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Children, Sleep, and the Pediatric Sleep Debt Crisis

Sleep is very in vogue right now (literally, it’s in Vogue) — and we’ve been hearing all about how important it is to get enough (good) sleep in the media, on podcasts, and in books over the last couple of years. Yes, it seems clear that sleep — the overlooked sibling to diet and exercise — is indeed a pillar of a healthy lifestyle.

But few Americans actually get enough sleep…

children sleep - sleep debt

…and I was struck by a recent piece published in JAMA Pediatrics announcing that children in particular are suffering from a “sleep debt crisis.” 

Pediatricians are saying that “chronic sleep loss is endemic to children.”

This is shocking to me: over half of children in the US — some 29 million kiddos — are sleep deprived. And unfortunately, these effects tend to fall along class lines. Children living in poverty or with diminished access to resources are the most likely to suffer from a lack of sleep.

But the problem is apparently a public health mess.

Sleep deprivation impacts “every aspect of children’s and adolescents’ well-being and daytime functioning.” Every aspect

“Healthy sleep is essential for child health.”

children sleep nap - sleep debt

As scientists are learning more and more about the importance of sleep, they’re increasingly urging that we take the time to think about the ramifications of sleep debt and poor sleep for kids: sleep, the JAMA authors say, can influence “some of the salient challenges for families,” like school performance, friendships, behavior, and more.

For babies and toddlers especially, “sleep is the primary activity of the brain during early development.” If little children need nothing else, they need sleep.

And so, some doctors are pressing for a “stimulus package” (!!) to address widespread pediatric sleep debt. Here’s some of what they’re calling for: 

  • Treating sleep as a vital sign that pediatricians would monitor at regular well-child visits, no different from height/weight/eyesight; 
  • Improving data collection and available resources on sleep behaviors for families (including — somewhat controversially, I think — the use of electronic monitoring devices and apps for sleep tracking); 
  • Initiating a public health campaign to get the word out about the significance of pediatric sleep health; 
  • Delaying school starting times (no earlier than 8:30);
  • Improving parent/physician communication about pediatric sleep. 

Needless to say, rebranding sleep is NECESSARY, but it’s not going to be an easy battle. In fact, it strikes me as a project fit for the likes of Don Draper: transform sleep from a marker of laziness, sloth, apathy to a desirable bragging right, a staple ingredient for good health, a hallmark of wellness.

sleep debt - marketing sleep
“sleep: gotta do it”

Some of this work is already underway: we do seem to be in the midst of an emergent (and overdue) cultural sleep renaissance. Americans are learning to prioritize sleep and to take it more seriously, I think (if slowly). (Although, nothing instills the value of sleep quite like new parenthood.)

children sleep baby - sleep debt

I admit, I’ve jumped aboard the sleep train like it’s a freaking PARTY. I love sleeping. I suck at it (ugh), but I still love it, and I’ll keep trying my best. 

And with my kids, “trying my best” means being just a *tad bit* of a fanatic. I’m not particularly proud of the hard line I take when it comes to my kids and sleeping, but let’s be honest: I am the one who deals with the repercussions of a super-late night, a skipped nap time, or an unexpectedly-bright-and-early morning, so I’ve been loathe to stray from my family’s carefully-culled sleep routines. 

children sleep bed -sleep debt

Which is why I think starting a conversation about the importance of sleep in early childhood is a step in the right direction.

The concept I most love about striving to prioritize sleep for my children: that in so doing, I am giving them a gift —  “the gift of a good night’s sleep.”

Pediatric Sleep Debt: Doing the Math

You know why it’s hard to give our kids enough sleep? Because we’re busy, that’s why. And putting our kids to bed early, at an age-appropriate time, just doesn’t work with our schedules.

But, according to the AAP, here is roughly the amount of sleep kids should be getting:

  • Infants 4 months to 12 months ~ 12 to 16 hours per 24 hours (including naps)
  • Children 1 to 2 years ~ 11 to 14 hours per 24 hours (including naps)
  • Children 3 to 5 years ~ 10 to 13 hours per 24 hours (including naps)
  • Children 6 to 12 years ~ 9 to 12 hours per 24 hours
  • Teenagers 13 to 18 years of age ~ 8 to 10 hours per 24 hours

That means if your kindergartener needs to catch a bus at 7:30am (gulp), they’ll wake up at 6:30am and need to be asleep by about 7:30pm, which means heading up to bed even earlier…. As you can see, it doesn’t leave a lot of time for dinner and such. Working parents often feel this squeeze the hardest. Imagine if you don’t even get home from work until 6:30. Then it’s like… the mad dash to do dinner and bath and everything in one hour.

BAH! There’s not enough time!

mom mother GIF - sleep debt

So we keep our kids up a little later so we can see them. That’s just life.

Pediatric Sleep Debt: Nighttime at Charlene’s

My husband is a pediatric anesthesiologist at one of the busiest Children’s Hospitals in the New York City/Long Island area. He’s got a busy schedule, with an average of 8 to 10 calls and late shifts every month. More often than not, he gets home after our children’s bedtime — if he’s lucky (with traffic and all), he gets the luxury of tucking them into bed. There are weeks when he only sees our boys 2 or 3 times a week, which means he misses a lot of quality time with them.

So when he does make it home in time to see them, he often keeps it going wayyyy past their bedtime. Cute (and probably necessary for their relationship), yes! But the boys still have to wake up at 6:40am on weekdays, even if they go to bed at 8:30pm. And let me tell you — the difference one less hour of sleep makes on their moods is… astounding! They’re cranky, they don’t listen, and they’re just overall “on the edge.”

Since all the public schools in our neighborhood start at the same time (8:25 am), the only option to sleep a little later is to switch them to a private school. But it’s a lot more costly, and many of them are farther away, which means longer commutes and thus the same (if not earlier) wake-up times. So for now, we’re simply doing our best to put our kiddos to bed by 7:30pm and deal with the consequences of sleep deprivation when we keep them up to see daddy.

Bottom line: Sleep is hugely important for so many reasons, and kiddos need a lot of it. That said, honoring our children’s sleep needs is hard!! As parents, we need to figure out a way to prioritize our kids’ sleep, while also maintaining a realistic routine and lifestyle that works best for the entire family. There’s no one perfect solution, that’s for sure; what matters most is that we do the best we can and remember that adequate sleep is crucial for the health and wellbeing of… everybody.

What do you think about the sleep revolution? How do you handle sleep in your family? 

PS — You can read more about how to promote sleep for your family here — and take note that there is no one right way to do so.

Comments

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    The classic book on this issue is Healthy Sleep Habits, Happy Child, by Marc Weissbluth, MD. We call it the “sleep bible” in our home and it should be essential reading for parents of children at any age.

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