Melanie Cole, MS (Host): Welcome to Children's Health Checkup, where we answer parents' most common questions about raising healthy and happy kids. I'm Melanie Cole. And today, we're talking about teenage fatigue. Why is my teen always tired? Joining me is Dr. Erin Wallace. She's a pediatrician at Children's Health Primary Care Mansfield.

Dr. Wallace, thank you so much for joining us today. So, let's talk about teens because they are on a whole different planet, and we know that. If you're a parent of teens, you know that this is a very interesting time of life. So, let's start with fatigue. Is it normal for teenagers to seem or feel tired all the time?

Dr. Erin Wallace: Sure. This is actually a really common complaint that I see on a weekly basis in my office. So, I would first say that it is normal for teenagers to feel tired sometimes, but it's not normal for teenagers to be tired all the time. And so, what I mean by that is if your teenager is complaining of feeling tired, but then you guys go on vacation and they come back and feel rested, usually, that's actually really reassuring that there's not anything serious going on with your child's or your teenager's fatigue.

Melanie Cole, MS: Okay. So, that's good to know. When we think of sleep, and we know that it's elusive in some teens' orbit because they're on their phones and there's all this different blue light and maybe they stay up late studying and, again, they're on laptops. They have terrible sleep hygiene. Let's just say that, right? So, how much sleep do teens actually need? Why are their sleep needs different from those of younger children and adults?

Dr. Erin Wallace: Sure. So, teenagers on average need anywhere from about eight to 10 hours of sleep per night. Their brains naturally release melatonin, which is that I'm getting tired hormone later than children and adults. And so, that's why when mom has come in and said, "Hey, it's time for bed," and the teenager's like, "But I'm not tired." It's because naturally their melatonin hasn't released.

The other thing is certainly, just that natural sleep cycle of if my melatonin to make me tired releases later and I'm not as tired, but then with life and how society is, school starts early in the morning, so that conflicts with their just natural sleep cycle.

And like you certainly alluded to, phones, social media, tablets, being on computers, doing your homework late at night, burning the candle at both ends, sports, extracurricular activities, stress, anxiety, friends, family, and just those inconsistent sleep schedules, all of that contribute to teens being tired.

Melanie Cole, MS: Can poor nutrition or eating habits contribute to teen fatigue too?

Dr. Erin Wallace: Yes. So especially for a lot of teens, certainly if they're doing athletics, there are teens that have decided from a lifestyle standpoint, "I want to be a vegetarian or a vegan." Those will increase your risk of iron deficiency anemia. So if you're sitting around eating your Hot Takis and drinking Gatorade all day, you're really not getting iron in your diet.

And then, also, females, they have the disadvantage of every month they have their periods, which also sets them up for iron deficiency. So certainly, poor eating habits contribute to that fatigue.

Another common thing where we say breakfast is the most important meal of the day, a lot of times teenagers given the option of hitting snooze and sleeping an extra 10 minutes versus eating breakfast, they usually pick sleeping over eating, and a lot of times will skip breakfast and not getting that good protein-rich breakfast to kind of start their brain for the day, can also contribute.

Melanie Cole, MS: Yeah, you're funny with the Hot Takis, because they do like those. And of course, there are the kids that run out of the house with a Hot Pocket in their hand and eating that on the bus. So, some of them are getting breakfast. But for the most part, as you said, they're really not.

So, Dr. Wallace, how do we tell the difference between normal teenage tiredness and something more concerning? Are there some red flags you'd like to tell us about that should prompt us to schedule an appointment with our child's physician?

Dr. Erin Wallace: So, fatigue deserving medical attention, certainly if it's been going on for longer than a month or two, if the parents are noticing significant weight loss or weight gain, if the teenager is also starting to have more somatic complaints, so headaches, abdominal pain, if dizziness or even fainting is associated with it. For females, heavy and frequent period cycles. And then, certainly, if you're also starting to see behavioral changes with concerns for depression or anxiety, failing grades where your child used to do really well in school, or just that persistent fatigue of "I'm sleeping that eight to 10 hours at night. But then, I'm still coming home and taking two or three-hour naps, just kind of the extent of the fatigue."

Melanie Cole, MS: Well, thank you for letting us know those warning signs. Now, you just briefly touched on something that I think is an issue with teens, and that's depression and anxiety disorders. Are you seeing, Dr. Wallace, more of these anxiety disorders in teens lately? Tell us what you're seeing.

Dr. Erin Wallace: So, we have seen a significant increase in mental health disorders. I do think that there is a strong correlation certainly with social media, screen time, and then just all of the normal things that we didn't have 15, 20 years ago with the social media component, but just all of the things that we had discussed before, certainly just school stressors, family stressors, those types of things and, certainly, as the adolescent's brain is continuing to grow and develop, the contribution of social media and being on tablets.

So with that light or that screen, I tell parents that you really want to stop your child's screen time, whether that is on the phone or doing their homework. You really want to shoot for one to two hours before bedtime simply because there are a lot of brains, and the teenage brain being most susceptible to that, that if I'm getting that signal of light, then my brain thinks that it is still daytime, and won't start to release that melatonin. And so with that, then, again, you know, the child is not getting as much sleep, which then does set them up for more mental health issues, because of poor rest and poor sleep.

But then, also, the other X factor of being on social media is the continuous scroll. The scroll is never ending. And so, even if your teenager is sitting there and like, "Oh, I'm just going to look one more thing. Oh, just one more thing." And then, all of a sudden three hours has passed.

And then, certainly, you can go down the entire rabbit hole of cyberbullying and messaging and the pictures and all of those things that can contribute when they are online. And so, really, that whole just combination of just being a teenager and then you throw basically the gasoline on the fire with social media and that definitely does contribute to the mental health issues that we see with kids.

Melanie Cole, MS: Wow. Yes, you said it perfectly. I mean, as far as sleep, energy levels, all of those things can be affected by those screens and social media and technology. And, you know, as somebody who does like to scroll myself, I don't mind watching my recipes on TikTok. I do know how truly addicting it can be.

But when we think of our kids and their fatigue, their energy levels, their motivation, their discipline, all the things that go into this, Dr. Wallace, what are some practical steps that you advise families every day that they can take to help their teens get better sleep, improve their energy levels, and really that helps with some of those mental health disorders you were mentioning?

Dr. Erin Wallace: So, the easiest is also the hardest, which is remove the phone from the room. So really, having your teen's bedroom, the bed is for sleeping, not scrolling, not talking on the phone. It is just when it is time for bed, to be very just almost rigid about "We're going to get that eight to 10 hours of sleep." And so, really, trying about an hour before bed that the phone goes into a central area where even mom and dad try to not do as I say, but do as I do. And everybody's phone goes in the same spot. The teenager then spends the next half hour, 45 minutes winding down, doing quiet things.

So whether that's taking a hot shower, some kids if they enjoy drawing or journaling, listening to just calming music. And then, really, shooting for a pretty similar bedtime-wake time most days, if that's possible. Again, burning the candle at both ends sometimes, so school activities, but also really looking at your child's academics and their extracurricular activities and really trying to not overschedule them. Allowing them to explore and do things that they want to do, but not where they're losing good sleep for their just overall brain growth and their overall mental health.

Certainly, trying to encourage physical activity. And some kids, they do that on their own because of activities that they're in. But even if it's just that "Every day, I'm going to walk with my teenager. We're going to go walk around the block to just get their bodies moving, and then getting rid of just some of that energy of, 'I've been sitting all day in school.'"

Avoiding late-night caffeine. I generally tell my patients that if they're going to have their sweet tea or they're going to have their sodas or their Starbucks, they really need to cut that off by noon, so that the caffeine's not contributing to their I'm not tired feeling. Also, workout supplements or energy drinks that some kids will drink before or after workouts, really trying to avoid those things. But the easiest, which is the hardest, is keep the screens out of the bedroom.

Melanie Cole, MS: Well, it's all great advice. And as adults, we really do need to model this behavior you're discussing. And as you said, it can be great to do those family walks and eat together as a family and cook together and try and do these modeling because that will help our children. Do you have some final thoughts you'd love to leave parents with about their teens, just in general, raising a happy, healthy teen?

Dr. Erin Wallace: Just that teenagers overall are not lazy. Their biology is working against the early school schedules and all of the things that they're trying to do and explore in their day. And so, many are just chronically sleep-deprived.

And really, with that just simple intervention of trying to keep tablets and phones and screens out of the bedroom, really to just take that time to know that sleep is not downtime for our teenagers. It really is when their brains are learning and growing and recovering and regulating their emotions. And so, sleep is something that we should really focus on with our teenagers.

Melanie Cole, MS: Thank you so much for joining us today, Dr. Wallace, and sharing your incredible expertise for parents listening. Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review or share the episode, and please follow Children's Health on your social channels.