: A child may scream, struggle or speak gibberish, and nothing a parent does can console him.

It's caused when the child is "caught" between deep sleep stages and wakefulness. Parents with sleepwalking children

should take safety precautions to prevent them from leaving the home, Owens says. It's important that these children get adequate sleep; if the body is shortchanged, it naturally goes into the deep sleep stage, which could prompt more episodes.

Narcolepsy -- in which the body suddenly collapses or grows weak or paralyzed, or the child hallucinates -- typically peaks around age 14, Kushida says. Scheduled naps can help this disorder, as can medications such as tricyclic antidepressants.